In this GLP-1 round up:
Phase 3 data for retatrutide, Eli Lilly’s investigational triple agonist (GLP-1/GIP/glucagon), showed up to 28% weight loss in participants with obesity. According to Patient Care Online, this level of efficacy pushes pharmacotherapy into the range historically associated with bariatric surgery outcomes.
IAPAM Perspective: Physicians need to prepare their practices for managing patients through massive, rapid weight loss, which requires more intensive nutritional and metabolic monitoring than older agents. This is not a drug to prescribe and check in on quarterly.
On May 1, 2026, Novo Nordisk announced that Ozempic (semaglutide) tablets — a new oral formulation of semaglutide with an expanded cardiovascular indication — would be available at 70,000+ US pharmacies beginning May 4. As detailed by PR Newswire, it is available in 1.5 mg, 4 mg, and 9 mg doses and is the only FDA-approved oral GLP-1 indicated for both primary and secondary cardiovascular risk reduction in adults with type 2 diabetes. Insurance coverage is available as low as $25 for eligible commercially insured patients via Novo Nordisk’s savings card, with self-pay starting at $149/month through NovoCare Pharmacy and select telehealth providers.
IAPAM Perspective: With Foundayo (orforglipron, approved April 1) and now the Ozempic pill, the oral GLP-1 era is fully underway. Providers now have two distinct oral agents with different mechanisms, dosing structures, and indicated populations. Understanding both is essential for counseling needle-hesitant patients and building oral maintenance protocols.
A new preprint study (not yet peer-reviewed) suggests that tirzepatide may cause slightly more relative lean body mass loss than semaglutide. This adds nuance to the ongoing debate we covered in our March 2026 update. The core action item for providers remains unchanged: continue prescribing resistance training and adequate protein intake for all patients on GLP-1 therapy. Given the preprint status of this data, providers should await peer review before adjusting clinical protocols.
A meta-analysis published in The BMJ found that patients stopping GLP-1s regain weight approximately four times faster than after behavioral weight-loss programs such as low-calorie diets, returning to baseline weight within approximately 1.5 years — 2.4 years sooner than patients who lost weight through behavioral programs alone. Studies presented at Digestive Disease Week (DDW) 2026, covered by Medscape, highlighted endoscopic procedures — including endoscopic sleeve gastroplasty (ESG) and duodenal mucosal resurfacing — as viable “off-ramp” strategies to prevent weight regain after stopping GLP-1 therapy. With discontinuation rates running between 50% and 65% within the first year, the off-ramp is not a hypothetical — it is a clinical reality that every practice needs a plan for.
Phase 3 data from the ATTAIN-MAINTAIN trial, published in Nature Medicine, showed that patients previously on tirzepatide maintained 74.7% of their prior weight loss with orforglipron versus 49.2% with placebo at week 52. Patients previously on semaglutide maintained 79.3% versus 37.6% with placebo. As a secondary finding, 43.7% of tirzepatide switchers and 55% of semaglutide switchers on orforglipron maintained at least 80% of their prior weight loss, compared with 16.4% and 6.9% on placebo, respectively.
The SURMOUNT-MAINTAIN trial, published in The Lancet, found that at week 112, patients continuing tirzepatide at their maximum tolerated dose maintained a 21.9% weight reduction, those stepped down to 5 mg maintained a 16.6% reduction, and those on placebo maintained only a 9.9% reduction.
IAPAM Perspective: These three data points together tell a clear story: stopping GLP-1 therapy without a plan is a clinical failure mode. Structured step-down protocols — whether to a lower dose, an oral agent, or a combination of both — are the standard of care. This is precisely where physician-led programs differentiate themselves from direct-to-consumer telehealth models that lack the infrastructure for ongoing, personalized management.
A study published in Cell Reports Medicine found that weight loss with GLP-1 medicines does not result in a disproportionate loss of muscle mass or function. While absolute muscle mass decreased slightly, relative muscle mass and strength improved, resulting in better mobility and functional performance. The study included four preclinical studies and a proof-of-concept clinical trial.
In direct contrast to the above, a survey of 406 U.S. healthcare professionals presented at the SCALE Music City 2026 conference, as reported by EMJ Reviews, found that 91% reported GLP-1-associated weight loss had at least a moderate impact on skin laxity, and approximately 90% reported an aged appearance as a significant patient concern. Loss of muscle contour and tone, cellulite, and posture changes were also frequently noted. Around half of HCPs who owned a muscle stimulation device were already offering muscle stimulation treatments to GLP-1 patients concerned about muscle tone.
IAPAM Perspective: The Cell Reports Medicine study measures relative metabolic function — an important but incomplete picture. The SCALE data reflects what patients actually experience and what they bring to their providers. Rapid, significant weight loss creates structural changes that require active management. This is a direct opportunity for weight loss practices to build muscle-preservation programming into their standard of care.
Ready to build a comprehensive weight loss program that addresses these realities? Explore the Clean Start Weight Management Program — now including an exclusive muscle-preservation program bonus.
National insurance data published in JAMA Surgery found that GLP-1 medication use increased by 140.4% from 2022 to 2024, while metabolic bariatric surgery utilization declined by 34.1% over the same period.
IAPAM Perspective: The referral pathways are shifting. Medical weight loss is increasingly the primary intervention, placing the clinical and monitoring responsibilities previously managed by surgical centers onto medical practices. Providers who have built comprehensive programs are well-positioned; those still operating on a prescription-only model are not.
