Obesity: oral therapy for those afraid of needles

INTRODUCTION: Glucagon-like peptide-1 receptor agonist (GLP-1 RA) pharmacotherapy has transformed obesity management, yet subcutaneous administration remains a barrier for patients with needle phobia. This review examines needle phobia and agoraphobia as contributors to treatment non-adherence and evaluates the evidence for oral GLP-1 RA alternatives. AREAS COVERED: We synthesize evidence on the epidemiology of needle phobia (trypanophobia) and agoraphobia, their mechanisms and psychiatric comorbidities, real-world discontinuation rates of injectable GLP-1 RAs, and clinical efficacy data for oral semaglutide and emerging oral agents. A brief overview of the literature search methodology (PubMed/MEDLINE, Cochrane Library, ClinicalTrials.gov; searched to June 2026) is provided in the Introduction. A structured clinical decision algorithm is proposed. EXPERT OPINION: Oral semaglutide 25 mg/day (the currently approved dose for weight management) demonstrates weight loss of similar magnitude to subcutaneous formulations across separate trials and should be considered preferentially in patients with moderate-to-severe needle phobia. Systematic needle phobia screening at obesity clinic entry, combined with a severity-based treatment algorithm integrating pharmacological and psychological approaches, is recommended to maximize equitable access to obesity pharmacotherapy.