Semaglutide weight loss reduced by diabetes, older age, and Hispanic ethnicity in real-world obesity patients
Background
While semaglutide 2.4 mg has demonstrated robust weight loss efficacy in controlled clinical trials for obesity, real-world data, especially concerning clinically complex and underrepresented populations, remains limited. Current standard-of-care often overlooks how demographic and clinical factors might influence treatment outcomes, leading to a gap in personalized expectations and strategies. This study addresses this by identifying specific patient characteristics that predict poorer weight loss responses to semaglutide in a diverse, real-world clinic setting, providing crucial insights beyond trial populations.
Study Design
Researchers conducted a retrospective cohort study on 163 patients with a BMI >25 kg/m2 receiving weekly injectable semaglutide for at least 12 months at a multidisciplinary obesity clinic. The primary outcome measured was percent total weight loss (%TWL) after 12 months. Secondary outcomes included the percentage of patients achieving >5% TWL and the impact of factors like gastrointestinal side effects (GI SE), achieved dosing, and provider visit frequency. Patients were identified from a pool of 294 prescribed semaglutide, with 55.4% continuing for the full 12 months.
Results
After 12 months of weekly semaglutide, the mean weight loss achieved was 8.1 kg (± 18.5 kg), corresponding to 8.1% (± 8.3%) total weight loss. Univariable analysis revealed several significant predictors of reduced weight loss: patient-identified Hispanic ethnicity (95% CI -6.82, -0.55, p=0.02), a history of type 2 diabetes (95% CI 0.74, 5.76, p=0.01), and age >60 years (95% CI -14.76, -2.41, p=0.007). Interestingly, the development of GI SE (95% CI 1.86, 3.36, p=0.57) and the number of provider visits (95% CI 0.15, 0.28, p=0.56) were not associated with weight loss outcomes. > On multi-variable regression, patient-identified Hispanic ethnicity was independently associated with a significantly lower likelihood of achieving 5% TWL (OR 0.32, 95% CI 0.14-0.74).
Key Findings
- Mean weight loss with semaglutide was 8.1 kg (8.1% TWL) after 12 months in a real-world cohort.
- Hispanic ethnicity was associated with reduced weight loss (p=0.02) and independently predicted failure to achieve 5% TWL (OR 0.32).
- History of type 2 diabetes was linked to reduced weight loss (p=0.01).
- Age >60 years was associated with significantly reduced weight loss (p=0.007).
- Gastrointestinal side effects and provider visit frequency did not correlate with weight loss outcomes.
Why It Matters
This study highlights that demographic and clinical factors significantly influence semaglutide's real-world weight loss efficacy, necessitating personalized treatment expectations. For clinicians and individuals using semaglutide, this means that patients with type 2 diabetes, those over 60 years old, or of Hispanic ethnicity may experience less pronounced weight loss compared to other groups. This insight could inform more tailored counseling, potentially suggesting the need for longer treatment durations, higher doses (if tolerated and indicated), or adjunctive therapies for these populations to achieve desired outcomes. It underscores the importance of considering individual patient profiles beyond just BMI when prescribing GLP-1R agonists for weight management.
semaglutide
obesity
type-2-diabetes
real-world-data
cohort-study
weight-loss