ECO 2026: Weight Loss and Blood Pressure Reduction with GLP-1 Receptor Agonists and Multi-Hormone Receptor Modulators in Overweight and Obesity: A Meta-Regression Analysis of Phase-3 Clinical Trials

Presenter: Muskiet, M.

The link between weight loss and BP reduction is complex. The GLP‑1RAs act through both weight‑dependent and independent pathways, that are further complicated by multi‑hormone receptor modulators (MHRMs), also targeting GIP, glucagon, and amylin receptors. A meta‑analysis of 32 phase-3 trials was conducted to study the impact of GLP-1RAs/MHRMs on this link (43,618 adults; mean age 54 yrs, BMI 35.5 kg/m², 50% female, 9.2% with T2DM, median treatment duration; 66 weeks). The baseline SBP of the study population was 128 mmHg, 59% of them had hypertension.

GLP‑1RAs and MHRMs produced placebo‑adjusted mean weight loss of –10.9% (95% CI –12.1 to –9.7; I²=97.9%) and SBP reduction of –5.2 mmHg (95% CI –5.8 to –4.6; I²=77.8%). As per a meta‑regression analysis, 77% of BP variance could be explained by weight loss with GLP-1RAs/MHRMs (P<0.01), 1% weight loss was associated with reduction of 0.34 mmHg SBP. These findings highlight the clinically meaningful BP‑lowering potential of GLP‑1RAs/MHRMs in obesity management.

ECO 2026: Sequential Swallowable Intragastric Balloon (Allurion) and Low-Dose Tirzepatide Therapy Produces Major Fat Mass–Driven Weight Loss with Excellent Tolerability

Presenter: Flagiello, L.

Swallowable intragastric balloons and incretin-based therapies are established treatment options for people with obesity. Nevertheless, real-world data on the sequential combination of a swallowable intragastric balloon followed by low-dose dual GIP/GLP-1 receptor agonist (tirzepatide) and their impact on body composition is scarce.

In a prospective cohort of 79 adults with obesity, a 12‑month program combining a 4‑month swallowable Allurion intragastric balloon and 8 months of low‑dose tirzepatide (2.5–5.0 mg) achieved substantial weight loss. Baseline mean weight for the study participants was 121.65 kg (BMI 40.92 kg/m²); at 12 months, weight decreased to 94.32 kg (BMI 31.59 kg/m²), with mean total-body weight loss (TBWL) of 27.33 kg (22.44%). Fat mass declined by 16.6 kg and 6.97 percentage points, while lean mass (LM) percentage rose by 6.94 points despite a 9.44 kg absolute reduction in LM. No serious adverse events or discontinuations occurred. Low-dose tirzepatide resulted in substantial weight loss predominantly driven by fat mass reduction with good tolerability.

ECO 2026: Early Metabolic Outcomes and Adjunct Pharmacotherapy for Weight Management after Bariatric Surgery in a Mexican Cohort: A 12-Month Retrospective Analysis

Presenter: Galaz, F. P

The retrospective study assessed the 12‑month metabolic outcomes after bariatric surgery and documented the adjunct pharmacotherapy use for weight management in a Mexican cohort of 51 adults with obesity (mean age: 42.5 years; 65.4% women, baseline weight: 99.5 kg; BMI 35.4 kg/m²). Patients underwent either sleeve gastrectomy (n=39) or Roux-en-Y gastric bypass (n=12).

Early metabolic improvements were observed. At 6 months, fasting glucose decreased by 8.84 mg/dL, HbA1c decreased by 0.43%, insulin levels decreased 14.67 μU/mL, and HOMA‑IR decreased by 3.97. Lipids improved: total cholesterol decreased by 20.77 mg/dL, triglycerides decreased by 66.51mg/dL and LDL-C by 17.14 mg/dL. Hepatic enzymes improved: ALT decreased by 7.37 U/L and AST by 0.50 U/L. Thirteen patients required adjunct pharmacotherapy for weight management, primarily due to anxiety-driven eating issues, weight-loss plateaus, increased cravings, or high-risk eating behaviors that threatened optimal weight-loss trajectory or raised concern for early weight regain. Most of the patients (11/13) received low-dose semaglutide, yielding additional total weight loss (TWL) of 2.33, reaching a TWL of 34.28%.

