Over seven out of ten patients prefer to start oral therapy. At the SIO WIP 2026 Congress in Palermo, the new data on semaglutide explain how much weight you can lose, how the tablet works and what the limits are to be aware of.
More than seven out of ten people with overweight or obesity prefer to start treatment with pills. And over eight out of ten choose the profile of oral semaglutide compared to another oral treatment. These are the results of the OPTIC study, conducted on 800 adults and presented at SIO WIP National Congress 2026 in Palermo. Preferring a tablet is not just a matter of convenience. The possibility of integrating treatment into daily life can influence therapeutic choice, even if it does not automatically demonstrate greater adherence.
“Obesity is a chronic and complex disease, which requires timely and broader management,” he explained Paolo Sbraccia, full professor of Internal Medicine at the University of Rome Tor Vergata and president of the IBDO Foundation. The professor underlines that, for some patients, the oral formulation can represent an important element in the choice of treatment. «Listening to this preference is part of taking charge promptly and attentive to the needs of each patient»he added.
Oral semaglutide, how much weight do you lose
The clinical results come from OASIS 4 studypublished in 2025 on New England Journal of Medicine. The research evaluated oral semaglutide 25 mg in adults with overweight or obesity, without diabetes, combining treatment with lifestyle interventions. After 64 weeks, the average weight reduction was 13.6% with semaglutidecompared to 2.2% with placebo, according to the analysis considering the assigned therapeutic regimen. An analysis based on taking the drug according to the protocol reported an average loss of 17%, versus 2.7% for the placebo. The percentages depend on the statistical method used and do not represent a one-size-fits-all prediction. The answer varies from person to person and requires an individual clinical evaluation. The benefits aren’t just about weight. The available evidence indicates improvements in some cardiometabolic parameters, including waist circumference, blood pressure and glycemic control. The effects must be interpreted on the basis of the specific populations studied, without automatically attributing to the oral formulation all the results obtained with the injectable one.
“Having a molecule with significant efficacy on weight and other cardiometabolic risk factors, with a well-established safety profile,” he said Luca Busetto, full professor of Nutrition at the University of Padua and vice-president of the European Association for the Study of Obesity, «it allows us to personalize the treatment based on the clinical profile and daily needs of the person with obesity or overweight».
How the tablet works and what precautions it requires
The problem of biological drugs taken by mouth is well known: Digestive enzymes can break down proteins and peptides before they are absorbed. To overcome this barrier, oral semaglutide was developed together with SNACa substance that promotes the absorption of the active ingredient at the gastric level. The tablet is taken once a day on an empty stomach, with a little water. You need to wait at least 30 minutes before eating, drinking or taking other medicines. Compliance with these indications is essential to promote absorption.
In the OASIS 4 study, definitive discontinuations due to adverse events were comparable between the treated and placebo groups. This does not mean that the drug is free of side effects: nausea, diarrhea, vomiting and other gastrointestinal disorders may appear during treatment. Comparisons with other oral drugs also require caution. The ORION study found, through an indirect comparison, a greater probability of discontinuation due to adverse events with orforglipron compared to oral semaglutide. Since it is not a head-to-head study, the result does not allow a definitive ranking between the two treatments. The introduction of the pill therefore broadens the therapeutic possibilities, but does not replace the need for continuous management. The choice must consider clinical conditions, tolerability, concomitant therapies and individual preferences.
«In the OPTIC study the preference for the oral semaglutide profile is very clear» concludes Sbraccia. «It is a fact that deserves attention and is part of a now extensive clinical experience with semaglutide and solid evidence of efficacy and tolerability. The results go beyond the number on the scale and also affect body composition. Added to this is the oral modality: one tablet a day, which for some people can be simple to integrate into daily life, following the instructions provided. Listening to this preference is part of taking charge promptly and attentive to the needs of each patient”
