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Oral therapies could reshape obesity care — what could this mean for real-world practice?

As of 2025, the obesity treatment landscape continues to evolve. Injectable GLP-1 receptor agonists have set new clinical benchmarks, achieving 15–20% average weight reduction and improving cardiometabolic outcomes in adults with obesity. Yet real-world use often lags, hampered by injection hesitancy, supply constraints, and insurance variability.

Emerging research suggests the next frontier may lie with oral GLP-1–based therapies. In phase 3 studies, these agents have delivered weight reductions of 14–15%, closely mirroring injectables. Meanwhile, early-phase data on dual and triple agonists targeting GLP-1, glucagon, and amylin pathways show promising results, with up to 24% reductions reported in select populations. Gastrointestinal effects remain the most common treatment-related events and are typically mild and transient.

As these therapies near clinical integration, clinicians must consider how oral options will complement current care models—aligning with behavioral interventions, supporting adherence, and broadening access. Framing obesity as a chronic, manageable disease remains key, with new therapies positioned as tools for long-term metabolic health.

Pharmacologic therapy—oral or injectable—should enhance, not replace, nutritional, behavioral, and physical activity strategies. As HCPs, your role is pivotal in ensuring optimal treatment pairing and fostering durable outcomes.

Which of your patients might be best suited for oral anti-obesity therapy once available? What strategies have been most effective in supporting adherence and tracking response over time?

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  • 15min
    Any aptient who has tried diet and exercise and has coverage
  • Yesterday
    would offer to all my pts who do not want to take injections or previously did not tolerate other weight loss medications. many pts are asking for oral GLP-1 and I have to use it off label for obesity, I am looking forward to offer this new medication to all my pts who want to take weight loss meds
  • Yesterday
    The highest dose of oral semaglutide approved by the FDA today does not come anywhere close to the equivalent dose of the highest dose of injectable semaglutide. Couple that with the inconvenience of having to take this on an empty stomach and waiting half an hour before eating anything. Be reminded that this is the patient population that cannot stop itself from eating mindlessly. Oral semaglutide is not going to be a major player in the weight loss market.
  • Yesterday
    I can count on one hand, the amount of patients that truly have needle phobia. Patients are more than willing to take an effective medication anyway possible. Unfortunately, the literature seems suggest that oral medication seems to be less efficacious. The advantage of weekly injections which are more potent in the weight loss, and even more convenient than daily oral medication makes this choice superior.
  • Yesterday
    Oral therapy is best suited for patients with needle phobia or take a low number of daily pills or no GI issues. Track response with periodic weight assessment, certain lab parameters and input as to tolerance or any ongoing issues
  • Yesterday
    The price of Wegovy , Ozempic Zepbound and Mounjoro is expected to go down as per govt neogotiations with these companies next year and that will be big factor in they way of a new oral weight loss medication from the price perspective yet there will be small perentage of the pts who would still prefer an oral med. Pts need continued motivation and inspiration to be compliant with these meds and need to be counselled that it is the maxmium tolerated dose that they are going to see expected results ,Once pts tolerate these meds well at the maximum tolerated dose then i give them a 6 months supply to ensure compliance
  • Yesterday
    Oral agents may:
    Normalize pharmacologic treatment earlier
    Reduce the psychological “threshold” to starting medication
    Increase primary care–led obesity management

