Studies with greater sample sizes and longer periods of follow-up are further needed to support the effectiveness of semaglutide. Finally, using the EMR database might have increased susceptibility to coding errors and missing data during the data extraction phase. Moreover, some of the abstracted weights were self-reported, which might be not as accurate as clinic measurements (noncalibrated vs calibrated scales). This study has some strengths, including an adequate sample size at 3 and 6 months of follow-up. People taking orlistat typically lose 5-10 pounds in six months. But it causes a range of digestive side effects, including stomach pain and oily stools. Side effects include nausea, constipation, headaches, vomiting, dizziness and insomnia. A review of several studies shows you can lose up to 20 pounds with bupropion-naltrexone. The most common side effects include dry mouth, constipation and an uncomfortable tingling sensation. Dr. Chao reports grants from WW International Co and Eli Lilly and Co, outside the submitted work. However, the use of an injectable can be a barrier to initiation and adherence due to concerns about self-administering a medication, convenience, and social acceptance. More gradual titration of semaglutide or down-titrating insulin could help mitigate rapid decreases in glucose concentrations and reduce the risk of diabetic retinopathy worsening, though further research is needed. Adverse events are primarily derived from randomized clinical trials that occur under a wide variety of conditions and with different inclusion and exclusion criteria. Patients should be monitored for depression, suicidal thoughts and behavior, and mood changes, and those who experience suicidal thoughts or behavior should discontinue semaglutide. Individuals were started on semaglutide in the time period between November 2021 and November 2022, with no more patients initiated on semaglutide afterward due to its supply shortages. Despite the wealth of high-quality evidence, there is a paucity of real-life data limited to one cohort study . These promising results suggest that a variety of novel pharmacotherapies will become available in the next few years, revolutionizing the treatment of obesity . This indication followed its initial approval for the treatment of type 2 diabetes mellitus (DM) in 2017. The worldwide obesity prevalence, defined by body mass index (BMI) ≥30 kg m−2, has nearly tripled since 1975 (ref. 1). NIH study finds extreme obesity may shorten life expectancy up to 14 years Press release. Many individuals affected by excess weight and obesity do not have access to specialized care. Among 25 individuals who completed six-month semaglutide treatment, 16 patients received 1 mg, and the remaining nine individuals received 2 mg semaglutide dose. The thresholds of losing 5% (5.6 kg) or more, 10% (11.2 kg) or more, and 15% (16.8 kg) or more of the baseline body weight were reached in 88% (22 participants), 68% (17 participants), and 32% (eight participants), respectively. Out of 40 patients, 28 (70%) and eight (20%) patients achieved greater than 5% (5.6 kg) and 10% (11.2 kg) weight loss, respectively, as illustrated in Figure 1. This includes addressing underlying issues like hormonal imbalances, metabolic disorders, or unhealthy eating habits that may contribute to weight gain. The battle against overweight and obesity is a challenge faced by millions of people worldwide. They will also be able to help identify and treat medical barriers that may prevent you from losing weight as well as you could. They’ll need to monitor your weight loss and make sure it’s still safe for you to take the medication. You should only use weight loss drugs if you plan on keeping regular checkups with your healthcare provider. Most people lose around 5% of their body weight after three to six months. Most adults can expect to lose between 3% to 12% of their starting body weight after one year. Talk to your healthcare provider before buying weight loss supplements on your own. Ask about safe and effective ways to lose weight NIDDK translates and disseminates research findings to increase knowledge and understanding about health and disease among patients, health professionals, and the public. Ufholz, K. Peer support groups for weight loss. Association between objectively measured sleep duration, adiposity, and weight loss history. The role of the chronic use of lower maintenance semaglutide doses in clinical practice, especially in individuals with great initial response or persistent gastrointestinal side effects, remains unclear and needs to be explored further. Out of 40 participants, 26 individuals (65%) reported adverse events, including 55% experiencing gastrointestinal side effects, with the most frequent being nausea, constipation, abdominal pain, diarrhea, and dyspeptic symptoms, as illustrated in Table 2. Patients with psychiatric disorders were overrepresented in the non-responders group, with