SUN-702 - Baseline Predictors of Real-World Weight Loss Outcomes with Injectable Semaglutide: Cohort Analysis of over 36,000 Individuals

Background: Whilst weight loss outcomes with injectable semaglutide (e.g. Wegovy) are well characterised in randomised trials, emergent evidence suggests that the magnitude of weight loss with GLP-1 receptor agonists may be associated with baseline comorbidities. Understanding factors associated with weight loss outcome variation could inform the development of individualised prediction tools.

Aims &

Methods: We undertook a retrospective open cohort analysis of all adults commencing treatment with injectable semaglutide as part of a UK-based digital weight loss service. To characterise factors associated with weight loss in a real-world setting, we used Cox proportional hazards modelling and mixed modelling. Data extraction occurred in November 2025.

Results: Of the 36,647 adults in the final analysis cohort (mean age 45.76), 7,077 attained 6 months of follow-up on semaglutide (19.31%), and 2,329 attained 12 months of follow-up (6.36%). Women were more likely than men (HR = 1.93, p< 0.001) to attain a total body weight loss of 20% by 12 months. Regarding baseline comorbidities, significant associations were seen between diabetes (HR = 0.71, p< 0.001), high cholesterol (HR = 0.76, p< 0.001), hypertension (HR = 0.76, p< 0.001) and sleep apnoea (HR = 0.62, p< 0.001) and the likelihood of attaining 20% total weight loss at 12 months (non-significant associations were observed for MAFLD and asthma). On multivariate mixed models examining trajectories over 12 months, variables significantly associated (p < 0.01) with lower % weight loss on semaglutide included: those who reported prior challenges with weight consistency, erectile dysfunction, polycystic ovary syndrome, sleep apnoea.

Interpretation &

Discussion: In this large real-world study, we identified numerous baseline factors (motivational and clinical) that could ‘pattern’ individuals’ weight loss trajectories whilst prescribed semaglutide. Notably, factors determining treatment persistence may also influence weight loss magnitude, representing a potential source of bias. Future research should consider integrating these factors into clinical prediction tools to provide individualised estimates of the benefits of semaglutide - these could be beneficial for counselling, expectation/goal setting and treatment decisions.

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