STEP 1 for Effective Weight Control — Another First Step

This editorial examines the STEP 1 trial evaluating once-weekly subcutaneous semaglutide in adults with overweight or obesity. The authors highlight semaglutide’s substantial efficacy, noting a mean 14.9% weight reduction and significant improvements in cardiometabolic risk factors, physical function, and quality of life. However, concerns persist around gastrointestinal side effects, cholelithiasis, and long-term safety, including risks of pancreatitis and thyroid tumors. Limitations include underrepresentation of non-White and male participants, lack of long-term efficacy data, and the trial’s comparison only to placebo. The editorial calls for future head-to-head studies with other weight-loss drugs and bariatric surgery, and suggests that oral GLP-1 formulations may enhance adherence and accessibility. Despite its constraints, STEP 1 marks a promising advance in obesity pharmacotherapy.

This editorial examines the STEP 1 trial evaluating once-weekly subcutaneous semaglutide in adults with overweight or obesity. The authors highlight semaglutide’s substantial efficacy, noting a mean 14.9% weight reduction and significant improvements in cardiometabolic risk factors, physical function, and quality of life. However, concerns persist around gastrointestinal side effects, cholelithiasis, and long-term safety, including risks of pancreatitis and thyroid tumors. Limitations include underrepresentation of non-White and male participants, lack of long-term efficacy data, and the trial’s comparison only to placebo. The editorial calls for future head-to-head studies with other weight-loss drugs and bariatric surgery, and suggests that oral GLP-1 formulations may enhance adherence and accessibility. Despite its constraints, STEP 1 marks a promising advance in obesity pharmacotherapy.