There is a new generation of antiobesity drugs in development or just arriving 
on the scene. First, setmelanotide has been approved for three of the ultrarare 
genetic conditions that cause obesity-pro-opiomelanocortin deficiency, 
proprotein convertase subtilisin and kexin type 1 (an important enzyme in the 
melanocortin pathway) and leptin receptor deficiency. Setmelanotide marks the 
first in a personalized medicine approach to obesity. Second, semaglutide 2.4 mg 
once weekly has been submitted to regulators in the United States and the 
European Union for approval for patients with obesity (body mass index [BMI] ≥30 
kg/m2) or overweight (BMI ≥27 kg/m2) and at least one weight related 
comorbidity. This drug has been studied in five phase 3 clinical trials, four 
discussed herein: semaglutide produces roughly twice as much weight loss as we 
have seen in older antiobesity medications. Semaglutide is already in use for 
treatment of diabetes and, as a glucagon-like peptide 1 (GLP-1) receptor analog, 
is part of a class of drugs used widely in diabetes. Tirzepatide, a 
glucose-insulin peptide and GLP-1 dual agonist is in phase 3 study for obesity 
management, and bimagrumab is a new agent in phase 2 with a unique mechanism of 
action; they are generating much interest. The purpose of this narrative review 
is lay the groundwork for a discussion of the clinical impact of these new 
medications on the clinical practice of obesity. Further, these developments 
shall be used to launch a speculation of what is likely to be their impact on 
the future of obesity pharmacotherapy.