Why adherence determines weight loss success with semaglutide

By Dr. Sanchari Sinha Dutta, Ph.D.Reviewed by Benedette Cuffari, M.Sc.Jan 12 2026

Analysis of a large unsubsidized digital weight-loss service reveals that consistent treatment adherence and active engagement, not access alone, are the key factors separating modest results from clinically meaningful weight loss. 

Study: Patient Outcomes Under Varying Engagement Patterns on Real-World Lifestyle-Supported Pharmacological Weight-Loss Therapy. Image Credit: Kokosha Yuliya / Shutterstock.com

A recent study published in Obesities examines how the effectiveness of weight-loss medications may depend on the patient’s adherence to their treatment protocol in unsubsidized lifestyle-supported, pharmacological digital weight-loss services.

The growing role of GLP-1 therapies in digital obesity care

Overweight and obesity are chronic metabolic conditions characterized by excessive fat accumulation throughout the body. The prevalence of both overweight and obesity continues to rise globally, with 64 % of adults residing in England considered obese or overweight. Both overweight and obesity significantly increase the risk of cardiovascular disease, metabolic syndrome, diabetes, and certain cancers.

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) like semaglutide mimic the effects of the hormone GLP-1 to increase insulin secretion, regulate appetite, and delay gastric emptying, all of which promote weight loss. Global health agencies like the World Health Organization (WHO) and the United Kingdom National Institute for Health and Care Excellence (NICE) recommend that GLP-1 RAs be prescribed along with comprehensive lifestyle interventions to ensure long-term success.

Digital weight loss services, which use mobile apps, web-based consultations, text messaging, and digital personal assistants to deliver care, have emerged as a promising modality to improve weight management. These services allow patients to comfortably discuss their overweight- or obesity-related complications with healthcare and fitness professionals in digital settings.

Some digital weight-loss services align with the recommended guidelines of combining pharmacology with behavioral therapy. Early evidence suggests that these services can deliver safe and effective care; however, their efficacy in unsubsidized real-world digital services remains unclear.

In the current study, researchers explore the effectiveness and adherence patterns associated with the digital weight loss service Juniper Health, a large provider operating in the U.K., Australia, Germany, and Japan.

Evaluating treatment adherence and effectiveness in a real-world digital weight loss program

Data from 7,279 patients who initiated the Juniper U.K. digital weight loss service between January 2023 and May 2024 were included in the study. All patients were prescribed semaglutide by Juniper clinicians following recommended guidelines.

The primary objectives of the study were to determine treatment effectiveness under the ideal condition of full protocol adherence, as well as under real-world settings characterized by ideal adherence and non-adherence.

The ideal condition included patients who received between eight and 15 medication orders, submitted weight data within a predefined 341–379-day window after program initiation, and did not pause treatment for longer than 90 days. The real-world condition included all patients from the ideal condition and those who exhibited limited adherence, with missing 12-month weight values conservatively imputed using a baseline observation carried forward approach.

Adherence leads to clinically meaningful weight loss

An average of 15.67 % weight loss was reported within 12 months after treatment initiation among patients with ideal adherence. In this condition, a significant proportion of patients achieved clinically significant weight loss, with 53.69 % of patients achieving a weight loss of more than 15 %. In real-world conditions, patients achieved a mean weight loss of 7.88 %, with a median weight loss of 5.9 %.

Among patients who followed ideal adherence conditions, 32 % and 68 % were prescribed Wegovy and Ozempic, respectively. The analysis by semaglutide brand type revealed that a significantly higher proportion of Wegovy users achieved clinically meaningful weight loss as compared to Ozempic users, even after adjustment for baseline differences using propensity score matching and dose-restricted sensitivity analyses.

The comparison of patient data under ideal adherence conditions and real-world conditions revealed that a significantly higher proportion of patients in the ideal adherence conditions achieved clinically meaningful weight loss compared to those in the real-world conditions.

Older age at consultation and male gender were significantly associated with lower weight loss. Among ethnic groups, weight loss percentage was significantly lower among Asian patients as compared to that among White or Caucasian patients.

A strong positive association was observed between the frequency of weight tracking on the digital platform and weight loss. Patients who recorded their weight at least 100 times achieved a significantly higher weight-loss percentage than those who recorded it less than 20 times. However, the authors note that this relationship may be bidirectional, reflecting both engagement-driven outcomes and outcome-driven engagement.

A significant association was also observed between weight loss and semaglutide orders. Patients who received fewer than 12 orders achieved a significantly lower weight loss percentage than those who received 12 or more orders.

Study significance

According to the findings, 23.05 % of Juniper U.K. patients met the study’s full efficacy estimand criteria, which corresponded to an average weight loss of 15.67 % over a period of 12 months. However, when adherence was defined specifically by medication schedule alone, approximately 33.9 % of patients received between eight and 15 semaglutide orders, indicating broader, reasonable adherence than suggested by the stricter efficacy definition. Significant differences in weight loss outcomes were observed among patients with reasonable adherence as compared to those with limited adherence, thus emphasizing the importance of adherence and attrition in real-world digital obesity care.

Achieving optimal effectiveness with pharmacological interventions may be limited by long-term program retention and the various financial or behavioral barriers associated with unsubsidized services. As an observational study relying on self-reported weight data and medication order frequency as a proxy for adherence, the findings may be influenced by selection bias and unmeasured confounding.

Future studies are needed to explore the effect of program engagement tools like trackers on weight loss, along with the association between program cost and patient adherence.

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