ECO 2026: Highlights from Day 2
ECO 2026:Tirzepatide for the Maintenance of Body Weight Reduction in People with Obesity: The SURMOUNT-MAINTAIN Trial
Presenter
Horn, D. B.
SURMOUNT‑MAINTAIN (Study of Tirzepatide [glucose‑dependent insulinotropic polypeptide/glucagon‑like peptide‑1 receptor dual agonist] for weight maintenance) was a Phase 3b randomized trial in adults with obesity (body mass index ≥30 kg/m² or ≥27 kg/m² with complications).
After 60 weeks of tirzepatide 10/15 mg (maximum tolerated dose [MTD]), participants are randomly assigned to continue MTD, reduce the dose to 5 mg, or switche to placebo for an additional 52 weeks. At Week 112, weight change was −21.9% (MTD), −16.6% (5 mg), vs −9.9% (placebo) (all p<0.001 vs placebo Participants maintained 96.5% of weight loss achieved during the Weight‑Loss Period with tirzepatide MTD, 67.9% and 42.8% of weight loss achieved during the Weight‑Loss Period with 5 mg and placebo, respectively. Rescue therapy was required in 7.9% (MTD) vs 65.9% (placebo).
Continued tirzepatide, especially at MTD, provides sustained and clinically meaningful weight‑loss maintenance with acceptable safety. Reducing tirzepatide to 5 mg was superior to placebo and may offer an alternative to discontinuation, though benefits varied with some weight regain.
ECO 2026:Orforglipron for the Maintenance of Body Weight Reduction Achieved with Injectable Therapy: ATTAIN-MAINTAIN Trial
Presenter
Aronne, L. J.
This phase 3b, randomized, double‑blind trial evaluated once‑daily oral orforglipron (non‑peptide glucagon‑like peptide‑1 receptor agonist) versus placebo in adults who had completed 72 weeks of tirzepatide or semaglutide, to maintain prior weight loss. Post-treatment with Tirzepatide or Semaglutide, participants are randomly assigned to orforglipron MTD (24 or 36mg) or placebo.
Participants switching to orforglipron largely maintained weight reduction achieved with injectables. Participants treated with tirzepatide had mean BW of 115.8 kg at SURMOUNT‑5 baseline, 90.3 kg at Week 72, and 95.9 kg at the end of ATTAIN‑MAINTAIN; corresponding values with semaglutide were 113.5, 94.3, and 95.9 kg.Maintenance was slightly greater after semaglutide. Visceral fat channges were similar. Gastrointestinal adverse events were common but mostly mild to moderate.
Orforglipron effectively helps sustain weight loss after injectable therapy and represents a potential option for long‑term weight maintenance.
ECO 2026: Cagrilintide Does Not Affect the Exposure of the Combined Oral Contraceptive Ethinyloestradiol/Levonorgestrel or Gastric Emptying as Measured by the Paracetamol Absorption Test
Presenter
Van Der Horst, J.
This open‑label one-sequence crossover trial evaluated the effect of once‑weekly cagrilintide 4.5 mg on the pharmacokinetics of oral contraceptive (ethinyloestradiol [EE] 0.03 mg, levonorgestrel [LN] 0.15 mg) and gastric emptying in Adult female participants of non-childbearing potential (n=30) with overweight/obesity (BMI 25-39.9 kg/m2).
EE exposure AUC0-24h was 1.10 (90% CI 0.94–1.28) and LN 0.92 (0.72–1.17); post-hoc sensitivity analysis showed EE 1.05 (1.00–1.10) and LN 1.01 (0.94–1.09). No differences were observed in Cmax or Tmax. Gastric emptying was unchanged (paracetamol AUC0–1h 1.10 95% CI [0.75–1.62]; AUC0–6h 1.18 [1.06–1.31]). All adverse events were non‑serious, mostly mild–moderate gastrointestinal, with 2 withdrawals.
Cagrilintide does not meaningfully affect contraceptive exposure or gastric emptying and demonstrates good tolerability.
ECO 2026: Prevalence of Hypertension in Prediabetic States among Subjects with Obesity
Presenter
Ouassila, H. N.
This multicenter, descriptive prospective study (2020–2024) included 332 prediabetic adults (mean age 48.6 ± 11.6 years; women,n=242) with obesity (n=50%) to assess hypertension prevalence and characteristics.
