Objective:

To describe early oral semaglutide initiation among US adults eligible for obesity management medications after its FDA approval for obesity.

Approach:

• Design and data: Retrospective descriptive cohort study using deidentified Epic Cosmos electronic health records.
• Participants: Adults eligible for obesity medication (BMI ≥30, or BMI ≥27 with an obesity-related comorbidity); individuals with type 2 diabetes or no documented BMI were excluded.
• Measures: New prescriptions for oral semaglutide, injectable semaglutide, and injectable tirzepatide were identified from December 22, 2025, through March 15, 2026, using a 12-month medication-specific washout. Weekly initiation rates were calculated per 10,000 eligible…

Key Findings:

• The cohort included 47,894,786 eligible adults; 148,792 initiated oral semaglutide during the study period.
• Of oral semaglutide initiators, 87.6% received Wegovy and 12.4% received Rybelsus.
• Weekly oral semaglutide initiation rose to 4.56 per 10,000 eligible adults (95% CI, 4.50-4.62) in the week of March 2-8, 2026.
• Oral semaglutide uptake neared injectable semaglutide and briefly exceeded it; tirzepatide had the highest initiation rate throughout the observation period.
• A total of 53.0% of oral semaglutide initiators had no previous GLP-1 receptor agonist use.

Interpretation:

The authors report that early oral semaglutide adoption involved both people without prior GLP-1 receptor agonist use and people transitioning from existing GLP-1 receptor agonist therapies.

Limitations:

• The EHR did not record prescribing indications, although excluding people with type 2 diabetes reduced the possibility of indication misclassification.
• Prescription orders may not reflect dispensing or actual use; prescriptions from outside participating Epic systems may have been missed.
• Data availability delays may have limited identification of early uptake.
• The descriptive analysis was not designed to determine causal effects.

Conclusion:

Among US adults eligible for obesity medication, oral semaglutide initiation increased rapidly after FDA approval and approached injectable semaglutide rates within the observation period.