    This could narrow the gap between guideline recommendations and actual prescribing.
  • Yesterday
    So as far as which patients are more appropriate for oral therapy, it’s more a matter of patient preference. The patient would prefer oral therapy or is more likely to stay on that long-term than that is where I will go. If there is no real preference and there is superiority in injection version That’s when I might try injection preferentially. as far as strategies to improve in here it’s the biggest thing is to figure out what the potential hurdle is is it cost? Is it remembering? Is it stigma and then worked to overcome that specific barrier? I generally don’t track adherence it’s usually not necessary for the weight loss meds tracking the weight usually is sufficient
  • 2d
    Patients that have a fear of needles, although I've had patients not complain of the injection since weight loss is the incentive. Oral GLP-1s have become more popular and we will see a increase request for these meds once it becomes more widely available with certain brands and insurance coverage. Usually I meet w/ patients monthly for medical assisted weight loss to monitor for weight loss, muscle mass loss, dietary opinions, etc.
  • 2d
    Needle phobic patients are best suited for oral therapies; Orforglipron is going to be in the market early next year and it has an average weight loss of 12 % so I am probably going to position it as a maintenance therapy after adequate weight loss has been achieved with the injectables; Oral Wegovy is now approved and boasts of 16 % weight loss and can be offered as an option to patients who don't mind taking a daily pill to achieve the weight loss they desire.
  • 2d
    Tracking response involves assessing for ≥5% total body weight loss at three months, which defines medication efficacy. Oral anti-obesity therapy is best suited for adults with BMI ≥30 or BMI ≥27 with weight-related comorbidities and for those who have low adherence to injection therapy.
  • 2d
    There is one oral therapy available, Rybelsus. I have had no issues with adherence with my patients who have had adherence issues with all their other medications. I think because they see results quickly, the hype has been so strong and they have struggled with their weight for so many years, to have a pill that helps them lose weight is quite a miracle for them. The only issues a few patients have had is with the dehydration. Then it is adherence to keeping up with water intake can be an issue. I have motivated them to stay on top of it by saying that I won't be able to keep prescribing it if their kidneys are showing the effect of the dehydration.
  • 2d
    There is not tool or way to predict response. Keep open mind. Cost and coverage definitely are keys.
  • 3w
    I have some patients who are highly needle-phobic, despite the injectables being just once weekly dosing. I also have some patients who are not as reliable doing a weekly injection as they would be taking a pill daily. I have many obese patients who would rather take a pill than do a shot. Of course, cost is going to be the biggest factor when these drugs become available in regards to whether patients will fill the scripts or not. In regards to long term adherence, if the patient is already used to taking a daily medication, I don't think it will be a great issue for adherence. I would likely follow up with these patients every several months to monitor progress.
  • 4w
    Insurance will be a big driver. Oral GLP1s may also be limited on how they need to be taken (rybelsus for exapmple)
  • 4w
    Any patient who is adverse to needles and needs weight loss would benefit. Not sure if patients currently on injections would benefit unless we see that orals are more effective or better tolerated.
  • 1mo
    Most likely when transitioning to maintenance chronic therapy as well as for patients who need to lose only 5-10 % of body weight
  • 1mo
    That’s great alternative for patients with phobia of needle and wants to use oral GLP
  • 1mo
    I am still very concerned about rebound weight gain. I love seeing a patient lose weight, reduce risk, etc-however, when the pt changes insurance and no longer can afford her meds, watch out. I really want to see prices drop and competition improve in this market. Most of my patients who could really use these meds are still excluded.
  • 1mo
    Oral GLP-1 is questionable at this point I've tried prescribing Rybelsus in the past and found it intolerable by the few patients I've tried it on. However as new GLP-1 products are expected to be available in 2026 I will re-explore these oral GLP-1s once it becomes available. Patients do come in asking for a GLP-1 many times and initiate the conversation and those are the ones that continue to adhere to therapy over time. usually I do monthly monitoring to make sure they're staying on track and titrate their dosing as needed.
  • 1mo
    I would use oral GLP1s as maintenance therapy for patients who have achieved weight loss with injectables but want an oral option as maintenance therapy. Oral GLPs are also a good option for needle phobic patients who want to lose weight, Oral Semaglutide 25 mg has shown about 16 % weight loss in clinical trials whereas Orforglipron has about 13 % weight loss at maximum dose. With the approval of medication like Cagrisema, Retatrutude and Maritide , I believe most patients would still prefer an injectable option as the weightt loss and frequency of administration is far superior with the injectables
  • 1mo
    Definitely great time top practice Bariatric medicine and an addition of oral GLP-1 indicated for Obesity will be definitely welcome . Rybelsus is already around for some time as on Oral GLP-1 agonist for Diabetes so familiarity with this oral molecule is there and so lot of experience as well so novelty is not there ! There is a subset of patient who are needle phobic but it is very small percentage and most of the time it is overcome when they come across the small size of the needle and ease of the available injectable ! With the oral therapy compliance will become an isssue as compared to the weekly injectable and doubt that pts who are comfortable using them and seen good response will switch over to oral as such also doubt that cost will be any less that could be a motivating factor ! Imagine this is the Lilly orforglipron that is coming out and is $499 for month cash price for all doses will be interesting to see the coverage and patient acceptability am sure Novo will come out an oral one for weight loss indicated soon too ! i would still prefer an injectable one for weight loss to prescribe given pretty good expereince and results
  • 1mo
    Patients who are needle phobic would benefit from an oral version. The cost will have to be weighed with injectable now being sold at lower rates. We have patients scheduled every 3 months for weight checks and prescriptions renewals. We track weight loss and how this has positively impacted patients and their ADL
  • 1mo
    patients who are afraid of injections or are hesitant to use the injections for fear of long term side effects are perfect for the oral version. Also, if the oral version is cheaper then the injection, cash pay patients. The strategies that have been most effective are coaching at appointments and following the weight gain. Often celebrating the weight loss with them will be the best way to motivate. We track weight at every visit, and I always remind them of the original and goal weight. Try to aim for 1-2 pounds a week

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