A quarterly, fully sourced read on GLP-1 medicines and fibre, written from a European vantage point: what moved in Europe this quarter, what every pivotal trial recorded about gastrointestinal tolerability, and how that sits against Europe’s own fibre intakes. A short global-context layer records what moved elsewhere. Free to cite.
What moved between 1 April and 30 June 2026, and what did not. We publish the nulls too. A quarter in which nothing changed is a finding, not a gap.
EASO, EFAD and ECPO published a joint consensus statement on incretin-based therapies in obesity care, presented at the European Congress on Obesity in Istanbul and published in The Lancet Diabetes and Endocrinology. It positions medical nutrition therapy as a cornerstone of care alongside the medication, and names gastrointestinal symptom management among its practical considerations.
EFADAt its meeting of 18 to 21 May, the CHMP adopted a positive opinion for Ablymico (liraglutide, STADA Arzneimittel AG), a hybrid application indicated for diabetes and weight management.
EMAThe CHMP recommended adding a once-daily oral tablet to the Wegovy (semaglutide) marketing authorisation, alongside the weekly injection. The EMA describes it as the first GLP-1 receptor agonist for weight management developed for oral use. The opinion went to the European Commission for a decision.
EMAFrance began publicly reimbursing Wegovy and Mounjaro for weight control at a 65% base rate, for a BMI of 40 or above, or 35 and above with a listed weight-related comorbidity. The first prescription is reserved to specialists involved in obesity care.
HASGLP-1 medicines for weight management remain outside statutory reimbursement as lifestyle medicines under section 34 SGB V. They are covered only in the type-2-diabetes indication.
§34 SGB V · G-BAFrance was the only country in our tracked set of 16 to change its obesity-indication funding status this quarter. The other 15 hold the position recorded at the last refresh.
The Good Fiber CompanyDeliberately lighter than the European brief above. Three dated, sourced items that put the European quarter in proportion, not a second monitor.
The FDA approved Foundayo (orforglipron, Eli Lilly), a once-daily GLP-1 receptor agonist tablet, for weight management alongside a reduced-calorie diet and increased physical activity. It is the first new molecular entity cleared under the agency's National Priority Voucher pilot and, per the FDA, the fastest approval of a new molecular entity since 2002. The contrast with Europe is the point: in the same quarter, the CHMP recommended an oral tablet form of an existing molecule.
FDAThe FDA's announcement lists nausea, constipation, diarrhoea and vomiting among the side effects of the new tablet. That is the same four-symptom cluster this monitor tracks across the injectable pivotal trials, which suggests the tolerability question does not resolve itself as the category moves from peptides to small molecules and from injections to pills.
FDAThe Lancet reported on manufacturers preparing cheaper generic versions in India and China as semaglutide patents expire there, and on whether those health systems are ready for the volume. European and US patents run considerably later, so this is a change in access that Europe will read about long before it experiences it.
The LancetTen pivotal trials, one row each, taken from posted results on ClinicalTrials.gov. Pick a symptom to re-rank the table. No efficacy or weight outcome is recorded in this dataset.
Sample-weighted pooled incidence across the 9 placebo-controlled trials (15,242 participants on a GLP-1, 13,368 on placebo).
Across the 9 placebo-controlled trials, 12.8% of participants on a GLP-1 reported constipation, against 4.5% on placebo. Excluding SELECT, which alone is more than half the pooled denominator and records the lowest rates, the same figures are 19.2% and 8%. Both are shown for every symptom below, because which one is the fair number depends on the question being asked.
Showing: Constipation
The 15 European countries for which we hold both a national fibre-intake survey and a position on public funding for the obesity indication. Fibre figures come from our European Fibre Gap Index, funding status from our GLP-1 access tracker.
