Following several days at ECO 2026 in Istanbul, Julie Russell and Adam Pett, Associate Directors, reflected on a congress that demonstrated just how rapidly the obesity landscape is evolving.
While pharmacotherapy continued to dominate much of the discussion, one message emerged consistently across sessions: obesity can no longer be viewed in isolation. Increasingly, it is being discussed within the broader context of cardiovascular, renal and metabolic (CVRM) disease - with growing recognition that improving metabolic health extends far beyond weight loss alone.
Here are five themes that particularly stood out from this year’s congress.
1. Obesity is increasingly being framed as part of broader metabolic dysfunction
One of the clearest shifts across the congress was the growing emphasis on obesity as a disease of systemic metabolic dysfunction rather than simply excess weight.
Sessions repeatedly explored the interconnected roles of adipose tissue biology, insulin resistance, inflammation and ectopic fat deposition in driving downstream cardiovascular, renal and hepatic disease - including increasing focus on MASH risk and long-term cardiometabolic outcomes.
This reframing feels significant because it changes how clinical success is measured. Weight loss itself is increasingly being positioned less as the endpoint, and more as a marker of broader metabolic improvement and disease modification.
The conversation is clearly shifting toward integrated CVRM management, with obesity recognized as intrinsically linked to overall metabolic health outcomes.
2. Oral obesity therapies are emerging - but their role is still being defined
Oral obesity therapies were among the most widely discussed topics at ECO 2026, particularly with new data emerging around higher-dose oral therapies and next-generation agents.
What stood out throughout the congress was how differently these therapies are being conceptualized within future care pathways.
Some discussions focused on patient choice, accessibility and the potential for earlier intervention among people who may prefer not to initiate injectable therapies. Others explored whether oral agents could play a particularly important role in long-term weight maintenance following clinically significant weight reduction.
New higher-dose data presented at the congress appears likely to further support the use of oral therapies in clinical practice.
At the same time, questions remain around where oral therapies ultimately sit alongside injectables in future treatment algorithms. Rather than replacing injectable therapies outright, the future may instead involve offering increasingly personalised treatment options across different stages of obesity management.
3. Weight maintenance is becoming just as important as weight loss
Another major theme throughout ECO was the growing recognition that achieving weight loss is only part of the long-term challenge - maintaining it may prove equally important.
There was significant discussion around durability of response, sustained metabolic improvement and how obesity therapies may support long-term disease management as obesity increasingly becomes treated as a chronic condition.
New data presented and published by Lilly during the congress added further momentum to this conversation, particularly around maintenance strategies following initial weight reduction.
Increasingly, the focus appears to be shifting from “how much weight can be lost” toward how sustainable metabolic health improvements can be achieved over time.
4. The pipeline is expanding beyond first-generation GLP-1 therapies
While GLP-1 and GLP-1/GIP therapies continued to dominate many discussions, there was clear excitement around emerging mechanisms beyond traditional incretin pathways.
Therapies targeting amylin, glucagon and combination or triple-agonist approaches generated considerable interest, reflecting both the scale of ongoing investment in obesity care and the recognition that patient needs are highly individual.
What increasingly emerged throughout the congress was the sense that future obesity care is unlikely to follow a “one pathway fits all” model.
Instead, therapies may ultimately differentiate not only on weight loss efficacy, but also on cardiovascular benefit, hepatic outcomes, tolerability, satiety, durability of response and broader metabolic impact.
5. Women’s health is becoming central to obesity care conversations
One of the standout moments of the congress was the women’s health symposium, which drew exceptionally high attendance throughout.
Discussions around obesity medication in mitigating cardiovascular disease and MASH risk in women generated significant interest, alongside conversations exploring the potential future interplay between obesity therapies and hormone replacement therapy (HRT).
Sessions spanning fertility, pregnancy, PCOS, menopause and cardiometabolic risk reinforced just how interconnected obesity and women’s health are across the life course.
There was a strong sense throughout the congress that women’s health is increasingly moving from the margins toward becoming a central component of obesity and metabolic care discussions.
Final reflections
Perhaps the clearest overall takeaway from ECO 2026 was just how complex the future of obesity management is becoming - and how important multidisciplinary approaches are likely to be moving forward.
The congress reinforced that obesity care is unlikely to sit within a single specialty or treatment approach. Instead, improving long-term patient outcomes will increasingly require closer collaboration across endocrinology, cardiology, hepatology, nutrition, behavioral science, women’s health and public health.
Ultimately, the future of obesity management appears to be evolving beyond weight loss alone, toward a broader focus on improving overall metabolic health and long-term disease outcomes.
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