four out of nine patients (44.4%) not showing favorable responses to semaglutide therapy. The total response rate was 72.5% (29 out of 40 individuals), using a cutoff of achieving a minimum 5% weight reduction within a three-month period to define clinically relevant weight loss. A series of randomized controlled trials (RCTs) have consistently demonstrated the great efficacy of semaglutide for weight management 7-12.Medical weight loss programs work by focusing on a personalized, multi-faceted approach to weight loss.People often lose more on Wegovy than on Ozempic because Wegovy is often prescribed at higher doses.In this article, we will delve into the facts and fiction about Semaglutide therapy in the context of medical weight loss.But these medications have risks and side effects.However, recent research has shown that Semaglutide can also be effective in promoting weight loss in individuals who are overweight or obese.Ask your doctor or pharmacist, as you may need to stop your treatment.We were able to collect long-term weight data on a reasonable proportion of the cohort.To minimize gastrointestinal side effects, it is titrated up starting at 0.25 mg once a week with dose increases every 4 weeks until the full dose of 2.4 mg is reached.Whether a patient is at risk for medical problems due to being overweight, or if it's a personal health goal, then it's my job to provide counseling. To lose weight (and keep it off), it’s important to address your attitudes and emotions related to food. Even if you lose weight, the pounds can return – the process can go on and on. It may seem like you can’t lose weight no matter what you eat and what you do. A medical weight loss program typically begins with a comprehensive evaluation of the patient. These programs approach weight loss holistically, considering medical, nutritional, psychological, and lifestyle factors. Finding a good medical weight loss program may initially seem daunting, but many physicians are able to offer this important service. Important attributes driving patient preferences for particular medications include dose frequency, efficacy, adverse event profiles, and if the medication is provided as an injection, injection preparation, type of device, and needle size.90 Semaglutide is provided as a prefilled, single-dose pen with an integrated needle. Patient preference is an important consideration in providing high-quality obesity treatment. Kidney function should be monitored in patients, especially those with severe gastrointestinal adverse effects as these may result in dehydration. Cardiovascular outcome studies of semaglutide to date have been carried out in high-risk populations to increase the hazard rate for major cardiovascular events, and such patients do appear to benefit from a reduction in adverse cardiovascular events. In this cohort study of 175 patients with overweight or obesity, the total body weight loss percentages achieved were 5.9% at 3 months and 10.9% at 6 months. It is a formal program that gives you ongoing guidance and support to build healthy lifestyle habits that may promote weight loss.2 The program should include These programs combine medical supervision, tailored nutrition plans, and lifestyle guidance for effective weight loss. Your doctor will determine if medications are appropriate based on your health and weight loss goals. Considering the scarcity of AOMs, choosing the most suitable and individualized therapy is important.6 Retrospective studies comparing high doses of semaglutide (ie, 1.7 and 2.4 mg) with other AOMs are limited. These results may support the applicability of semaglutide in a less controlled environment, as previously proven in RCTs.18,19,20 Other adverse effects included dizziness, depression, bloating, dry mouth, and taste change. Nausea and vomiting were the most encountered adverse events (64 patients 36.6%), followed by diarrhea (15 patients 8.6%) and fatigue (11 patients 6.3%). Gastrointestinal symptoms were the most reported adverse effects. In this real-life study, the rate of gastrointestinal side effects was 55%, mostly mild to moderate with only 7.5% of individuals experiencing serious adverse events, compared to a 74%-84% rate for gastrointestinal side effects and 7.9%-9.8% for serious side effects in STEP trials 7,9,10. In total, identifying predictors for the effectiveness of semaglutide is essential in order to optimize therapeutic benefits in the management of obesity. In light of the bidirectional link between psychiatric disease and obesity, the weight outcomes of semaglutide in this context need to be studied . You can report false claims or scams by weight-loss programs to the Federal Trade Commission. Stay away from weight-loss programs that make these types of promises If you’re thinking about joining a virtual weight-loss program, make sure it includes Digital weight-loss programs, also called virtual weight-loss programs, are still being researched. Our evidence-based