Early Uptake and Spread of Oral Semaglutide Use Among US Adults With Obesity

By
Yuqing Lei
Huilin Tang
Xinyao Jian
David A. Asch
Yong Chen
October 7, 2026

Jama Network Open

At a Glance

Category	Detail
Condition	Obesity and use of obesity management medications (OMMs)
Key Mechanisms	The study describes prescribing uptake and prior GLP-1 RA exposure; it does not assess pharmacologic mechanisms.
Target Population	US adults aged 18 years or older with BMI ≥30, or BMI ≥27 with at least one specified obesity-related comorbidity; adults with type 2 diabetes or undocumented BMI were excluded.
Care Setting	Retrospective analysis of deidentified electronic health records from US hospitals and clinics; findings describe prescription initiation recorded in participating Epic Cosmos systems.

Key Highlights

Among 47,894,786 OMM-eligible adults, 148,792 initiated oral semaglutide from December 22, 2025, through March 15, 2026.
Weekly oral semaglutide initiation reached 4.56 per 10,000 eligible adults (95% CI, 4.50-4.62) during the week of March 2-8, 2026.
Oral semaglutide uptake approached injectable semaglutide and briefly exceeded it; tirzepatide had the highest weekly initiation rate throughout the observation period.
Of oral semaglutide initiators, 53.0% had no GLP-1 RA use in the previous 12 months; 87.6% received oral Wegovy and 12.4% received Rybelsus.
Oral semaglutide initiators were generally older and more often female, had lower baseline BMI, and more often had Medicare coverage than injectable semaglutide or tirzepatide initiators.

Guideline-Based Recommendations

Diagnosis

The study defined OMM eligibility as age ≥18 years and BMI ≥30, or BMI ≥27 with at least one specified comorbidity: hypertension, dyslipidemia, obstructive sleep apnea, atherosclerotic cardiovascular disease, or heart failure.
Adults with type 2 diabetes or without documented BMI were excluded from the analysis.

Management

The article reports prescribing patterns and does not provide treatment recommendations or comparative treatment-effect estimates.

Monitoring & Follow-up

Initiation was defined as a first prescription for the study medication with no prescription for that same medication in the preceding 12 months.
Weekly initiation incidence was calculated per 10,000 OMM-eligible adults; analyses among GLP-1 RA-naive adults excluded those with any history of GLP-1 RA use.

Risks

EHR prescription orders may not reflect dispensing or actual medication use.
Prescriptions issued outside participating Epic health systems, including through online or direct-to-consumer platforms, may have been missed.
The EHR did not provide prescribing indications; excluding adults with type 2 diabetes reduced, but did not eliminate, possible indication misclassification.
The descriptive study was not designed to determine causal effects.

Patient & Prescribing Data

The cohort included 47,894,786 eligible adults (mean age 52.4 years; 57.7% female). Oral semaglutide initiators had a mean age of 53.3 years, 72.7% were female, and mean baseline BMI was 36.6.

There were 148,792 oral semaglutide initiators; 78,861 (53.0%) had no GLP-1 RA use in the previous 12 months. Oral semaglutide initiation neared injectable semaglutide by approximately 3 months after approval, while tirzepatide remained the most frequently initiated medication.

Clinical Best Practices

Interpret the reported rates as EHR-recorded prescription initiation, not confirmed dispensing or medication use.
The 12-month washout defined new use of the same study medication; GLP-1 RA-naive analyses excluded anyone with any history of GLP-1 RA use.
Interpret the findings as descriptive early uptake patterns; the study did not test hypotheses or establish causal effects.