ECO 2026: Abdominal Obesity, Hepatic Steatosis, Oxidative Stress and Diastolic Dysfunction in Patients with MASLD

Presenter: Colangeli, L

Metabolic dysfunction–associated steatotic liver disease (MASLD) is highly prevalent in people with obesity and has been increasingly recognized as a contributor towards the prognosis of HFpEF patients.

In a cross‑sectional study of 73 obese patients ≥50 years with MASLD, 27.4% had diastolic dysfunction (DD). Those with DD had higher BMI (37.1 vs 34.4 kg/m², p<0.05), waist circumference (122.3 vs 113.1 cm, p<0.01), fatty liver index (FLI; 95.6 vs 88.3), and controlled attenuation parameter (CAP; 300.0 vs 266.8 dB/m, p<0.05). Multivariate analysis revealed body weight (ORadj 1.087), BMI (ORadj 1.173), WC (ORadj 1.072), and CAP (ORadj 1.012, 95% CI 1.001–1.024) independently associated with DD. CAP and fatty liver index correlated with LV structural changes. After adjustment for WC, the association between CAP and DD lost statistical significance, suggesting that abdominal adiposity may mediate the relationship between hepatic steatosis and DD.

ECO 2026: Prognostic Value of the Edmonton Obesity Staging System among Hospitalized People with Obesity: Findings from the ROBEMIN Registry

Presenter: Carretero Gomez, J.

A prospective multicenter study conducted across 26 Spanish internal medicine departments, classified 496 hospitalized patients with obesity (mean age 75 years, 50.1% women, BMI >30 kg/m²) using the Edmonton Obesity Staging System (EOSS). The BMI staging system fails to reflect the burden of comorbidity or functional impact, but the EOSS provides a comprehensive assessment based on the presence and severity of metabolic and non-metabolic comorbidities, degree of functional impairment, and impact on quality of life (grades from stage 0: no obesity to stage 4: obesity with severe disabilities).

Most of the study participants were classified as stage 2 (35.9%) or stage 3 (33.1%). Advanced stages correlated with higher comorbidity burden, renal dysfunction, anemia, and greater therapeutic complexity. Use of cardiometabolic agents increased (SGLT2 inhibitors 33%, GLP‑1/GLP‑1‑GIP agonists 11.8%). EOSS stage 4 was associated to with higher readmission risk (ORadj 2.48, 95% CI: 0.78–7.93) and the composite outcome of readmission/death (ORadj 3.01, 95% CI: 0.98–9.83). EOSS proved valuable tool for prognostic stratification.

ECO 2026: Association Between Obstructive Sleep Apnea Risk and Obesity Phenotypes in Korean Adults: Nationwide Population-Based Study

Presenter: Kim, S. Y

This cross-sectional study assessed the link between obesity phenotypes categorized by metabolic health status and the risk of sleep apnea in 10,930 Korean adults from KNHANES (2019–2021) cohort.

The obesity phenotypes were classified using body mass index and metabolic syndrome markers as metabolically healthy normal weight (MHNW), metabolically abnormal normal weight (MANW), metabolically healthy obese (MHO), and metabolically abnormal obese (MAO). Sleep apnea risk was assessed using STOP‑Bang scores. Compared to MHNW, MAO (OR 1.752, 95% CI 1.207–2.543), and MANW (OR 1.651, 95% CI 1.055–2.584) were associated with a significantly higher risk of sleep apnea. MHO was not associated with a significant increase of risk (OR 1.170, 95% CI 0.759–1.805). MAO carried greater risk than MHO (OR 1.290, 95% CI 0.999–1.667). These findings highlight the need to consider both body composition and metabolic health for the management of sleep apnea.

ECO 2026: GLP-1 Receptor Agonists and Reductions of Disease Burden in Individuals with Asthma and Either Overweight, Obesity or Type 2 Diabetes: A Nationwide Self-Controlled Study

Presenter: Høj, S.