strategies combine medical knowledge with practical lifestyle changes to encourage sustainable weight loss. A safe weight loss program prioritizes health and sustainability. Although our study lacked the stringent and closely controlled nature of RCTs, we report similar weight loss results within the same time period as in RCTs. Another serious limitation is the exclusion of patients who did not reach 3 months of follow-up, which might have resulted in an overestimation of the association of semaglutide with body weight. In addition, the weight loss data of semaglutide use might be more representative of day-to-day clinical practice, including a more heterogenous patient population, compared with RCTs. Excessive weight loss can lead to the following clinical complications- But after significant weight loss, the following symptoms are observed- The global health burden of obesity and other complications has catalyzed this change. Weight management programs have gained momentum in the recent years. Remember, there is no quick fix for lasting weight loss. In fact, in most SUSTAIN trials, patients on semaglutide reported better overall treatment satisfaction over comparators.27 Comparing other long-acting GLP-1 RAs with semaglutide, namely exenatide ER10 and dulaglutide,24 semaglutide showed superiority in overall weight loss and in the number of participants achieving a weight loss of ≥5%.4 Three of the 13 total trials comprising the SUSTAIN program were not included in this review due to redundancy of the medications’ comparisons.17–19 The most recent literature search was performed in July 2021. Semaglutide not only showed improvement in diabetes and body weight but also lowered the rate of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke in patients with diabetes mellitus type 2 at high risk of cardiovascular disease.16 The primary outcome was the average change in weight (in kilograms) from baseline to follow-up. The study was approved by the Kaiser Foundation Research Institute’s institutional review board. Participants were counseled on exercise methods and goals by the group facilitator, with a focus on increasing daily activity early in the program for the development of this behavior to become a long-term habit. The model, validated in other clinical scenarios,18 was based on providing accurate information and motivation to initiate change, with the premise being that this will lead to acquisition of a self-management skill set that can lead to behavioral change over time. From Weeks 31 to 82, meetings were open to all participants who had completed the first 30 weeks. Despite this unmet clinical need, anti-obesity medications (AOMs) have been underutilized in routine clinical practice, with less than 1.5% of those eligible for pharmacotherapy having received AOMs . In most cases, lifestyle interventions have limited efficacy and durability with the long-term maintenance of weight loss remaining a big challenge . The maintenance semaglutide dose was 1 mg in 16 cases and 2 mg in nine cases, leading to a similar weight loss of 13.6% (14.9 kg) and 12.8% (14 kg), respectively. Whether you’re looking to shed a few pounds or embark on a long-term weight loss journey, it’s crucial to rely on scientifically-backed methods. With countless diet trends, weight loss products, and quick-fix solutions, separating fact from fiction can be overwhelming. Semaglutide therapy can support your weight loss efforts by helping you feel full and satisfied, making it easier to stick to your weight loss plan. The second is to take your time; sustainable weight loss happens slowly but steadily. Future research efforts should not only evaluate the potential synergistic effect of combining semaglutide with other AOMs and different lifestyle interventions but also explore its use as neoadjuvant or adjuvant therapy along with bariatric surgery. Finally, a direct comparison of the weight loss effect between 1 mg and 2 mg maintenance doses was not possible since the titration decision was at the discretion of the treating clinicians, taking into account individual responses to lower doses and drug affordability. Moreover, the lack of a strictly controlled lifestyle intervention in combination with possible differences in individual adherence introduces a potential confounder, since varying responses may be explained by different types and intensities of lifestyle modification in subgroups, rather than different drug effects per se. In the future, the availability of numerous potent AOMs could usher in an era of precision medicine with the application of personalized treatment strategies, based on predictive models, encompassing age, gender, different obesity phenotypes, coexisting complications, genotype, and predictors of response to each treatment modality . In view of the substantial budgetary effects, negotiating the price of new-generation AOMs may be needed to address health inequities across different categories of