Mean BMI was 30.2 ± 9.28 kg/m². Known hypertension was present in 62.4% of Obese subjects, while 47.5% had previously undiagnosed hypertension and ABPM newly identified hypertension in 44.6%. Overall confirmed hypertension reached 60.7% in obese vs 39.3% in non‑obese (p=0.016). Hypertension prevalence by prediabetes type was based on IFG 62.1%, IGT 56.2%, HbA1c 66.7%. Obesity was associated with higher hypertension phenotypes compared with Non-obese subjects: systolic (59.5% vs 40.5%, p=0.048), diastolic (66% vs 34%, p=0.034), and combined hypertension (64.6% vs 35.4%, p=0.031).
Hypertension is highly prevalent and often underdiagnosed in obese prediabetics, with higher burden and variability, highlighting the need for early detection and targeted management.
ECO 2026: Obesity in the Pregnancy and Risk of Pre-Eclampsia
Presenter
Cintra, R. G.
This observational study (n=131; 2024–2025) evaluated pre‑pregnancy BMI and dietary habits in pregnant women with hypertensive disorders.
Obesity was highly prevalent (79.2%), with an additional 10% overweight. Preeclampsia occurred in 12%, with obesity present in 57% and excess weight in 14% of these cases. Most had chronic hypertension. Healthy food intake was moderate (fruits 69.5%, vegetables 71%), while 93% consumed animal protein. Unhealthy dietary patterns were notable, including high intake of sugar‑sweetened beverages (70%) and industrialized seasonings (39%).
Excess pre‑pregnancy weight is strongly associated with hypertensive disorders, and unhealthy dietary habits may further increase risk, highlighting the need for targeted nutritional interventions.
ECO 2026: Effects of Liraglutide Therapy on Mental Health Status of Adolescents with Morbid Obesity
Presenter
Draxler-Dworzak, S.
This prospective study examined the psychological effects of liraglutide in 28 adolescents (12–18 years) with morbid obesity compared to 28 controls over two years with the collection of somatic parameters and standardized psychological parameters score based assessments.
Early results showed improvements in depressive symptoms in self- and parent-reports (DISYPS-III; 3), emotional and behavioural problems (CBCL, YSR; 4), quality of life (KINDL-R; 5) and obesity-related pathogenic eating behaviours (FEV Path; 5) by 12 weeks. Although effects partially declined by 6 months, outcomes remained better than baseline. Findings suggest liraglutide may provide early psychological benefits, though variability increases over time. Ongoing data collection will strengthen conclusions and address gaps in understanding mental health impacts of GLP-1 therapy in pediatric obesity.
ECO 2026: Weight Variability and the Risk of Metabolic Dysfunction Associated Steatotic Liver Disease: A Longitudinal Study from the Kangbuk Samsung Health Study
Presenter
Rhee, E. J.
This cohort study (n=1,669; males [50.8%], mean age 38.6 years) examined whether body weight variability predicts metabolic dysfunction-associated steatotic liver disease (MASLD) between 2007-2019 and participants had at least 5 health visits. Weight variability was quantified using Average Successive Variability (ASV) across the five visits and categorized into quartiles (Q1–Q4). Over follow-up, 31.5% developed MASLD, with incidence rising across weight variability quartiles [Q1: 21.0% (87/415), Q2: 28% (118/422), Q3: 32% (133/416) to Q4: 45.5% (187/411)]. Kaplan-Meier analysis showed that Higher weight variability significantly reduced MASLD-free survival and, after adjustment, the highest variability group had a 64% increased risk (aHR 1.64; 95% CI: 1.253–2.144; p < 0.001)). Findings indicate that weight fluctuation independently contributes to MASLD risk, highlighting the importance of maintaining stable body weight rather than repeated weight cycling for effective prevention.
ECO 2026: Machine Learning-Based Model for Predicting Metabolic Dysfunction-Associated Steatotic Liver Disease Using Non-invasive Parameters in Young Adults
Presenter
Kwon, Y.
Metabolic dysfunction-associated steatotic liver disease (MASLD) is increasingly common in young adults, requiring effective non-invasive detection. This study developed a machine learning based model to predict MASLD in adults aged 20–40 years using data from over 15,000 participants. Three predictive models incorporating demographic, clinical, and body composition variables were tested using logistic regression, random forest, and gradient boosting.
The most comprehensive model achieved strong performance, with Area Under the Receiver Operating Characteristic Curve (AUROC) 0.90 (LR), 0.91 (RF), and 0.91 (XGB), with accuracies up to 0.81 in internal validation and 0.89 (LR), 0.88 (RF), and 0.88 (XGB) in external validation. Body mass index and body fat percentage were key predictors, while higher skeletal muscle index unexpectedly increased risk. The model enables accurate early screening in clinical settings.
33rd European Congress on Obesity (ECO 2026), 12th -15th May 2026, Istanbul, Turkey.
