A clinical debate examined whether weight loss should become first-line treatment for obstructive sleep apnea, prompted by the emergence of highly effective GLP-1 receptor agonists like semaglutide and tirzepatide. The discussion highlighted that excess weight contributes to a growing proportion of OSA cases, and modern weight-loss therapies can produce significant reductions while simultaneously addressing cardiovascular and metabolic comorbidities that frequently accompany sleep apnea. However, the case against weight loss as primary therapy noted critical limitations: not all OSA patients are obese, weight loss often fails to completely resolve sleep apnea, and crucially, no head-to-head trials have compared GLP-1 agonists with CPAP therapy on patient-centered outcomes or long-term health benefits specific to OSA populations. This represents a pivotal moment in sleep medicine where pharmaceutical advances are forcing reconsideration of established treatment hierarchies. The debate reflects broader tensions between addressing root causes versus managing symptoms, particularly relevant as obesity rates climb and sleep apnea prevalence expands. While personalized treatment remains essential, the discussion signals that sleep specialists must develop competency with these powerful new obesity medications, potentially reshaping OSA care paradigms within the next decade.