This week on On The Pen, The Weekly Dose Podcast, retatrutide heads into a major federal court fight as the Department of Justice gives FDA fresh legal ammunition just days before oral argument.

At the same time, FDA is escalating its scrutiny of mass GLP-1 compounding, with a warning letter to Empower Pharmacy that could have major implications for semaglutide, tirzepatide, telehealth prescribing, and patient access.

We also break down Viking Therapeutics’ new VK2735 maintenance data, including early weight-loss numbers that are starting to draw retatrutide comparisons and the possibility of every-other-week or even monthly maintenance dosing.

Plus, Roche’s enicepatide, formerly CT-388, just posted a 2.65 percentage-point A1C reduction and 15.5% weight loss in people with type 2 diabetes and obesity, raising new questions about how competitive the next generation of GLP-1/GIP drugs may become.

This episode is about more than one drug. It is about where obesity medicine is heading, who gets access, how regulators are drawing the lines, and why the next few years may look very different from the market we know today.

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Lilly just gave us a glimpse of what could come after today’s GLP-1s, and it may not be about simply pushing patients to stronger drugs and higher doses.

This week on On The Pen: The Weekly Dose, we break down Lilly’s surprising early data combining just 5 mg of tirzepatide with 3 mg of eloralintide, producing roughly 17% weight loss in only 16 weeks. Could combinations like this eventually approach retatrutide-level efficacy with better tolerability? And when retatrutide reaches the real world, how many patients will actually need or tolerate the higher doses responsible for its biggest clinical-trial numbers?

We’re also digging into the bigger stories shaping the future of obesity medicine, including new research suggesting semaglutide may influence aging beyond calorie restriction in mice, the emerging race to preserve lean mass during GLP-1 weight loss, apitegromab’s eye-popping price, Lilly’s legal battle over retatrutide’s classification, the underground market already selling unapproved Reta, and the latest development in Lilly’s lawsuit against Mochi.

The science is getting better incredibly quickly. The bigger question may be whether we can deliver enough efficacy, tolerability and muscle preservation at a price patients can actually access.

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Is obesity still a disease worthy of treatment when the patient is six years old?

This week, Novo Nordisk released Phase 3 STEP Young data in children ages 6 to 11 with obesity. After 68 weeks, 40.4% of children treated with semaglutide moved below the obesity threshold, compared with 0% on placebo. More than 85% of the children entered the trial with class II or class III severe obesity, and both groups received lifestyle intervention.

That raises a harder question than whether people are comfortable with kids taking GLP-1s: compared with what? A nearly 90% chance that obesity present at age 3 persists into the teen years? An approximately 80% chance that a teen with obesity carries it into adulthood? Another decade of stigma, bullying, and metabolic disease while we keep telling families to try harder?

I’m unapologetically supportive of studying and treating severe childhood obesity. That does not mean ignoring long-term questions around growth, puberty, nutrition, lean mass, or what happens when treatment stops. It means recognizing that withholding treatment is also a decision with consequences.

We also break down the new Structure Therapeutics data, including aleniglipron, an oral small-molecule GLP-1 that produced up to 16.2% mean weight loss at 72 weeks, and ACCG-2671, an experimental oral amylin/calcitonin agonist that produced 3.3% mean weight loss after a single dose, with some important tolerability caveats.

Plus, we look at a preliminary semaglutide signal involving asthma and COPD, and one of the strangest Ozempic access stories of the week.

Recorded from the Bask Health Studios.

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