GLP‑1 receptor agonists (GLP‑1 RAs), widely used for obesity and type 2 diabetes, may also improve asthma outcomes through weight loss, reduced airway inflammation, and better metabolic control.

In a Danish nationwide self-controlled cohort of 27,523 adults with asthma and comorbid overweight, obesity, or T2DM, initiation of GLP‑1 RAs was linked to a 26% reduction in asthma exacerbations. Secondary outcomes, including reliever use, inhaled corticosteroid exposure, and pneumonia events, also decreased.

Benefits were consistent across subgroups, suggesting GLP‑1 RAs significantly improve asthma control irrespective of treatment indication. GLP1 RA was associated with significant reductions in exacerbations, reliever use, exposure to ICS and pneumonia in patients with asthma and overweight/obesity/T2DM,

ECO 2026: Prevalence of Chronic Kidney Disease in Patients with Obesity: An Under-Recognised Comorbidity

Presenter: Lozano-Aida, C

Obesity increases risk of chronic kidney disease (CKD) via glomerular hyperfiltration, yet renal screening is often overlooked in obesity care.

This retrospective cross-sectional study of 147 adults (mean age 48.6 years, BMI 43.6 kg/m²) attending a specialist clinic found CKD prevalence of 12.4%. Despite relatively low rates of diabetes and cardiovascular disease, many had severe obesity and additional cardiometabolic risk markers like lipoprotein (a) and fibrosis-4 index. Limited albuminuria testing suggests underdiagnosis. Findings highlight that CKD may be common even in young population with obesity and support integrating routine renal assessment into obesity management for earlier detection.

ECO 2026: Preservation of Skeletal Muscle Mass during GLP-1 Receptor Agonist Therapy: An As-Treated Mixed-Effects Analysis by Drug Type

Presenter: Jürets, A.

GLP‑1 receptor agonists (GLP‑1RAs) promote weight loss in obesity, but concerns exist about potential skeletal muscle loss. This retrospective cohort study of 451 individuals compared body composition changes with liraglutide, semaglutide, and tirzepatide using bioelectrical impedance analysis.

Relative muscle mass slightly increased over time across all agents, with no evidence of accelerated loss. Absolute muscle mass differences between drugs were small (<1 kg). Tirzepatide showed marginally lower relative muscle mass than liraglutide. Overall, findings suggest GLP‑1RAs preserve muscle mass, supporting their metabolic safety without clinically meaningful muscle loss during treatment.

ECO 2026: Efficacy and Safety of Oral Orforglipron in Adults Living with Obesity: A Systematic Review and Meta-Analysis

Presenter: Hammad, N.

Orforglipron, a once-daily oral GLP‑1 receptor agonist, was evaluated in a meta-analysis of five randomized trials (4,618 participants) with obesity, with or without diabetes.

It produced dose-dependent weight loss, exceeding 6 kg in diabetes and nearly 12 kg without diabetes at highest doses, alongside improvements in BMI, waist circumference, and HbA1c (up to −1.29%). Gastrointestinal side effects and discontinuations increased with higher doses, but no rise in pancreatitis was observed. Overall, orforglipron shows effective weight and metabolic benefits with an acceptable safety profile, supporting its potential as an oral treatment option.

ECO 2026: Real-World Effectiveness and Metabolic Outcomes of Tirzepatide in Adults with Obesity

Presenter: Angelopoulos, N.

This prospective real-world study evaluated tirzepatide in 95 adults with obesity over 6 months.

Patients experienced significant weight loss (−8.2 kg at 3 months; −16.7 kg at 6 months, ~14% total). Improvements were seen in HbA1c, LDL cholesterol, and liver markers (AST, GGT, HSI), indicating better glycemic, lipid, and hepatic outcomes. Renal function remained stable. Despite heterogeneous patients and variable dose-escalations in routine practice, tirzepatide showed consistent benefits. These findings confirm that the substantial weight loss and metabolic benefits observed in clinical trials translate effectively into real-world obesity care.

ECO 2026: Impact of GLP 1 Receptor Agonists on Atherogenic Index of Plasma and Metabolic Profile in Adults Living with Type 2 Diabetes and Obesity

Presenter: Bozkur E.

