Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study.

Tournayre S, Bonnet JB, Anitcheou J, Faivre M, Boegner C, Jalek A, Jullien D, Le Rouzic C, Attalin V, Myzia J, Kemba Y, Sultan A, Avignon A

Journal of medical Internet research26 Aug 2026

PMID42684246PMCIDPMC13515347DOI10.2196/80119PepBankPUB-42684246

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Summary

BackgroundReal-world persistence with antiobesity pharmacotherapy is suboptimal: only 32% to 50% of patients persist with glucagon-like peptide-1 receptor agonists at 12 months, and fewer than 15% reach the 2.4 mg/week target dose. Digital platforms may support engagement, but their role remains poorly characterized.ObjectiveThis study aimed to evaluate whether baseline engagement with a structured digital assessment platform (Aviitam) predicts 48-week persistence and mediates weight-loss outcomes in adults with severe obesity initiating semaglutide 2.4 mg/week and to identify clinical and behavioral predictors of pharmacological response.MethodsIn this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled. Baseline engagement with the Aviitam digital assessment platform was operationalized as a 3-level ordinal variable (never used, partial use, and full completion of validated questionnaires), reflecting the patient's responses to a nonenforced preclinical request. The primary outcome was 48-week persistence; secondary outcomes were full-dose attainment, percentage weight change, and dose-response. Adjusted logistic and linear regressions estimated the engagement-persistence and engagement-weight-loss associations. A Baron-Kenny mediation analysis with bootstrap CIs decomposed the engagement-weight-loss association. Missing 48-week weights were imputed using multiple imputation (m=20) as a sensitivity analysis. Among persistent participants who completed all 7 baseline questionnaires (n=91), behavioral-scale associations with weight change were analyzed using Benjamini-Hochberg false-discovery-rate correction.ResultsOf 191 participants (mean age 51.7, SD 6.8 y; 61/191, 31.9% male; mean BMI 45.7, SD 6.8 kg/m²), 37 (19.4%) had never used the platform, 32 (16.8%) used it partially, and 122 (63.9%) fully completed the questionnaires. At 48 weeks, 142 (74.3%) remained on semaglutide, and 124 (87.3%) of them reached the 2.4 mg/week dose. Persistence followed a monotonic gradient across engagement levels (22/37, 59.5%; 23/32, 71.9%; 97/122, 79.5%; P=.02), and each engagement increment was associated with higher odds of persistence (adjusted odds ratio 1.62, 95% CI 1.05-2.50; P=.03), unchanged under multiple imputation. Mean weight loss was 11.8% (SD 8.4%) in the full cohort and 14.6% (SD 7.3%) among persistent participants, with a steep dose-response (mean 3.9%, SD 5.8% in discontinuers to mean 15.3%, SD 7.2% at 2.4 mg/week; P<.001). Mediation analysis showed 48-week persistence mediated approximately 69% of the engagement-weight-loss association; the direct effect was nonsignificant. The Intuitive Eating Scale-2 was the only behavioral predictor surviving false-discovery-rate correction (q=0.05).ConclusionsBaseline engagement with a structured digital assessment platform predicts 48-week semaglutide persistence in a graded manner; low-engagement patients can be identified at initiation and supported with targeted strategies to maintain persistence and achieve full-dose titration.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study7

5 results from studies that gave the peptide. 5 results from people.