socioeconomic status, as well as ensure their affordability and equitable patient access. It was left to the discretion of each individual whether they sought regular dietician input, participated in a structured physical activity program, or received behavioral/psychological therapy. All individuals received counselling sessions about nutrition and regular exercise at the time of semaglutide initiation and every 12 weeks thereafter by an endocrinologist, following the principles of motivational interviewing. After the completion of a 12-week semaglutide therapy, a decision for maintenance semaglutide dose was made on a case-by-case basis, taking into account clinical response, as well as drug affordability. Individuals who had undergone bariatric surgery or had taken other AOMs in the past were not excluded, while the concomitant administration of other AOMs during the study period was an exclusion criterion. Myth #6: “Crash Diets Are a Quick Fix for Weight Loss” You’ll receive regular one-on-one support from health care professionals to help you achieve your health goals. If you have questions about this medicine, talk to your doctor, pharmacist, or health care provider. It is important to get rid of the medication as soon as you no longer need it or it is expired. If it is stored at room temperature, get rid of any unused medication after 28 days or after it expires, whichever is first. Ozempic is an injectable medication used to treat type 2 diabetes. There’s also research showing that this medication can help you keep the weight off. This weight loss pill stimulates your nervous system, reduces your appetite and makes you feel full. Most FDA-approved medications are only available by prescription. Furthermore, as BMI exceeds 30 kg m−2, weight loss amounts are more similar for class I, II and III obesity. An interesting observation from this SELECT weight loss data is that when BMI is ≤30 kg m−2, weight loss on a percentage basis is less than that observed across higher classes of BMI severity. Asian individuals would probably benefit from weight loss and medication approaches undertaken at lower BMI levels in the secondary prevention of CVD. Patients in the semaglutide treatment arm of STEP 1 were more likely to be exposed to the medication at the full dose of 2.4 mg than those in SELECT. The weight can come back if you stop the medication.Www.cdc.gov/nchs/data/hestat/obesity-child-17-18/overweight-obesity-child-H.pdf (PDF, 352 KB)There were no clinically substantive changes between the average weights at baseline and follow-up with or without the use of multiple imputation methods (data furnished on request).This is a retrospective review of the medical records of all individuals treated with semaglutide for weight management in an endocrine clinic in Athens, Greece.Our first on-treatment analysis demonstrated that those on-drug lost more weight than those in-trial, confirming the effect of drug exposure.And when you make a healthy weight loss plan, it's important to stick with it.A total of 408 patients with a body mass index (BMI) of 27 or more were prescribed weekly semaglutide subcutaneous injections for 3 months or more.That’s why developing healthy eating and exercise habits should be part of your treatment plan, too. Our study expanded on this and shows the changes in these 3 lipid concentrations during a 5-year period. Mehta et al,35 in their systematic review of 27 trials, described changes in lipid concentrations during a 1-year period. Traditionally, behavior modification sessions have been provided on-site and in groups of 10 to 20 participants. We did not have data on the amount of participant meal replacement used to ascertain the role of long-term partial meal replacement. The overall short-term trends in weight outcomes were similar, but low sample sizes and substantial losses to follow-up rendered comparing long-term outcomes unfeasible. The study also showed that weight loss provides other health benefits, such as better physical mobility and improved blood glucose, blood pressure, and cholesterol levels. Successful weight-loss programs help you set specific goals for adopting healthy lifestyle habits and tracking your progress.2 Successful weight-loss programs promote healthy behaviors that may help you lose weight safely and keep the weight off. IV Therapy! Multiple weight loss interventions have been developed during the past decades. Studies with longer periods of follow-up are needed to evaluate prolonged weight loss outcomes. The study included 175 patients (132 women 75.4%; mean SD age, 49.3 12.5 years; mean SD BMI, 41.3 9.1) in the analysis at 3 months and 102 patients at 6 months. Effect of semaglutide treatment or… They can also affect the signaling between your gut and your brain, ultimately changing how your body responds to food. But semaglutide isn’t simply a tool that suppresses appetite, Dr. Butsch clarifies. Using a medication “off-label” means it’s prescribed for a