This study evaluated the effect of GLP‑1 receptor agonists on the atherogenic index of plasma (AIP) in 48 adults with type 2 diabetes and obesity over 3 months. AIP was calculated as the log10[triglycerides/HDL-choleserol (HDL-C)].

Significant reductions were observed in body weight, BMI, fasting glucose, HbA1c, and triglycerides. AIP improved due to a lower triglyceride/HDL ratio, indicating a less atherogenic profile. Liver enzymes also declined. Lipid fractions showed no significant changes, and renal and thyroid function remained stable.

These findings suggest that GLP 1 RAs may contribute to a less atherogenic cardiometabolic profile, beyond its glycemic control.

ECO 2026: Cardiometabolic Impact of GLP-1 Receptor Agonists in Inflammatory Bowel Disease: Evidence from a Systematic Review and Meta-analysis

Presenter: Koufakis, T.

The role of GLP-1 receptor agonists (RAs) in patients living with obesity and inflammatory bowel disease (IBD) is limited. Hence this meta-analysis was done to analyze weight, glycaemic and lipid outcomes in this population.

A meta-analysis of thirteen studies (n=74,513) in patients with inflammatory bowel disease (IBD), with 9,202 patients receiving GLP-1RA therapy, was conducted. Ulcerative colitis predominated (64.9%), and semaglutide was most used (67%). GLP-1RA initiation led to clinically meaningful weight loss, with pooled data showing a 6.32% reduction. HbA1c improved while lipid changes were mild; although none were statistically significant. Overall, GLP-1RAs appeared effective for weight reduction in IBD.

ECO 2026: Tirzepatide Improves Mental and Psychosocial Health-Related Quality of Life in the Real-World Setting

Presenter: Pérez Pevida

Tirzepatide has shown effective weight loss in overweight/obese patients, with improvement in health-related quality of life (HRQoL). However, there is limited real-world data on mental and psychosocial HRQoL.

 

In a 6-month prospective, real-world study in 107 obese/overweight adults with comorbidities, the effect of tirzepatide on HRQoL was evaluated using Short Form Health Survey (SF-36v2), EuroQol 5-Dimension 5-Level questionnaire (EQ-5D-5L), International Physical Activity Questionnaire (IPAQ), and Impact of Weight on Self-Perception (IW-SP) scale. Tirzepatide 7.5 mg produced a mean weight loss of 18.04 kg (95% achieved ≥5% and 60% achieved ≥15% weight loss). Glycaemic, lipid profiles and HRQoL improved significantly. A statistically significant improvement was observed in the IW-SP, indicating better weight-related self-perception after the treatment.

Patient-reported outcomes showed marked gains across SF-36 domains, EQ-5D-5L dimensions and physical activity scores. Tirzepatide demonstrated robust weight reduction, metabolic improvements, and psychosocial benefits, highlighting its potential to address physical and mental aspects.

ECO 2026: Beyond Weight Loss: The Effects of Incretin-Based Therapies (IBT) on Behavioral Robustness and Lifestyle Adherence in Adults Living with Obesity

Presenter: Dozzani, I.

A 6‑month prospective, observational study examined whether incretin-based therapies (IBT), including GLP-1 and GLP-1/GIP receptor agonists, facilitate behavioral robustness. Eating behavior architecture was assessed using the Three-Factor Eating Questionnaire, evaluating Cognitive Restraint, Uncontrolled Eating, and Emotional Eating and spontaneous physical activity was objectively measured via daily step counts to capture behavioral integration beyond prescribed exercise interventions.

IBT combined with behavioral therapy produced notable clinical and behavioral benefits in 40 adults with obesity. Mean body weight decreased by 10.4% (p<0.001). Eating behavior improved: uncontrolled eating scores dropped from 58.2 to 24.5 (p<0.001), cognitive restraint scores rose from 45.3 to 62.1 (p<0.01), dietary adherence reached 88%, and spontaneous physical activity increased by >2,100 steps/day (p<0.05). Along with weight loss, IBT showed improvement in eating behaviour and spontaneous physical activity.

