New research being presented at this year's European Congress on Obesity (ECO 2025) has found that patients of an online obesity clinic achieved similar weight loss to that reported in clinical trials – but with less than half the medication. The study is to be published in the journal The Lancet Digital Health.
Patients who followed the programme had an average weight loss of 16.7% (16.8kg/2st 9lb) after 64 weeks, which is on par with that seen in randomised controlled trials of the same drug, semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist.
Achieving the same weight loss in day-to-day life as in the tightly controlled conditions of a clinical trial, while also using lower doses of drugs, has many potential benefits, from lower costs and fewer side-effects for patients, to ensuring that stocks of the drug go further."
Dr. Henrik Gudbergsen, lead researcher and Chief Medical Officer of Embla, an online weight loss service
Semaglutide and other GLP-1 agonists for weight loss have had impressive results in clinical trials. However, real-world trials have reported smaller weight losses and lack details about whether patients are also making lifestyle changes that will increase the likelihood of their achieving optimal weight loss.
Real-world trial results also suggest that few patients follow the standard dosing schedule, with most staying on lower doses.
In the first study of its kind, Dr Gudbergsen and colleagues at the University of Copenhagen evaluated the real-world effects of an online weight loss programme that provides intensive behavioural therapy and advice on diet and exercise, as well as doses of semaglutide that are tailored to individual patients.
The cohort study involved 2,694 individuals in Denmark (78% female, average age 47 years, average BMI 34.3, average body weight 100.5kg/15st 12lb) who were enrolled in a weight management programme run through the Embla app, available in Denmark and in the UK.
The programme included advice on healthy eating, increasing exercise and on how to use cognitive behavioural therapy (CBT) and other therapies to overcome the psychological barriers to weight loss, access to doctors, nurses and psychologists through the AI-powered app and a course of the weight- loss drug semaglutide (Wegovy).
The standard dosing schedule, in which a low initial dose of 0.25 mg once weekly is increased every four weeks for 16 weeks to a maximum dose of 2.4mg (which the patient remains on until treatment ends), was tailored to individual patients.
Patients received the lowest effective dose, and increases were only considered if they had stopped making progress. If they maintained a weekly weight reduction >0.5% of their body weight and experienced manageable levels of side-effects and hunger, they remained on the existing dose. Treatment continued in this way until they reached their desired weight or a BMI of 25 – an approach known as "treat to target".
After 26, 64 and 76 weeks, 1,580, 712 and 465 patients, respectively, were still taking part in the programme.
Average weight loss among those who were still taking part in the programme was 12.2% (12.2kg/1st 13lb) at week 26, 16.2% (16.3kg/2st 8lb) at week 52 and 16.7% (16.8kg, 2st 9lb) at week 64.
The researchers note that this is similar to the 15-16% weight loss at 64 weeks achieved by patients who took part in clinical trials in which semaglutide was combined with lifestyle interventions such as calorie-controlled diets and behavioural therapy.1-3
However, it was achieved with less than half the medication used in the clinical trials. The average dose of semaglutide in this study was about 1mg/week and only 28.8% of patients reached doses higher than this.
In contrast, about 90% of the patients in the clinical trials reached doses of 2.4mg/week.
Dr Gubdergsen, who is also an associate professor at the University of Copenhagen, says: "By combining diet and exercise advice with psychological coaching and personalising patients' doses of semaglutide it was possible to achieve the same amount of weight loss with lower doses of the drug."
Some 98% of the 515 patients with a reported weight at weeks 52-64 achieved at least 5% weight loss and 82%, 51%, and 23% achieved 10%, 15% and 20% weight loss, respectively.
Females had a higher weight loss than males (17·6% vs 13·4 %) and patients who used the online app more lost more weight than those who used it less.
The analysis also found that patients' weight loss was similar, regardless of their initial BMI, age or the amount of semaglutide used. In other words, lower doses of semaglutide were just as effective as higher ones.
Side-effects, such as nausea, vomiting, and stomach ache were generally mild and transient.
The study's limitations include the use of self-reported data and the lack of a control group.
Dr Gudbergsen concludes: "Our results show that by giving personalised doses of semaglutide along with diet, exercise and psychological support, it is possible for patients to achieve clinical trial-level weight loss in their day-to-day lives.
"Our 'treat-to-target' approach, in which amount of medication was tailored to each patient's goals, allowed us to keep doses as low as possible, which should mean lower costs and fewer side-effects for patients.
"This approach was effective across all age groups and all starting weights and in both sexes."
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