A perspective in STAT News by a clinical endocrinologist argues against the growing trend of “microdosing” compounded GLP-1s for cosmetic weight loss, noting a complete absence of long-term safety or efficacy data. The piece draws an important distinction between unstudied microdosing and legitimate, medically supervised dose adjustments during maintenance. Providers must actively counsel patients against unverified microdosing protocols promoted by direct-to-consumer platforms.
Millions of patients are now using consumer apps to track GLP-1 doses, side effects, and weight loss. While some clinical-grade platforms paired with coaching show improved persistence, consumer apps lack clinical validation and raise concerns about privacy and tracking-induced anxiety, as reported by Medscape. Providers should proactively ask patients which apps they are using and clarify that consumer apps are organizational tools, not clinical decision support. The physician-patient relationship — not an algorithm — remains the appropriate locus of clinical judgment.
The CMS BALANCE Model for expanding GLP-1 coverage in Medicare Part D has been indefinitely delayed. However, according to KFF, the Medicare GLP-1 Bridge demonstration program has been extended through the end of 2027, providing eligible Medicare beneficiaries continued access to discounted GLP-1s. Providers should identify eligible patients now ahead of the July 1, 2026 program launch.
The evidence for GLP-1 benefits beyond weight loss continues to expand. Here is a brief roundup of notable findings from May 2026.
A large retrospective analysis presented at ASCO 2026 and reported by MedPage Today found that GLP-1 use was associated with a 31% to 50% lower risk of cancer progression to metastatic disease across colorectal, liver, breast, and lung cancers. Researchers noted that the anti-inflammatory and metabolic effects of GLP-1 therapy may play a role independent of weight loss.
GLP-1 and dual agonist therapy reduced the incidence of new-onset sleep apnea by 54% in patients with obesity, according to new data covered by Healio. This adds to a growing body of evidence supporting GLP-1s as a broad metabolic intervention, not just a weight loss tool.
Data presented at the American Urological Association (AUA) 2026 annual meeting and reported by MedPage Today found that men on semaglutide or tirzepatide showed significant increases in both total and free testosterone. For male patients with obesity and low testosterone, this is a clinically meaningful secondary benefit worth discussing at intake.
A landmark randomized controlled trial found that semaglutide reduced heavy drinking days by 41% compared to 26% for placebo in patients with alcohol use disorder, as reported by U.S. News. This builds on earlier observational data and represents the first large-scale RCT to confirm the signal.
A phase 2a randomized clinical trial published in JAMA Network Open found that once-weekly semaglutide was associated with reduced cigarette cravings in adults with daily cigarette use. While preliminary, this adds to a pattern of GLP-1s modulating reward-driven behaviors beyond food intake.
30-Day: Audit your current maintenance protocols. Do you have a documented step-down plan for patients who want to reduce or stop injectable therapy? If not, build one that incorporates oral agent options and structured lifestyle support.
90-Day: Integrate a muscle-preservation component into your weight loss program to address the structural realities of rapid weight loss. Practices that offer this as a standard part of their program will differentiate themselves as the GLP-1 patient population continues to grow.
May 2026 made one thing clear: the GLP-1 landscape is no longer about whether these drugs work. It is about who manages patients through the full arc of treatment — from initiation to maintenance to the inevitable transitions that follow. Retatrutide’s 28% efficacy benchmark, the arrival of two oral agents, and the mounting evidence on weight regain all point in the same direction. The practices that will thrive are those built around structured, physician-led programs that address what happens after the prescription is written.
The muscle mass debate, the decline in bariatric surgery referrals, and the proliferation of unverified consumer tools are not peripheral issues — they are the daily reality of running a medical weight loss practice in 2026. Providers who stay current, counsel proactively, and build comprehensive programs are not just better positioned competitively. They are delivering better patient outcomes.
IAPAM’s Clean Start Weight Management Program is designed to give physicians exactly that infrastructure — including the clinical protocols, patient education tools, and now an exclusive muscle-preservation program bonus to address the realities this month’s data makes impossible to ignore.
What is the new oral Ozempic pill?
The new oral Ozempic pill is a new formulation of semaglutide launched in the US in May 2026. Unlike Rybelsus, which was approved only for blood sugar control in type 2 diabetes, the Ozempic pill carries an expanded indication for both primary and secondary cardiovascular risk reduction.
How fast do patients regain weight after stopping GLP-1s?
According to a BMJ meta-analysis, patients who stop GLP-1s regain weight approximately four times faster than those who lose weight through behavioral programs, returning to their baseline weight in about 1.5 years.
Do GLP-1s cause muscle loss?
While absolute muscle mass may decrease slightly during rapid weight loss, recent studies indicate that relative muscle mass and strength actually improve. However, the structural impacts — including skin laxity and loss of muscle tone — remain a significant concern for patients and are best addressed through a supervised muscle-preservation program.
What is GLP-1 microdosing and is it safe?
GLP-1 microdosing refers to using very small, unstudied doses of compounded GLP-1 medications, often for cosmetic weight loss. There is currently no long-term safety or efficacy data supporting this practice, and it is distinct from legitimate, medically supervised dose adjustments.
Request your Quick Start Checklist for Starting or Integrating a New GLP-1 for Weight Loss.
Sources
Request your Quick Start Checklist for Starting or Integrating a New GLP-1 for Weight Loss Guide.