Recent data suggests that over 1.6 million UK adults have used a weight-loss medication in the last year. But the start of 2026 has brought a whirlwind of updates that shift the narrative from simple "weight loss" to a complex, long-term clinical challenge.
For this issue’s feature article, we’re diving into the "four faces" of the GLP-1 story that every prescriber needs to understand to navigate this rapidly shifting landscape.
1. Reaching New Heights: The 7.2mg Approval
The therapeutic ceiling for semaglutide just moved. On 6 January 2026, the MHRA officially approved a new maximum maintenance dose for Wegovy: 7.2mg weekly for obesity only (BMI over 30). This decision was underpinned by data from the STEP UP clinical trial (published in the Lancet), which targeted adults who had plateaued on the previous 2.4mg maximum.
The trial demonstrated further weight reduction (averaging an additional 6% over 32 weeks); plus significant improvements in secondary endpoints like waist circumference and HbA1c in non-diabetic patients. The dedicated 7.2mg pen will be available later this year; for now, patients taking this higher dose will need to used 3x 2.4mg pens. If you're escalating a patient, a "slow and low" approach to the 7.2mg transition is essential:
Dose escalation | Weekly dose |
|---|---|
Week 1-4 | 0.25mg |
Week 5-8 | 0.5mg |
Week 9-12 | 1mg |
Week 13-16 | 1.7mg |
From week 17 | 2.4mg |
From week 21 - for adult patients with obesity, if needed | 7.2mg |
2. A Lifeline for the most vulnerable
Perhaps the most moving update this month comes from the world of psychiatry. An editorial in Expert Opinion on Pharmacotherapy (21 Jan 2026) highlights that GLP-1s might do more than just lower BMI, they could close the mortality gap for patients with severe mental illnesses.
It is a stark clinical reality that patients with schizophrenia or bipolar disorder often die 15 to 20 years earlier than the general population, largely due to cardiometabolic disease exacerbated by antipsychotic medications like clozapine or olanzapine.
As a class, the GLP-1 RAs are potentially the most promising class of agents in the near-term to address this strategic imperative and to improve the length, quality and productivity of lives of persons living with SMI.- BMJ 2026;392:e085304
3. The "Hidden catch"
A major meta-analysis published in The BMJ on 8 January 2026 confirmed a sobering trend: the "rebound" is real, rapid, and biologically driven. The study followed patients who ceased GLP-1 therapy after achieving their target weight.
The findings were clear: weight regain after stopping these medications is significantly faster than after ending traditional intensive behavioural programmes. On average, patients regained one-third of their lost weight within the first year, returning to baseline within two years. The researchers point to "biological adaptations", shifts in hunger hormones like ghrelin, that persist long after the drug leaves the system. This reinforces a vital conversation we must have at the point of initiation: for many, this isn't a "course" of treatment, but a long-term management plan that requires a permanent "exit strategy" involving structured lifestyle support.
4. A critical safety reminder
Finally, we must balance our enthusiasm with clinical vigilance. On 29 January 2026, the MHRA issued a strengthened warning regarding all GLP-1 and dual GLP-1/GIP agonists (including Mounjaro). While rare, there have been increasing reports of necrotising and fatal acute pancreatitis.
The updated guidance is explicit: we must educate patients to recognise the signs, such as severe, persistent abdominal pain that may radiate to the back, often accompanied by vomiting. If a patient presents with these symptoms, the medication must be stopped immediately. Crucially, the MHRA now advises that if pancreatitis is confirmed, the drug must never be restarted. As we prescribe more widely, our "safety netting" conversations have never been more important.
The bottom line for GLP-1s
As we move through 2026, our role is evolving from "gatekeepers" to "navigators." Whether we are escalating doses to 7.2mg or helping a patient manage the metabolic anxiety of coming off the medication, the key is transparent, evidence-based communication. We are managing a powerful biological shift, not just a number on a scale.
