Aims. Semaglutide is widely used for weight management, but there is a paucity of data on factors influencing degree of weight loss. We aimed to evaluate effects of clinical characteristics on weight response in Asian adults treated with weekly injectable semaglutide.
Methods. This was a retrospective analysis of electronic medical records of patients started on semaglutide between July 2022 and January 2024 in weight management clinics in Changi General Hospital in Singapore, with ≥ 2 visits at least 3 months apart. Variables were assessed in a multivariate regression model including age, sex and BMI.
Results. 113 patients (mean age 49.7 years, mean BMI 37.2 kg/m2, mean weight 100.0 kg, 44.2% male) completed 3 months (mean 10.8 months, range 3-15) of semaglutide (mean dose 1.00 mg/week, range 0.25-2). Weight reduction at 3 months was 3.8 kg (95% C.I. 3.2, 4.4; p < 0.001), 5.8 kg (95% C.I. 4.9, 6.7; p < 0.001) at 5-7 months, and 6.7 kg (95% C.I. 5.4, 8.0; p < 0.001) at 12-15 months (82 individuals, 72.6%). There were 64 (56.6%) individuals with diabetes (baseline HbA1c 8.4 ± 1.8%), of whom 42 (65.6%) were on sulphonylureas and/or insulin. Metabolic dysfunction-associated steatotic liver disease (MASLD) was present in 75 (66.3%) patients. 62 (54.9%) patients experienced gastrointestinal adverse effects (bloating, nausea/vomiting and/or change in bowel habit). 41 (36.3%) individuals reported increasing physical activity to ≥ 150 minutes/week. Diabetes, MASLD and the use of sulphonylureas and insulin were associated with less weight loss. Gastrointestinal effects and physical acitivity were associated with greater weight reduction.
Conclusion. Real-world weight loss with semaglutide up to 2 mg was significant, but lower than in trials1 and in clinical settings2 using 2.4 mg/week. Weight loss with semaglutide may be improved by modification of weight gain-inducing diabetes treatment, and increasing physical activity.