Semaglutide in Routine Obesity Care: A Narrative Review of Effectiveness Outside the Trial Population
DOI:
https://doi.org/10.5281/zenodo.22258301Keywords:
Semaglutide, Obesity, Real-world effectiveness, Treatment persistence, Dose titrationAbstract
Randomised trials of semaglutide for obesity report mean weight reduction of roughly 15 to 16 per cent at 68 weeks. Routine
practice reports considerably less. In a cohort of 7,881 adults treated outside a trial, mean weight reduction at one year was 8.7
per cent, and the reason is visible in the same dataset: those who stopped within three months lost 3.6 per cent, those who stopped
between three and twelve months lost 6.8 per cent, and those who continued lost 11.9 per cent. Among patients who continued at a
high maintenance dose, semaglutide achieved 13.7 per cent. Dose is the other half of the explanation, since 80.8 per cent of that
cohort remained on a low maintenance dose, against 86 to 90 per cent reaching the full dose in the trials. Discontinuation ran at
42 per cent in one outpatient clinic against approximately 5 per cent over two years in a trial extension. A digital clinic pairing
individualised dosing with intensive behavioural support reported 16.7 per cent at 64 weeks with only 28.8 per cent exceeding 1
mg weekly. The gap is one of delivery rather than of drug.
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