ECO 2026: 5 Studies That Will Change How You Use GLP-1s

Twelve thousand researchers. Hundreds of presentations. Five studies that matter.

Dr. Clete Barrick breaks down the most important GLP-1 research presented at the European Congress on Obesity 2026 in Istanbul, and what each finding means for patients on Ozempic, Wegovy, Mounjaro, and Zepbound right now.

He covers the new higher-dose Wegovy data (7.2 mg), the maintenance dosing trial Zepbound patients have been waiting for, what happens when you switch from an injection to an oral pill, the real-world data showing half of patients quit before they get the benefit, and the Viking Therapeutics oral pill that may compete with injectable tirzepatide by 2028.

Each study gets the same three-beat treatment: what happened, why you should care, and what you should do about it.

In this episode:

• STEP UP: Wegovy 7.2 mg delivers 20.7% weight loss, with responders hitting 27.7%
• Medicare BRIDGE program adding Wegovy 7.2 on July 1
• SURMOUNT-MAINTAIN: 5 mg tirzepatide as a legitimate maintenance dose
• Why the dose ladder mental model is wrong
• ATTAIN-MAINTAIN: Switching from Wegovy to oral orforglipron (Foundayo) vs. switching from Zepbound
• Why the GIP receptor matters when you change medications
• Wilding real-world data: 50% discontinuation, dose-dependent metabolic benefits
• The most important variable in GLP-1 treatment (it's not which drug)
• Viking VK2735: 12.2% loss in 13 weeks from an oral dual agonist
• What the pill landscape looks like in 2028

New episodes weekly. Subscribe and visit barrickhealth.com for physician-led GLP-1 care.

Everything discussed in this episode is education, not medical advice for your specific situation. Talk to your prescriber before making changes to your treatment.

LINKS

barrickhealth.com https://www.youtube.com/@BarrickHealth

TAGS/KEYWORDS

(Paste into Buzzsprout tags field, comma-separated)

ECO 2026, European Congress on Obesity, STEP UP trial, Wegovy 7.2, SURMOUNT-MAINTAIN, tirzepatide maintenance dose, Zepbound maintenance, ATTAIN-MAINTAIN, orforglipron, Foundayo, Viking VK2735, VENTURE-2, Wilding real-world data, GLP-1 discontinuation, GLP-1 news, oral GLP-1 pill, Medicare BRIDGE program, semaglutide vs tirzepatide, dual agonist, GIP receptor, obesity medicine, Dr. Clete Barrick, Straight Shot podcast

REFERENCES CITED

• STEP UP trial. Higher-dose semaglutide 7.2 mg for obesity. Presented at European Congress on Obesity (ECO) 2026, Istanbul. Novo Nordisk.
• Wadden TA, et al. Tirzepatide for maintenance of weight reduction (SURMOUNT-MAINTAIN). The Lancet. 2026.
• ATTAIN-MAINTAIN trial. Transition from injectable semaglutide or tirzepatide to oral orforglipron. Presented at ECO 2026, Istanbul. Eli Lilly.
• Wilding JPH, et al. Real-world discontinuation and metabolic outcomes of GLP-1 receptor agonists in 90,000 patients (UK/EU). Presented at ECO 2026, Istanbul.
• VENTURE-2 trial. Phase 2 results for oral dual GLP-1/GIP agonist VK2735. Presented at ECO 2026, Istanbul. Viking Therapeutics.
• Medicare BRIDGE Program formulary update, effective July 1, 2026.