use other than its stated purpose. Ozempic is the same medication as Wegovy, which the U.S. And doctors are hailing it as a research-backed breakthrough medication that could make a big difference. This review identifies and clarifies the role of several factors that may hinder weight loss after the exploration of existing evidence. A wide degree of interindividual variability in weight loss is common in studies even after controlling for variables such as adherence, sex, physical activity and baseline weight. A scoping review of the literature was performed using weight loss-related search terms such as ‘Obesity,’ ‘Overweight,’ ‘Lifestyle,’ ‘weight loss,’ ‘Basal Metabolism,’ ‘physical activity,’ ‘adherence,’ ‘energy balance,’ ‘Sleep’ and ‘adaptations. Few studies point out that weight loss eventually slows down, stagnates or reverses in 85% of the cases. Clinical trials have demonstrated the effectiveness of Semaglutide in helping patients achieve and maintain weight loss. Sustainable weight loss requires commitment, dedication, and lifestyle changes, such as healthy eating and regular physical activity. Additionally, the long-term health benefits of weight loss can help prevent costly medical conditions down the line. While some weight loss programs may come with a higher price tag, Semaglutide therapy is often covered by insurance plans, making it a more accessible option for those looking to lose weight. Another misconception about medical weight loss is that it is unaffordable for the average person. This is a review paper of already published papers and clinical trials with ethics approval. From the included articles, relevant data were identified and summarized . All authors equally contributed to the data extraction process as discussed in the previous section. To our knowledge, there are no long-term studies of this scale evaluating the effectiveness of a real-world, nonsurgical, nonpharmacologic, behavior-based weight management program that included complete meal replacement at onset conducted either within or outside an integrated health care delivery system. In participants with 5-year data, the average weight loss in approximately half was −5.0% or greater weight loss with a third having, on average, −10% or greater weight loss compared with baseline. Average baseline and percentage change in lipid fractions and statin utilization during follow-up among participants of a weight management program across Kaiser Permanente Northern California Medical Centers. Average baseline and follow-up weights (kg) among participants of a weight management program across Kaiser Permanente Northern California Medical Centers. Flow diagram among participants of a weight management program across Kaiser Permanente (KP) Northern California Medical Centers. At our practice, we develop customized weight loss plans created by experienced nurse practitioners. Semaglutide is a once-weekly injectable medication initially developed for type 2 diabetes. Diet and exercise work synergistically to support weight management. Nutrition myths, like the idea of "superfoods" as singular solutions, oversimplify weight management. Diet alone cannot assure sustainable weight loss. It should also be noted that, as an incretin-based therapy, semaglutide (like other GLP-1 analogs) has a low risk of hypoglycemia. Treatment discontinuation due to GI events ranged from 4.9% to 12% and from 3% to 9.4% during the PIONEER32 35 and the SUSTAIN trials,10 23 respectively. To our knowledge, no previous studies have compared the differences in the efficacy of oral and subcutaneously injectable semaglutide, which should be addressed in future research. Around 60%–93% of the population were white in SUSTAIN 1–10, STEP, and PIONEER 1–8 trials, and about 2%–10% were black or Asian. SUSTAIN 1–10, PIONEER and STEP trials are multicenter, multinational, randomized controlled trials, except PIONEER 9 and 10, conducted in Japan. The Pitfalls of Fad Diets Baseline laboratory values of the weight management program participants are shown in Table 2. The duration of the meal replacement phase was chosen on the basis of prior efficacy and safety data.5,7,15,16 During this active weight loss phase (16 weeks), all participants were prescribed a minimum of 960 kcal/d (6 meal replacements per day). The program was designed to include an initial period of complete meal replacement therapy along with a behaviorally based lifestyle modification curriculum that aimed to enhance weight loss, with the exclusion of pharmacologic agents. That’s where weight loss medications come in. They aren’t as powerful or as well-studied as prescription weight loss medications. Similar observations occurred in another study assessing weight loss and dietary adherence across three popular diets . Vitamin D deficiency does not appear to obstruct meaningful weight loss during lifestyle intervention. Elderly patients will not lose as much weight as younger patients due to aging . Insulin