Why adherence determines weight loss success with semaglutide

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

Study: Patient outcomes under varying patterns of adherence to real-life lifestyle-supported pharmacologic weight loss therapy. Image credit: Kokosha Yuliya / Shutterstock.com

A recent study published in Obesity examines how the effectiveness of weight loss medications may depend on patient adherence to the treatment protocol in non-subsidized pharmacological lifestyle-supported digital weight loss services.

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

Overweight and obesity are chronic metabolic diseases characterized by excessive accumulation of fat throughout the body. The prevalence of both overweight and obesity continues to rise worldwide, with 64% of adults living 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) such as semaglutide mimic the effects of the hormone GLP-1 to increase insulin secretion, regulate appetite, and delay gastric emptying, which promote weight loss. Global health agencies such as the World Health Organization (WHO) and the UK National Institute for Health and Care Excellence (NICE) recommend prescribing GLP-1 RAs alongside 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 method for improving weight management. These services allow patients to conveniently discuss their overweight or obesity-related complications with health and fitness professionals in digital environments.

Some digital weight loss services align with recommended guidelines for combining pharmacology with behavioral therapy. Early evidence shows that these services can provide safe and effective care. However, their effectiveness in real-world unsubsidized digital services remains unclear.

In the current study, researchers investigate efficacy and adherence patterns associated with digital weight loss service Juniper Health, a large provider operating in the UK, Australia, Germany and Japan.

Assessing adherence and treatment efficacy in a real-world digital weight loss program

The study included data from 7,279 patients who started the Juniper UK digital weight loss service between January 2023 and May 2024. All patients were given semaglutide by Juniper clinicians following recommended guidelines.

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

The ideal situation included patients who received between eight and 15 orders of medication, submitted weight data within a predetermined window of 341–379 days after starting the program, and did not discontinue treatment for more than 90 days. The actual situation included all patients from the ideal situation and those who showed limited adherence, with missing 12-month weight values ​​conservatively imputed using a baseline carried-over observation approach.

Adherence leads to clinically significant weight loss

A mean weight loss of 15.67 % was reported within 12 months after initiation of treatment in patients with ideal compliance. In this setting, a significant proportion of patients achieved clinically significant weight loss, with 53.69% of patients achieving greater than 15% weight loss. In real-world conditions, patients achieved an average weight loss of 7.88%, with an average weight loss of 5.9%.

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

Comparison of data from patients under ideal compliance and real-world conditions revealed that a significantly higher proportion of patients in ideal compliance conditions achieved clinically significant weight loss compared to those in real-world conditions.

Older age at visit and male gender were significantly associated with lower weight loss. Among ethnic groups, the rate of weight loss was significantly lower in Asian patients compared with white or Caucasian patients.

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

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

Importance of study

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

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

Future studies are needed to investigate the effect of program engagement tools such as trackers on weight loss, along with the association between program costs and patient compliance.

Download your PDF copy now!