ECO 2026: Switching to Tirzepatide from a GLP-1 RA Resulted in Weight Reduction: Results from 2 Real-World Databases

Presenter: Gibble, T. H.

Two real-world databases (Optum Market Clarity [MC] and the Healthcare Integrated Research Database [HIRD]) were used to study weight reduction among individuals switching to tirzepatide from a GLP‑1 receptor agonist medication for obesity.

Mean weight loss with tirzepatide was 13.1% (MC) and 12.9% (HIRD). At 12 months, 78.9% (MC) and 83.8% (HIRD) achieved ≥5% weight loss, while 21.1% (MC) and 19.6% (HIRD) achieved ≥20% reduction. 71.5% (MC) and 72.1% (HIRD) of individuals were started on tirzepatide 2.5 mg; and 81.3% (MC) and 75.4% (HIRD) were on a ≥10 mg dose. Study highlighted tirzepatide’s effectiveness in real-world settings following GLP-1 RA therapy.

ECO 2026: Inhospital Mortality and Complications Associated with Obesity in Patients Hospitalized in Internal Medicine in Spain: Findings from the RECALMIN-Ob Observational Study

Presenter: Gomez, J. C.

The RECALMIN-Ob study analysed the impact of obesity-related comorbidities on health outcomes, both overall and in chronic obstructive pulmonary disease (COPD), stroke, heart failure (HF) and pneumonia in discharged 559,728 people with obesity. This study used data from the NHS Minimum Basic Data Set.

Cardiogenic shock and respiratory arrest were the strongest predictors, followed by sepsis and cancer. Stroke, HF and atrial fibrillation were obesity-related conditions linked to higher mortality. No obesity-related disease increased complication risk. Findings highlighted adverse impact of obesity on prognosis.

ECO 2026: Changes in Body Weight and Adiposity, and Their Associations with Cardiometabolic Risk Over 10 Years: The Kaunas Cardiovascular Risk Cohort Study

Presenter: Raskilienė, A.

The Kaunas Cardiovascular Risk Cohort Study evaluated the patterns of body weight and adiposity, and their link with cardiometabolic risk over 10 years in a Lithuanian adult population.

BMI increased in 76.1% of participants, with 31.5% shifting to a higher category, more often in women. Those with BMI increases had double the odds of developing arterial hypertension (OR 2.02) vs. those with stable/reduced BMI. Waist circumference increase correlated with higher triglycerides (p<0.001), total cholesterol (p=0.002), and fasting glucose (p=0.033), while inversely correlated to HDL cholesterol (p<0.001). Overall, long-term increases in body weight and central adiposity showed associations with lipid abnormalities.

ECO 2026: First-Year BMI Change after GLP-1-Based Treatment Initiation and Risk of Subsequent Adverse Clinical Outcomes

Presenter: Wilding, J.

A real-world study evaluated impact of first-year BMI change following GLP-1–based treatment (liraglutide, semaglutide, tirzepatide) on risk of osteoarthritis, chronic kidney disease (CKD), obstructive sleep apnea (OSA) and heart failure (HF). It used data from Optum Market Clarity health records. First-year BMI change was defined as the change from baseline to the mean BMI from 275 to 455 days following initiation.

GLP-1-based treatment was initiated in 89,718 patients; however, 50.1% of patients discontinued within one year. BMI reductions varied: 27% lost <5%, 22.4% lost 5 to <10%, 14.1% lost 10 to <15%, 15.8% lost ≥15%, while 20.8% gained BMI. BMI reduction ≥15% was linked to lower risks of osteoarthritis (HR 0.63; 95%CI 0.51-0.78), CKD (HR 0.70; 95%CI 0.56-0.88), OSA (HR 0.31; 95%CI 0.23-0.41) and HF (HR 0.68; 95%CI 0.40-1.16) vs. BMI reduction of 0 to <5%. Conversely, BMI gain increased risks (HF HR 1.69; 95%CI 1.26-2.25). The study highlighted the clinical significance of achieving and maintaining weight loss after GLP-1-based treatment initiation.

33^rd European Congress on Obesity (ECO 2026), 12^th -15^th May 2026, Istanbul, Turkey.