1. In this study, treatment with semaglutide at any of the 5 doses approved for long-term weight management led to significant weight loss at 3 and 6 months after medication initiation.

2. Furthermore, higher doses of semaglutide led to greater weight reduction compared to lower doses.

Evidence Rating Level: 2 (Good)

Obesity is a highly prevalent and costly medical condition. Therefore, multiple weight loss interventions raging from lifestyle and behavioral changes to medication and surgical procedures have been developed and trialed in the past decades. Semaglutide is a glucagon-like peptide-1 receptor agonist originally approved to treat type 2 diabetes and recently approved for long-term weight management. However, there have been few studies assessing the relative effectiveness of semaglutide at the different doses approved for treating obesity.

This was a single-site retrospective cohort study based in the Mayo Clinic Health System that included 175 patients (75.4% female) with body mass index (BMI) of 27 or more. Patients were prescribed weekly semaglutide at doses of 0.25, 0.5, 1, 1.7, or 2.4 mg. Patients with a history of weight loss surgery or taking other anti-obesity medications were excluded. The primary outcome was percentage weight loss at 3 and 6 months after starting semaglutide, with further analysis stratified by patients with or without type 2 diabetes.

Results demonstrated that at 3 months, patients had a mean weight loss of 5.9%. Only 102 patients had follow-up at 6 months, with mean weight loss of 10.9%. At 6 months, 87.3% of patients achieved weight loss of 5% or more. Patients receiving higher approved doses (1.7 and 2.4mg) had more significant weight loss compared to patients receiving lower doses (0.25, 0.5, and 1mg) at 3 months (6.9% compared with 5.1%) and 6 months (12.1% compared with 9.2%). Lastly, patients with type 2 diabetes had less weight loss compared to those without at 3 months (2.9% vs 6.3%) and 6 months (7.2% vs 11.8%). However, this study was limited by potential unmeasured confounders such as other interventions provided by the weight loss clinic as well as lack of generalizability given the patient population was mainly White females. Nonetheless, these results suggest that for patients with obesity, semaglutide may be effective in weight loss across the range of approved doses.

Click to read the study in JAMA Network Open

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