Transcript

SPEAKER_00 0:00

Last week in Istanbul, about twelve thousand obesity researchers, endophronologists, and pharma executives got together for the European Congress on Obesity. Three days, hundreds of presentations, and five studies came out of the conference that are going to change how patients on GLP1 medications get treated over the next year. Today, I'm going to walk you through all five studies in the order they actually matter to you. What happened, why you should care, and what you should do about it, if anything. Let's start with the headline grabbers. I'm Dr. Cleet Berrick, dual board certified in internal medicine and obesity medicine. I've treated thousands of patients on GLP1 medications, peptides, and medical weight loss therapy. This is Straight Shot, the science of weight loss explained by a doctor who lives it. Quick note everything on this show is for education only. It is not medical advice for your specific situation. Always talk to your prescribing physician before making any changes to your treatment. Welcome to Street Shot. We'll kick off with study one, the Step Up, a higher dose of Wagovi trial. Here's what happened. Wigovi is the brand name for semaglutide for obesity, as you likely well know. The standard top dose has been 2.4 milligrams once a week. At that dose, the average patient loses about 17% of their body weight over a year and change. NovoNordisk ran a trial called Step Up, which tested a new higher dose, 7.2 milligrams. That's three times the standard. The results presented at ECO are now the basis for an FDA approval, and they're quite impressive. On 7.2 milligrams, the average patient lost 20.7% of their body weight at 72 weeks. That's already a meaningful bump over 17.5 on the standard dose. But the more interesting number is the responder analysis. About one in four patients on 7.2 turned out to be quote unquote early responders. And those patients hit 27.7% total body weight loss. For context, that's the kind of weight loss we've been getting from terzepotone, which is Z-bound. So Wagovi at 7.2 milligrams isn't quite Z-bound across the board. But in the patients who respond well, it's right there. And here's the access piece. Starting July 1st, Medicare's bridge program adds Wagovie 7.2 to its formulary. That's a meaningful expansion for patients who couldn't afford brand name semaglutide before. Here's why you should care. If you're on standard dose Wagovi and you've plateaued, this matters to you directly. There's a higher wrong on the ladder now, and the data says it works. If you're on Z-bound and have been wondering whether Wagovia is just a weaker version or the same thing, the answer is a little more nuanced now. For early responders, the gap is small. For everyone else, Z-bound still pulls ahead on average. But the gap has narrowed. And if you're a Medicare beneficiary who couldn't get GLP1 coverage before, bridge adding Wagovi 7.2 in July is genuinely new ground. Here's what you should do. If you're stalled on standard dose Wagovi, ask your prescriber about 7.2 milligrams. Not all patients need it. Some patients are doing fine at lower doses, but if you've been stuck for months and the prescriber is shrugging, this is a real option now. If you're on Medicare, mark July 1st on your calendar and check in with your insurance about bridge coverage details. And if you're on Zbound attempted to switch to Wagovi 7.2 because of the new data, well slow down. Switching between GLP1s isn't free of consequences, and we'll talk about that more in the next study. Study two is the Surmount Maintain trial. So what to do when you hit your goal? Here's what happened. This is the trial Zbound patients have been waiting for. The question, once you've lost the weight, can you drop the dose and hold on to your results? So Lilly ran a trial called Surmount Maintain. They took 378 patients who had already lost weight on their maximum tolerated trusepatite dose, and then they randomized them three ways. One group stayed on the high dose, another group dropped to five milligrams, and then one group switched to placebo, which is the trial design version of just stopping the medication. They followed them out to almost two years, and here's what they found. The patients who stayed on the high dose kept their full weight loss. Zero regain. Two years out, they were still at their lowest weight. The patients who dropped to five milligrams regained about 11 pounds on average. So some regain, but they kept a lot of it off, or what they had lost, and they significantly outperformed placebo. The patients who stopped completely regained 14% of their body weight. So that is a cliff. If you started at 200 pounds and went down to 160, stopping the medication would put you back in the 180s within two years. Both active treatment arms, high dose and 5 milligram were published in the LANSA this month. Why should you care? Well, if you're on Zeppelin or Monjaro and you've been told by anyone, including your doctor, that the plan is to stop the medicine once you hit your goal, this study is your data. And here's the most important takeaway from a clinical perspective. Five milligrams is not a starting dose, you know, it's a maintenance dose. The trial proved that. Patients on 5 milligrams kept the vast majority of their loss for two years. This matters because a lot of physicians are still thinking about GLP1 doses as a ladder that you climb to lose weight and then climb back down to come off the truck. That mental model, while I personally practice it