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Overcoming Obstacles in Obesity

CE / CME

Breaking Barriers in Obesity Care: Applying Emerging Evidence to Primary Care Practice

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

ABIM MOC: maximum of 1.00 Medical Knowledge MOC point

Physicians: maximum of 1.00 AMA PRA Category 1 Credit™

Nurse Practitioners/Nurses: 1.00 Nursing contact hour

Released: December 10, 2025

Expiration: December 09, 2026

Christopher Weber
Christopher Weber, MD, FAAP, FACP, CSCS, dABOM, FOMA
CME/CE Information

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STEP Program and OASIS 4 Post Hoc Analysis: Semaglutide in Overweight or Obesity by Menopause Status

Next, let us talk about FDA-approved incretin-based weight loss medications in specific populations.

A post hoc analysis of the STEP program and OASIS 4 trial combined data from 7 different trials to specifically evaluate responses to SC and oral semaglutide based on a patient's menopausal state. Weight gain around the age of menopause is very common, so determining what therapies are effective for pre-, peri-, and postmenopause is a key priority.16

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STEP Program and OASIS 4 Post Hoc Analysis: Outcomes

The short answer is that semaglutide is effective for weight loss in all patients regardless of their menopausal status. The post hoc analysis demonstrated significant weight loss with both the semaglutide 2.4 mg SC injection and the semaglutide 25 mg oral medication, compared to placebo. A small decrease in weight loss was observed with later reproductive stages compared to premenopause, but were not of statistical significance.16

When broken down by different weight loss thresholds (≥10%, ≥15%, ≥20%), the proportion of patients achieving each threshold was also very similar across all reproductive stages.16

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SURMOUNT Program Post Hoc Analysis: Tirzepatide in Overweight or Obesity by Reproductive Stage

A post hoc analysis of the SURMOUNT program sought to answer the same question with tirzepatide. This analysis assessed the efficacy of 5-mg, 10-mg, and 15-mg doses of tirzepatide, compared to placebo, for people at different reproductive stages: pre-, peri-, and postmenopause.17

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SURMOUNT Program Post Hoc Analysis: Outcomes

As with semaglutide, investigators reported that patients responded very well to tirzepatide, regardless of their reproductive stage, albeit with marginally less weight loss among people in peri- or postmenopause. Altogether, these results were comparable to overall outcomes for obesity treatment in other trials.17

The take-home point of these 2 post hoc analyses is that an individual is not doomed to be ineligible for treatment because they are perimenopausal or postmenopausal. At least according to these data, tirzepatide and semaglutide are very effective in treating obesity regardless of menopausal status.

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HISTORI: Semaglutide in SGA-Treated Patients With Schizophrenia, Obesity, and Prediabetes

It is very well established that second-generation antipsychotics (SGAs) can cause weight gain, other metabolic disturbances, dyslipidemia, and elevated blood sugar levels.

The HISTORI study sought to determine whether any of the currently available interventions can help treat obesity in this setting. This study enrolled patients receiving SGAs specifically for schizophrenia, and assessed whether semaglutide affected A1C, weight, waist circumference, and fasting glucose.

Of importance, all those variables significantly and dramatically improved in the group receiving semaglutide (NCT05193578).18

Together, the SURMOUNT post hoc analysis and the HISTORI study show that menopause- or medication-induced weight gain should not be barriers to treatment, and that these interventions can still be very effective.

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Case 3: Your patient has schizophrenia that is being treated successfully with an SGA, but they are upset by the weight gain, which has led to diagnosis of obesity and increased CV risk. What would you recommend?

Key Points for Individualizing Obesity Care: Recent Evidence for Specific Patient Populations

In practice, what does this mean?

In my clinic, I see a lot of patients who are referred from our behavioral health colleagues because of the interplay between depression, anxiety, weight stigma, and bias. There is a lot of overlap between behavioral health and obesity management.

Many medications used to help with mood disorders, such as depression and schizophrenia, cause significant weight gain. Ultimately, these results show that there are options for people who have gained weight because of SGAs. Of course, treatment should also focus on lifestyle changes, healthy nutrition, and physical activity, but semaglutide and other AOMs can be effective tools for addressing medication-induced weight gain as well.

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