The Weekly Dose: Hope for Maintenance, Hair Loss, Breastmilk, and the Fight for Access
- Dave Knapp
- 5 hours ago
- 2 min read
Original posted at obesity.news/ on Sep 30, 2025
Obesity medicine is moving at lightning speed, and this week’s episode of On The Pen: The Weekly Dose proves it. We’re talking new procedures that could help people get off GLP-1s without gaining all the weight back, gene therapies that might reprogram the pancreas, FDA updates on hair loss and breastfeeding, and the never-ending tug-of-war over drug pricing.
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I sat down with Dr. Harith Rajagopalan, CEO of Fractyl Health, who walked me through their Revita program. It’s a minimally invasive outpatient procedure that targets the duodenum, the part of the gut that plays a big role in hunger and satiety signals. Instead of relying on weekly injections forever, Revita could actually “reset” how the body responds to food.
The early results are striking. Patients who stopped tirzepatide and underwent Revita didn’t just avoid weight regain, they actually lost more weight. Compare that to the control group who regained about 10%. Pivotal trial data is expected in 2026, but this is the first time we’ve seen human data showing a credible off-ramp from lifelong GLP-1 dependence.
Fractyl isn’t stopping there. Their Rejuva program is tackling type 2 diabetes and obesity with gene therapy. Imagine your pancreas being able to produce GLP-1 and GIP naturally, on demand, without a weekly injection. Clinical trials begin in 2026, and while it sounds futuristic, the goal is simple: once-in-a-lifetime treatment that could bring long-term remission.
For months, women have been shouting into the void about hair loss on GLP-1s. The FDA has now officially added alopecia as a (postmarketing identified) recognized side effect. This is most commonly a stress response called telogen effluvium, often tied to rapid weight loss. Hair does grow back, but knowing the science can help calm fears and guide supportive care like protein, iron, zinc, and even minoxidil.
And for breastfeeding moms? New FDA labeling says tirzepatide is essentially undetectable in breast milk based on a small study that has been added to the packet insert for Zepbound and Mounjaro. That doesn’t mean it’s necessarily a green light for everyone, but it does validate what many medical professionals suspected, that infant exposure is minimal. Still, decisions should always be made with your care team.
Of course, access remains the elephant in the room. Pharma is pushing direct-to-consumer platforms, tariffs are being managed, and politicians are still waving around the Most Favored Nation policy. But the bottom line hasn’t changed, $500 a month is still out of reach for most families. Tools like Claimable can help fight insurance denials, but this is still a broken system.
This week’s main takeaway is hope. Hope that innovation is finally moving toward durability. Hope in the shared experience of living with chronic disease, and hope that together, armed with information and advocacy, we can push the system to deliver the care people deserve.
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