01HumanObservational studyEfficacy outcome
In adults with severe obesity starting semaglutide 2.4 mg/week, 74.3% remained on semaglutide at 48 weeks.
In plain wordsIn adults with severe obesity, about three in four were still taking semaglutide after 48 weeks.
Peptide
Semaglutide
Outcome
Not applicable48-week persistence on semaglutide
Study
n = 191
Analysis
Primary
Outcome group
Treatment adherence and retention · Metabolic and weight
Studied dose
2.4 mg/week · 48 weeksAs given in this study (human).
Measurements
Persistence
74.3%
48 weeks
Source sentences
Summary
At 48 weeks, 142 (74.3%) remained on semaglutide, and 124 (87.3%) of them reached the 2.4 mg/week dose.
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
Show in the study text Report a problemFND-4268424601
02HumanObservational studyEfficacy outcome
In adults with severe obesity, mean weight loss with semaglutide was 11.8% in the full cohort.
In plain wordsIn adults with severe obesity, semaglutide was linked to an average weight loss of 11.8% over 48 weeks.
Peptide
Semaglutide
Outcome
DecreasePercentage weight change at 48 weeks, full cohort
Study
n = 191
Analysis
Secondary
Outcome group
Body weight · Metabolic and weight
Studied dose
2.4 mg/week · 48 weeksAs given in this study (human).
Measurements
Weight loss
11.8%
full cohort
Source sentences
Summary
Mean weight loss was 11.8% (SD 8.4%) in the full cohort
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
Show in the study text Report a problemFND-4268424603
03HumanObservational studyEfficacy outcome
In adults with severe obesity still on semaglutide at 48 weeks, 87.3% reached the 2.4 mg/week dose.
In plain wordsAmong adults with severe obesity still taking semaglutide at 48 weeks, most reached the full 2.4 mg weekly dose.
Peptide
Semaglutide
Outcome
Not applicableAttainment of the 2.4 mg/week dose among persistent participants
Study
n = 142
Analysis
Secondary
Outcome group
Treatment adherence and retention · Metabolic and weight
Studied dose
2.4 mg/week · 48 weeksAs given in this study (human).
Measurements
Full-dose attainment
87.3%
persistent participants
Source sentences
Summary
At 48 weeks, 142 (74.3%) remained on semaglutide, and 124 (87.3%) of them reached the 2.4 mg/week dose.
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
Show in the study text Report a problemFND-4268424602
04HumanObservational studyEfficacy outcome
In adults with severe obesity who persisted on semaglutide, mean weight loss was 14.6%.
In plain wordsIn adults with severe obesity who kept taking semaglutide, the average weight loss was 14.6%.
Peptide
Semaglutide
Outcome
DecreasePercentage weight change at 48 weeks, persistent participants
Study
n = 142
Analysis
Secondary
Outcome group
Body weight · Metabolic and weight
Studied dose
2.4 mg/week · 48 weeksAs given in this study (human).
Measurements
Weight loss
14.6%
persistent participants
Source sentences
Summary
14.6% (SD 7.3%) among persistent participants, with a steep dose-response (mean 3.9%, SD 5.8% in discontinuers to mean 15.3%, SD 7.2% at 2.4 mg/week; P<.001).
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
Show in the study text Report a problemFND-4268424604
05HumanObservational studyEfficacy outcome
In adults with severe obesity, weight loss rose with the semaglutide dose reached, from a mean 3.9% in discontinuers to a mean 15.3% at 2.4 mg/week.
In plain wordsIn adults with severe obesity, those who reached the full semaglutide dose lost more weight than those who stopped.
Peptide
Semaglutide
Outcome
DecreaseDose-response of weight loss
Study
n: not reported in source
Analysis
Secondary
Outcome group
Body weight · Metabolic and weight
Studied dose
2.4 mg/week · 48 weeksAs given in this study (human).
Measurements
Weight loss
3.9%
discontinuers
Weight loss
15.3%
2.4 mg/week
Source sentences
Summary
with a steep dose-response (mean 3.9%, SD 5.8% in discontinuers to mean 15.3%, SD 7.2% at 2.4 mg/week; P<.001).
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
Show in the study text Report a problemFND-4268424605

Studies that did not test the peptide alone2

In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. These results are not evidence about taking Semaglutide.

06HumanNot a test of Semaglutide aloneObservational studyOther
In adults starting semaglutide, higher baseline engagement with a digital platform was associated with higher odds of 48-week persistence.
In plain wordsIn adults starting semaglutide, using a digital platform more at the start was linked to a higher chance of staying on treatment.
Peptide
Semaglutide
Outcome
IncreaseDigital engagement and persistence
Study
n = 191
Analysis
Primary
Outcome group
Treatment adherence and retention · Metabolic and weight
Measurements
Adjusted odds ratio
1.62
per engagement level
Source sentences
Summary
each engagement increment was associated with higher odds of persistence (adjusted odds ratio 1.62, 95% CI 1.05-2.50; P=.03), unchanged under multiple imputation.
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Show in the study text Report a problemFND-4268424606
07HumanNot a test of Semaglutide aloneObservational studyOther
In adults starting semaglutide, 48-week persistence mediated about 69% of the association between digital engagement and weight loss.
In plain wordsIn adults starting semaglutide, staying on treatment explained most of the link between digital platform use and weight loss.
Peptide
Semaglutide
Outcome
Not applicablePersistence as mediator of engagement and weight loss
Study
n = 191
Outcome group
Treatment adherence and retention · Metabolic and weight
Measurements
Mediated share
≈ 69%
persistence
Source sentences
Summary
Mediation analysis showed 48-week persistence mediated approximately 69% of the engagement-weight-loss association; the direct effect was nonsignificant.
1 context sentence(design, population, supporting numbers)
Summary · context
In this prospective 48-week single-center observational cohort, all consecutive adults (≥18 y) with a BMI ≥40 kg/m² initiating semaglutide 2.4 mg/week through the French early-access program were enrolled.
In this study, Semaglutide was a lab tool or a carrier, part of a mix, or the subject of a lab method. This result is not evidence about taking Semaglutide.
Show in the study text Report a problemFND-4268424607

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Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 2Current
11 Oct 2026, 00:04 UTC
Study results updated
Version 1
9 Oct 2026, 03:06 UTC
First added · source update from Europe PMC

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Terms as the source lists them.

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