therapy affects weight loss in diabetic individuals, triggering appetite, causing hypoglycemia and increasing body fat . Of 4021 obese nonpregnant adult respondents, 2523 (63%) tried to lose weight in the past year; and of these, 1026 (40%) lost ≥5%, and 510 (20%) lost ≥10% body weight. All respondents who tried to lose weight, regardless of whether they were successful, were shown a list of weight loss strategies and asked which ones they used to attempt weight loss (see Table 3). The current study presents a secondary analysis (performed 2009–2011) of data from the 2001–2006 National Health and Nutrition Examination Survey (NHANES), an ongoing stratified multistage probability sample, representative of non-institutionalized civilians in the U.S., which collects demographic, health, and health behavior information.22 The sample for this analysis included nonpregnant adults aged ≥20 years who were obese (BMI ≥30) 12 months prior to the interview and who completed in-home interviews and self-administered questionnaires. A substantial proportion of obese U.S. adults who attempted to lose weight reported weight loss, at least in the short term. Breast cancer survivors with overweight and obesity have an increased risk of recurrence, however there’s a lack of evidence on the effectiveness of weight loss to reduce risk.43Second, the respective study populations were quite different, with STEP 1 including a younger, healthier population with more women (73.1% of the semaglutide arm in STEP 1 versus 27.7% in SELECT) and higher mean BMI (37.8 kg m−2 versus 33.3 kg m−2, respectively)14,21.In a weight loss maintenance trial with liraglutide 3.0 mg/day, the effect of the medication on increasing heart rate was attenuated when liraglutide was combined with a moderate-to-vigorous-intensity exercise program.77 Encouraging moderate-to-vigorous-intensity exercise combined with semaglutide may help to mitigate increases in heart rate and improve cardiorespiratory fitness, but studies are needed to examine the efficacy of this strategy.Our main analyses, using multiple imputation and repeated-measures regression, were comparable to findings from the intervention arm of the Look AHEAD (Action for Health in Diabetes) study, a large, well-run, randomized clinical trial.34 Our sensitivity analyses further confirmed the findings, showing no substantive variation in the effect sizes.Thanks to my Medical Weight Loss support team, I was achieved my goal weight and maintained it!There were variations in the weight-loss response.A major strength of the current study is that the cohort is one of the largest followed in a behaviorally based MSWMP. The STEP trial examined the effects of 2.4 mg, once-weekly, subcutaneous semaglutide on patients with obesity. Further, a better understanding of the phenotypes of participants who may be well suited for specific medications and of the effects of switching medications among non-responders would enhance our understanding of best practices for patient selection and management. These novel medications will provide patients and providers with additional choices for effective weight management strategies. Thus, doses of other diabetes medications may need to be lowered if initiating semaglutide, and patients should be informed about hypoglycemia risk. As shown in STEP 2, semaglutide at a higher dose of 2.4 mg produces larger weight losses than the 1.0 mg dose approved for type 2 diabetes.39 Special considerations are needed when prescribing semaglutide in patients with type 2 diabetes. Multivariable logistic regression analysis was then used to obtain the predictors of clinically significant weight loss at five years. The comorbidities collected were the presence or absence of prediabetes, type 2 diabetes mellitus, hypertension, hyperlipidemia, liver disease, lung disease, myocardial infarction, congestive heart failure, ischemic stroke, hemorrhagic stroke, atrial fibrillation, sleep apnea, depression, and current tobacco use. Available lipid concentrations were captured using the KPNC electronic health records and the laboratory databases. Participant weights at baseline and follow-up were obtained using standard digital weighing equipment25 and were captured using the KPNC electronic health records. When recommended, this medication may be taken. Do not take this medication without first talking to your care team if you may be or could become pregnant. If you are going to need surgery or a procedure, tell your care team that you are taking this medication. Make sure you stay hydrated while taking this medication. Aim to lose a 1/2 pound to 2 pounds a week. Don’t be taken in by expensive weight-loss fads, such as pills, herbs, or special foods, that promise unbelievable results. Knowing the facts about losing weight can help you separate what works from what doesn’t. Semaglutide works by mimicking a hormone in the body that regulates appetite and food intake, helping you feel full and satisfied with smaller portions. Stay on top of latest health news from Harvard Medical School. PLUS, you'll get the latest news on medical advances and breakthroughs from Harvard Medical School experts, and special offers on content from Harvard Health Publishing. 