quite a bit, may not be entirely the case. The doses are not necessarily steps in and out of treatment. They're different levels of pharmacological effect, and any one of them can be a maintenance dose if it happens to hold your individual weight. So what should you do? If you hit your cold weight on turzepatite and your physician suggests stopping, ask about dropping the dose instead. Five milligrams is a legitimate maintenance dose option for a lot of patients. Whatever number on your pen holds your weight steady is the right number. Not the lowest one, not the highest one, the one that works for your body. And that could be five, it might be ten, it might be fifteen. Whatever it is, you know, that's your maintenance dose and you should stay there. It's different for everybody. And if your physician isn't comfortable navigating maintenance dosing, that's worth knowing. Not all of us were trained on this. In fact, very few were. It's worth seeking out someone who has done it before. Study three is the attain-maintain trial. That's switching from an injection to a pill. So here's what happened: same maintenance question, different drug. Lily also ran a trial in this case, attain maintain, which asked, can you transition off an injectable GLP1 and onto an oral pill? The oral pill in this case is orfore clipperon. That's the molecule that just got branded as Foundaio. It's a once daily tablet, no injection. So the trial took 376 patients who had already lost weight on injectable Wagovi or Zephon and switched them to oral foundo. Same drug, same dose, regardless of which injection they came off of. Then they followed them for 52 weeks. The result depends entirely on which injectable you came from. So patients who switched from Wagovi to Foundeo kept about 79% of their weight loss at one year. On average, they regained about two pounds. That's a successful transition in my book. But patients who switched from Zetbound to Foundeo kept about 75% of their weight loss. They regained about 11 pounds on average, so still significantly better than placebo, but noticeably more regained than the Wagovi group. Here's why you should care. If you're on an injectable GLP1 and you've been thinking about transitioning to an oral, this data tells you what to expect. And the expectation depends on which one you're transitioning from. The biology behind the difference is straightforward. Wagovi is a single-target drug. It hits GLP1 full stop. FoundAo is also a single target drug. It hits GLP1 full stop. So going from Wagovi to Foundaio is what we would call a lateral move. Same mechanism, different delivery. The body barely notices in this case, but Z-bound's different. Z-bound's a dual-target drug. It hits the GLP1 receptor and a second receptor that's called the GIP. That second receptor does a lot of work for you. So when you switch from a dual-target injection to a single target pill, you lose that second mechanism and the scale shows it and you notice it. That doesn't mean Foundo is a bad drug. It's a great drug, at least that's what the data says so far. It just isn't a one-to-one replacement for terzepatide. It is more so a one-to-one replacement for semiglutide. So what should you do? Well, if you're on Wigovi and you want off the needle, an oral switch to Foundo is a legitimate option. Expect to hold most of your loss. But if you're on Zbound and you want off the needle, you have two real choices. You can switch to an oral and expect some regain or stay on the injection and keep what you have. Either is defensible, but you should know the trade-off going in. Now what I will say as a quick aside here, and this is the sort of thing that a trial is not going to show you because it just doesn't have the resolution. If you're on a lower dose of Z bound 2.5, 5, 7.5, and you're a hyper responder, you've gotten to goal weight, well, that's a more realistic path likely to a transition to Found Ao still with success. Where you're going to see problems are patients who have gotten to goal up at a 10, 12.5, or 15 milligram Z-bound dose. If you're in that group, Found Ao is not going to be a good option for you. And then, you know, what I would say overall, don't make this decision alone. The mechanism mismatch is something a physician familiar with GLP1 pharmacology should be walking you through. So not a refill request you click through on a portal. Let's move on to study four wilding. So what's actually happening in the real world? This one's a different kind of study. The first three were clinical trials, very controlled circumstances where patients are followed very closely, get their medication reliably, and have a structured experience. This study is what we call real world data what actually happens out in the wild. John Wilding and his team at the University of Liverpool pulled the records of almost 90,000 patients in the United Kingdom and Europe who had started a GLP1 medication, semaglutide, trisepatite, or lyriclutide. Here's the number that got everyone's attention. About half of those patients had discontinued their medication within one year. They had what the study calls a 60-day gap or longer. And the patients who quit lost less weight. That part is not surprising. But the part that should make every clinician pay attention is what came next. The patient who lost more weight had significantly lower rates of osteoarthritis, chronic kidney disease, sleep apnea, and heart failure over the follow-up period. The metabolic and cardiovascular benefits of these drugs are dose-dependent