All 15 of 15 sit below their own national fibre target, by a mean of 8.2 g/day. Publicly funded access is arriving into populations that national surveys already measure below their own recommendation.
| Country | Intake | Target | Shortfall | Obesity-indication funding |
|---|---|---|---|---|
| United Kingdom | 16.4 | 30 | 13.6 | Restricted access |
| Spain | 12.6 | 25 | 12.4 | Not publicly funded |
| France | 20 | 30 | 10 | Publicly funded |
| Sweden | 20 | 30 | 10 | Not publicly funded |
| Finland | 21 | 30 | 9 | Not publicly funded |
| Austria | 22 | 30 | 8 | Not publicly funded |
| Belgium | 17 | 25 | 8 | Not publicly funded |
| Denmark | 22.5 | 30 | 7.5 | Not publicly funded |
| Poland | 17.8 | 25 | 7.2 | Not publicly funded |
| Ireland | 18 | 25 | 7 | Not publicly funded |
| Italy | 18 | 25 | 7 | Not publicly funded |
| Germany | 24 | 30 | 6 | Not publicly funded |
| Norway | 24 | 30 | 6 | Not publicly funded |
| Portugal | 19 | 25 | 6 | Not publicly funded |
| Netherlands | 20.3 | 25 | 4.7 | Not publicly funded |
g/day · European Fibre Gap Index · GLP-1 access tracker
The Good Fiber Company (2026). The GLP-1 Fiber Monitor, Q2 2026. https://goodfibercompany.com/glp1-fiber-monitor/ Published under CC BY 4.0. You are free to reuse and republish these figures, including commercially, with attribution to The Good Fiber Company and a link to this page.
This page keeps one permanent address. Each quarter is appended here rather than published at a new URL, so citations and links keep working.
First edition. Ten pivotal trials, a sample-weighted pooled gastrointestinal incidence across the nine placebo-controlled ones, and the fifteen-country overlap with the European fibre gap.
July 27, 2026Every adverse-event figure is taken from posted results on ClinicalTrials.gov, which are US Government public-domain records. We use one source for every row rather than mixing databases. For each trial we take the highest dose arm licensed for the indication studied, against its matched placebo. Where a trial carries several placebo arms that are strata of the same comparison, they are summed: SCALE splits both drug and placebo by prediabetes status, so each pair is combined. SUSTAIN-6 carries volume-matched placebos, so we use the matched pair rather than a pooled placebo.
The pooled figure is a crude sample-weighted incidence: the sum of affected participants divided by the sum of participants at risk, across the 9 placebo-controlled trials, computed separately for the drug arms and the placebo arms. It is not a random-effects meta-analysis. There is no variance weighting, no heterogeneity estimate and no confidence interval, and the trials differ in population, duration, background therapy and titration schedule. Treat it as an indicative summary, not a like-for-like comparison. SURPASS-2 compares two active drugs with no placebo, so it appears as a row but is excluded from every pooled figure.
One trial dominates the pool. SELECT contributes 8,803 of the 15,242 participants on a GLP-1 and reports the lowest rate for all four symptoms, because it is a four-year cardiovascular-outcomes trial in which adverse-event ascertainment is less intensive than in a dedicated obesity trial. We therefore publish the pooled figure with and without it, side by side, rather than picking one.
Two figures are deliberately absent. We do not publish an "any gastrointestinal event" rate, because it cannot be obtained by adding the four symptoms together when one participant may report several. And we do not publish discontinuation due to adverse events: no trial exposes it as an outcome measure, and the participant-flow records track study discontinuation using reason taxonomies that differ between sponsors, so a column built from them would not mean the same thing in each row.
Posted results on ClinicalTrials.gov can differ from the journal publication by a small number of participants, because the two can reflect different data cuts or analysis sets. For example, STEP 1 nausea is 576 of 1306 in the posted results and 577 in the New England Journal of Medicine paper. We use the posted results throughout and name the publication for each trial in the source list.
The country layer joins two of our own datasets on ISO country code and reports the shortfall as the national target minus the measured national intake. Switzerland appears in the access tracker but has no national fibre survey in the index, so it is left out rather than estimated. The underlying surveys are not harmonised across countries in method or year, and each country's own source and year are shown on the index page. This layer describes population intakes measured by national surveys. It is not a statement about any individual's diet.
