Obesity App May Enable Weight Loss With Less Semaglutide

Medscape

15-05-2025

MÁLAGA, Spain — An online obesity clinic named Embla was associated with weight loss like that seen in randomized controlled trials (RCTs) of semaglutide, but with less than half of the semaglutide dose, according to new real-world data.
Average weight loss reached 16.7% after 64 weeks' use of the digital health platform, which combines tailored semaglutide dosing with intensive behavioral therapy delivered via an app. In clinical trials of semaglutide, the dose was 2.4 mg/wk, but patients in the present study used an average of 1 mg/wk. Similar mean weight loss was observed across baseline body mass index (BMI) classes and with all medication doses.
'This [study] showed us that combining an intensive behavioral intervention within an e-health weight management clinic can reproduce some of the results we see in confirmatory trials but in the context of a real-world cohort and with far less medication used,' said lead researcher Henrik Gudbergsen, MD, chief medical officer at Embla and general practitioner.
'The intensive behavioral therapy is key, and it goes a long way when you want to lose weight,' Gudbergsen added. He presented the findings at European Congress on Obesity (ECO) 2025. Publication of the study in The Lancet Digital Health is pending, but a preprint version is available.
App Plus Semaglutide
Real-world data on semaglutide use in digital weight-loss interventions remain limited. Studies in this setting often show less weight loss than in RCTs of semaglutide and rarely report the details of lifestyle interventions or dosing patterns, said Gudbergsen. Real-world data also suggest that few patients follow the dose titration used in clinical trials, and most stay on lower doses than the standard 2.4-mg once-weekly dose, he added.
This study of the Embla platform evaluated the effects of combining video and chat-based coaching with diet, exercise, and psychological support using cognitive-behavioral therapy and acceptance and commitment therapy. Embla users interact with a multidisciplinary team, including doctors, nurses, and psychologists. The artificial intelligence–powered app also tracks weight, medication, physical activity, and patient-reported outcomes.
Semaglutide was prescribed to participants using a personalized, treat-to-target approach, titrated based on tolerability. The primary endpoint was percentage weight change at 64 weeks. The average weekly semaglutide dose was a key secondary outcome.
A total of 2694 participants with a BMI ≥ 27 were enrolled. At 64 weeks, 465 participants remained in the study. 'Although this is a large dropout [rate] after 1 year in more conventional RCT terms, it is actually very good for a real-world intervention,' Gudbergsen said in response to an audience comment by practitioner and semaglutide drug trialist Donna Ryan, MD, professor emerita at Pennington Biomedical Research Center in Baton Rouge, Louisiana.
Behavioral Therapy
Mean weight loss after 64 weeks was 16.7% (95% CI, 17.4%-16.0%) with an average semaglutide dose of 1.02 mg/wk (SD, 0.56). Women had 17.6% (95% CI, 18.4%-16.9%) and men had 13.4% (95% CI, 14.3%-12.5%) weight loss.
The app captured engagement metrics, and Gudbergsen noted that women tended to interact with it more frequently. 'We do see a higher engagement among women and a tendency for women to engage more in communities. This might explain some of the differences between the cohorts,' he pointed out.
Weight loss was approximately similar across baseline BMI categories for the first 6 months. Participants with a BMI of 27-29.9 lost 10.8% (95% CI, 12.7%-8.8%), those with a BMI of 30-34.9 lost 15.9% (95% CI, 16.6%-15.1%), those with a BMI of 35-39.9 lost 17.5% (95% CI, 18.2%-16.7%), and those with a BMI of ≥ 40 lost 17.2% (95% CI, 18.2%-16.2%). 'Then there's a split, with people with a baseline BMI between 27 and 30 losing slightly less than those with a BMI above 30,' said Gudbergsen.
Weight-loss outcomes remained consistent across semaglutide dose levels. For a dose of 0.25 mg/wk, weight loss was 17.3% (95% CI, 18.5%-16.0%); for 0.5 mg/wk, 17.3% (95% CI, 18.4%-16.2%); for 0.75 mg/wk, 18.1% (95% CI, 19.4%-16.7%); and for 1 mg/wk, 17.6% (95% CI, 18.6%-16.5%).
Weight loss of at least 5% and 10% was achieved by 98% and 82% of participants, respectively, over the 64 weeks. About 29% of participants who reached 64 weeks titrated above the 1-mg semaglutide dose.
When asked about adverse event reporting, Gudbergsen responded, 'There's spontaneous reporting, but in addition, the healthcare professionals ask patients if they've experienced adverse events.'
According to the preprint, depending on the severity of the adverse event report, the participant could either be 'maintained at current dose, reduced to a dose in between standard doses, reduced to the previous titration dose, or terminated until the adverse event was properly handled.'
Support Is Key
Commenting on the study for Medscape Medical News , Jason Halford, PhD, head of the School of Psychology at the University of Leeds, Leeds, England, and past president of the European Association for the Study of Obesity, said, 'It shows an important element of weight management: That is, the support.
'If you've got an app, and there's somebody to provide help with behavioral challenges through interacting with the app, then that's providing the support we need,' Halford added.
'These drugs are not meant to be given on their own. This [study] shows the benefit of additional obesity support mechanisms or tools we can bring to bear,' he said. 'Not only do we find people lose similar amounts of weight on a lower amount of drug, but it might also protect them when they come off the drug because there's lasting change. If you don't get the behavior change in while you're on the drug, once the drug is not there helping you, you're set up for failure.'
Embla costs users €150 per month to start, while patients can shift to a maintenance program once appropriate.