and time-dependent. The longer you stay on, the more benefit you get. The earlier you quit, the less you get. So let's talk about why we should care about this. So this is the most important study of the five for one reason, in my view. It explains why your friend who's been on Ozempic for two years lost 100 pounds, and you, you know, who's been on an Ozempic for four months has lost 15 or 20 pounds. The answer is usually time, not dose, not genetics, not metabolism, time on the drug, and also consistency of effort on your part. Half of patients walk away before they get the full benefit. Some of them quit because of the costs, some quit because of side effects that nobody really prepared them for. And some quit because their pharmacy ran out of supply. And some frankly quit because their physician told them to take a break, which is medical advice that has no evidence behind it for obesity treatment. Obesity is a chronic disease. We treat it the way we treat high blood pressure or type 2 diabetes chronically. Don't take a break from your blood pressure medication once your numbers look good. You stay on it because the disease is still there and the medication is doing the work. So what should you do? Well, if you're on a GLP1 right now, and the single most important predictor of your long-term outcome is whether you stay on the medicine. That is more important than which medicine, which dose, which brand, etc. etc. So staying on it is the king variable. If you're considering stopping, talk to a physician who understands obesity medicine before you do it. Not the friend of a friend, not read it, a real experienced clinician. And if you're having side effects that are making it hard to stay on, those are usually manageable. Don't quit silently. There are options for nausea, for constipation, for early treatment phase, GI rough patch. These strategies work. Let's talk study five. Viking BK2735, the oral pill that's coming. So, last study here. Uh, this is the one that's really forward-looking and pretty interesting and exciting. It's not approved yet, not on the market, but the phase two data presented at ECO is the kind of data that gets investors and clinicians paying attention and excited. Viking therapeutics presented phase two results from a trial called Venture 2. Drug is called BK2735. It's a once-daily oral tablet, and it hits both GLP1 and GIP receptors. So same dual target mechanism as turzepitide, but you swallow it, no injection. So this is kind of the flip side of the coin, like we were talking about earlier with Foundaio being just a GLP1 receptor agonist. BK2735 is a dual. At the top dose, patients lost 12.2% of their body weight in just 13 weeks. That works out to about 26 pounds in three months. More importantly, 80% of patients on the top dose had at least 10% weight loss. That's the kind of responder rates we see with injectable trazepatite from a pill. And the weight loss didn't plateau. So patients were still losing at week 13 at the end of the study. Where they, you know, would have ended up at six months or a year, nobody knows yet because the trial was only 13 weeks. Phase three starts later this year, and that's where we're going to find out. So why should you care? If this phase two signal holds up in phase three, we're looking at the first oral medication that genuinely competes with injectable GLP1s, not as a stepping stone, not as a potential maintenance option, but as a primary treatment from the start. That matters for a few reasons. First, a lot of patients hate needles. An oral dual agonist with injectable level efficacy is a meaningful patient experience upgrade. Second, the manufacture or manufacturing and distribution of oral pills is a lot easier than injectables. Supply problems, which we've had with injectable GLP1s for years, in spite of what Lily and Novo may claim, would likely be less severe. Third, an oral version creates real price pressures on the injectable market. Here's what you should do. Nothing yet. This is forward-looking, it's not actionable right now. Phase three takes one to two years, FDA review takes another six to twelve months. So realistically, this drug is not on pharmacy shelves until late 2027 or 2028 at the earliest. And that's if everything goes well, which it rarely does in these sort of things. But if you're on the fence about starting an injectable today because you don't want to commit to needles forever, it's worth knowing that the pill landscape is going to look very different in two or three years. In the meantime, don't wait. Untreated obesity over the next two years does more damage than starting an injectable today and switching to a pill in 2028 when a better option may arrive. So there you go. Five studies, and here's the through line. Wagovy is getting stronger. Maintenance has finally been studied, and switching between drugs has consequences that depend on the mechanism. Half of patients are quitting before they get the benefit, and the oral pill era is coming faster than most clinicians realize. If you take one thing away from this episode, take this. The most important question in GLP1 treatment is not which drug you're on, it's whether you're going to stay on it long enough for it to work. Everything else is downstream of that. If you want help with any of this, grab a free consultation at BarrickHealth.com. You want the full reference for everything we just covered and more, the GLP1 Bible is in pre order now. I'm Dr. Clee Barrett. Thanks for listening. We'll talk to you guys next week.