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ADA 2026 obesity studies

CE / CME

Translating Emerging Obesity Evidence Into Clinical Action: Highlights From ADA 2026

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

Pharmacists: 1.00 contact hour (0.1 CEUs)

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: July 21, 2026

Expiration: July 20, 2027

Donna H. Ryan
Donna H. Ryan, MD
CME/CE Information

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OASIS 4 Post Hoc Analysis: Why It Matters

The third study I will discuss is the OASIS 4 post hoc analysis. The phase III OASIS 4 trial evaluated oral semaglutide vs placebo in patients with overweight or obesity, and its post hoc analysis examined cardiometabolic outcomes according to patients’ baseline BMI. The objective was to better understand whether baseline BMI influenced treatment response.9

Oral semaglutide is a peptide GLP-1 RA taken once daily. Because of its absorption requirements, patients must take oral semaglutide on an empty stomach in the morning with up to 4 oz of water. They also must wait at least 30 minutes before consuming additional food, beverages, or other medications.10

The outcomes of the OASIS 4 post hoc analysis support risk-based treatment discussions with patients across all BMI ranges, but subgroup findings should be interpreted cautiously.3

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OASIS 4: Study Design

OASIS 4 (NCT05564117) was a multicenter, double-blind, placebo-controlled, randomized phase III trial that enrolled 307 adults with obesity or adults with overweight and at least 1 weight-related comorbidity, who reported at least 1 previous unsuccessful dietary effort to lose weight. Key exclusion criteria included diabetes and a self-reported body weight change of more than 5 kg within the 90 days before screening.

Enrolled patients were randomized to receive oral semaglutide 25 mg or placebo once daily.

The coprimary endpoints were change in total body weight and percentage of patients who achieved at least 5% weight loss at 64 weeks. Key secondary endpoints included percentage of patients who achieved additional weight loss thresholds, change in BMI and waist circumference, and safety at 64 weeks. This post hoc analysis compared outcomes by participants’ baseline BMI, creating a BMI <35 kg/m² cohort and a BMI ≥35 kg/m² cohort.

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OASIS 4 Post Hoc Analysis: Baseline Characteristics

Patients with a BMI ≥35 kg/m² were generally younger but had substantially greater mean body weight and waist circumference than those with a BMI <35 kg/m². According to the National Institute for Health and Care Excellence (NICE) risk categories, 100% of patients with a BMI ≥35 kg/m² were classified as high risk vs approximately 73% of those with a BMI <35 kg/m2.

As expected, the higher BMI cohort also had less favorable cardiometabolic markers, such as higher fasting glucose, blood pressure, and high-sensitivity C-reactive protein levels.3

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OASIS 4 Post Hoc Analysis: Change in Total Body Weight at 64 Weeks

One of the most notable outcomes was the consistency of weight loss seen across both BMI cohorts. The mean change in total body weight at 64 weeks was -14.8% in the BMI <35 kg/m² cohort and -14.1% in the BMI ≥35 kg/m² cohort.

Overall, oral semaglutide produced substantial weight reduction and generally improved cardiometabolic markers regardless of patients’ baseline BMI.3

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OASIS 4 Post Hoc Analysis: Other Cardiometabolic Outcomes

Although the extent of weight loss was similar across both cohorts, several cardiometabolic outcomes improved to a greater extent within the lower BMI cohort. That is, greater improvements were observed in mean fasting glucose, select lipid markers, high-sensitivity C-reactive protein, and diastolic blood pressure in the BMI <35 kg/m² cohort vs the BMI ≥35 kg/m² cohort.

Furthermore, 80% of patients with a baseline BMI <35 kg/m² achieved a BMI <30 kg/m² at 64 weeks. Among those with a baseline BMI ≥35 kg/m², 80% achieved a BMI <40 kg/m² and nearly 50% achieved a BMI <35 kg/m² at 64 weeks.3

These results illustrate why it is becoming increasingly important to move beyond weight loss alone in obesity management. HCPs should consider treatment targets that are linked to meaningful improvements in cardiometabolic risk alongside long-term weight reduction.

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OASIS 4: Safety

The safety profile for oral semaglutide was as anticipated. The most frequently reported AEs were gastrointestinal related (ie, nausea, vomiting, constipation, and diarrhea), mild to moderate in severity, and transient. No new safety findings emerged in this post hoc analysis.3

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OASIS 4 Post Hoc Analysis: Clinical Interpretation

The principal message from the OASIS 4 post hoc analysis is that oral semaglutide can produce similar levels of weight loss across low and high BMI thresholds. However, patients with a lower BMI at baseline appear to experience greater improvements in several obesity-related cardiometabolic risk factors compared with those with a higher BMI at baseline.

 

Although these findings should be interpreted cautiously due to the post hoc study design, they do reinforce the importance of intervening early before patients with obesity progress to more severe disease. Additional studies are needed to determine how best to optimize cardiometabolic outcomes among patients with a higher baseline BMI.3

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