Weight loss drugs such as Ozempic, Wegovy and Saxenda can help some people lose more weight than others, and a new study has revealed some key factors that might impact success.
"In patients with obesity who were prescribed semaglutide or liraglutide, we found that long-term weight reduction varied significantly based on the medication's active agent, treatment indication, dosage and persistence with the medication," said Hamlet Gasoyan, lead author of the study, in a statement.
"Our findings could help inform patients and providers regarding some of the key factors that are associated with the probability of achieving sustained weight loss of a magnitude large enough to provide clinically significant health benefits."
Glucagon-like peptide-1 receptor agonists (GLP-1 agonists) are medications prescribed for type 2 diabetes and obesity that mimic a fullness hormone to help people manage their blood sugars and lose weight.
Many GLP-1 agonists use semaglutide as their active ingredient—such as Ozempic and Wegovy—but it's not the only one; this study also looked at liraglutide, the active ingredient in Saxenda and Victoza, which are also GLP-1 agonists.
"Our findings...identify key characteristics that could inform the probability of achieving sustained weight loss of a magnitude large enough to provide clinically significant health benefits," Gasoyan told Newsweek.
"Recently, injectable forms of GLP-1 RA medications such as semaglutide have been more commonly prescribed, in part related to their ability to demonstrate clinically significant weight reduction."
He said that demand had "skyrocketed" as a result, but that patients "may be unaware of how several key factors including their persistence with the medication and type 2 diabetes as treatment indication, among others, might impact the long-term weight loss."
"Patients have high expectations to achieve substantial weight reductions with these medications," he continued. "Our real-world findings suggest that this was not the case for most patients in our cohort.
"However, those who persisted with the medication experienced weight losses comparable to those shown in corresponding clinical trials."
Obesity is a chronic disease that affects more than 41 percent of the U.S. adult population, according to the Centers for Disease Control and Prevention (CDC).
Studies show that these GLP-1 agonists can be remarkably effective for weight loss, with clinical trials demonstrating that some patients lose up to 15 percent of their body weight over two years.
But not everyone who takes GLP-1 agonists achieve similar results, and scientists at Cleveland Clinic, Ohio, have investigated reasons why some people might lose more weight than others.
They found that the patients who lost the most weight on GLP-1 agonist medication after one year were females who were prescribed semaglutide at a high dose to treat obesity.
Semaglutide (Ozempic and Wegovy) was found to be more effective than liraglutide (Saxenda and Victoza): overall, participants who took semaglutide lost 5.1 percent of their body weight, compared with just 2.2 percent among those taking liraglutide.
Higher doses brought more weight loss too. On average, those on a high dose lost 6.6 percent of their body weight versus 3.5 percent on a low dose.
Similar results were seen if participants were prescribed GLP-1 agonist medication for obesity rather than diabetes: 5.9 percent versus 3.2 percent of body weight lost.
This result might be because GLP-1 agonists are generally prescribed at higher doses when treating obesity. Wegovy, prescribed for obesity, is double the dose of semaglutide compared with Ozempic, prescribed for diabetes, for instance.
The scientists also found that patients who persisted with their medication achieved better results. Those who were consistent with their medication over at least 275 days lost an average of 5.5 percent of their body weight, compared with 1.8 percent among those whose medication covered less than 90 days.
For the 40.7 percent of patients who persisted with their medication for a full year, those taking semaglutide for obesity lost an average of 12.9 percent of their body weight. If they were taking semaglutide for type 2 diabetes, this number dropped to 5.9 percent; with liraglutide for obesity, they lost 5.6 percent; and liraglutide for type 2 diabetes delivered just 3.1 percent of body weight loss.
"Our study also underlines the current challenges with treating type 2 diabetes and obesity with these highly effective medications, as only 4 in 10 patients in our cohort had persistent medication coverage at one year," Gasoyan told Newsweek.
"Our future work will focus on identifying the reasons for the medication discontinuation."
"Having real-world data could help manage expectations regarding weight reduction with GLP-1 RA medications and reinforce that persistence is key to achieve meaningful results," he said in a statement.
The Cleveland Clinic scientists also investigated the factors that helped some patients lose at least 10 percent of their body weight, explaining that studies have shown clinically significant benefits from people with obesity losing this amount of weight.
Among those patients taking semaglutide for obesity, 37.4 percent managed to lose at least 10 percent of their body weight after a year, and 16.6 percent of patients taking semaglutide for type 2 diabetes did so too.
For the liraglutide cohort, 14.5 percent of patients treating obesity lost at least 10 percent of their weight, and 9.3 percent for type 2 diabetes.
The results were comparable if participants persisted with their medication for one year after their initial prescriptions. Among those prescribed semaglutide for obesity, 61 percent lost at least 10 percent of their body weight; and this number went down to 23.1 percent if they were prescribed semaglutide for type 2 diabetes, 28.6 percent on liraglutide for obesity, and 12.3 percent on liraglutide for type 2 diabetes.
This was a retrospective cohort study involving 3,389 adult patients with obesity, 82.2 percent of whom also had type 2 diabetes, who began treatment with injectable semaglutide or liraglutide between July 2015 and June 2022. The study follow-up ended in July 2023.
Out of all the study participants, 39.6 percent were prescribed semaglutide for type 2 diabetes, 42.6 percent were prescribed liraglutide for type 2 diabetes, 11.1 percent were prescribed semaglutide for obesity, and 6.7 percent were prescribed liraglutide for obesity.
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Reference
Gasoyan, H., Pfoh, E. R., Schulte, R., Le, P., Butsch, W. S., Rothberg, M. B. (2024). One-Year Weight Reduction With Semaglutide or Liraglutide in Clinical Practice. JAMA Network Open, 7(9). https://doi.org/10.1001/jamanetworkopen.2024.33326
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