25 Gut Health Hacks is yours absolutely FREE when you sign up to receive health information from Harvard Medical School. The phenotype of cardiometabolic disease but lower BMI (−2) may be one where reduction of excess abnormal and dysfunctional body fat does not require as much body mass reduction to achieve health improvement. Furthermore, the cardiometabolic benefits of weight loss are driven by reduction in the abnormal ectopic and visceral depots of fat, not by reduction of subcutaneous fat stores in the hips and thighs. Perhaps persons with BMI −2 are closer to their settling point and have less weight to lose to reach it. This plateau has been termed the ‘set point’ or ‘settling point’, a body weight that is in harmony with the genetic and environmental determinants of body weight and adiposity31. Although the data set is rich in numbers and diversity, it does not have the numbers of individuals in racial subgroups that may have revealed potential differential effects. Experts recommend an initial weight-loss goal of 5% to 10% of your starting weight within 6 months.2 For example, if you weigh 200 pounds, your goal may be to lose about 10 pounds in the first 6 months. Check for these features in any weight-loss program you are thinking about trying. Overweight and obesity may also be treated with weight-loss medicines and weight-loss surgery, also called metabolic and bariatric surgery. Stephanie Baldeweg Numerous studies have found benefits of modest weight loss for people with established T2D.Data provided is from Optum Medical Weight Loss program participation from January to December 2024.In the world of weight loss, it's easy to get entangled in a web of myths and misconceptions.It’s important to note that while medications like semaglutide and tirzepatide have been proven effective, GLP-1s can be expensive due to the lack of insurance coverage.Just being aware of your food in this way may help you lose weight -- and make eating more pleasurable to boot.Based on the SUSTAIN clinical trial program data, nausea and vomiting were minimally related to patients’ weight loss.8 The trial cited here also evaluated the primary causes of weight loss in patients taking semaglutide (Ozempic), a relatively new GLP-1 RA currently on the market only as an antidiabetic drug in both injectable and oral tablet forms.Percent initial weight loss at 68 weeks for STEP trials 1–4The medication is typically administered once a week via an injection pen, making it convenient for patients to incorporate into their routine.In conclusion, medical weight loss with Semaglutide is a safe, effective, and personalized option for individuals struggling to lose weight. Remember, sustainable weight loss takes time and dedication, but with the right support and guidance, you can achieve your weight loss goals and improve your overall health and well-being. These programs are overseen by medical professionals who monitor your progress and adjust your treatment plan as needed. ” Then set personalized goals in achievable increments, and introduce lifestyle changes to gradually lose weight and keep it off. Ask yourself, “How much weight do I need to lose to be healthy? If you feel uneasy talking about your weight, practice talking about your concerns before your office visit and bring your questions with you. Losing weight may also improve your quality of life. A number of these programs are advertised on social media, the internet, magazines, and other media. The funders had no role in the design and conduct of the study, nor in the collection, management, analysis, and interpretation of the data, nor in the preparation, review, or approval of the manuscript. Given that weight loss must be maintained to be truly successful, this study is limited by the lack of information about maintenance of weight loss. Although there is likely reporting bias for body weight, this study demonstrates a high correlation between self-reported current body weight and measured body weight. The most-popular strategies employed by obese participants who reported trying to lose weight were eating less, exercising more, eating less fat, and switching to lower-calorie foods. In contrast, only a small proportion used commercial weight loss programs, liquid diets, and prescription weight loss medicines (see Table 3). Caution should be taken when using semaglutide in patients with diabetic retinopathy, and retinal screenings should be performed regularly to detect progression of retinopathy. The increase in heart rate with semaglutide is especially important to consider for patients with heart failure and other cardiac conditions, and the safety of semaglutide in this population is unclear. No increase in QT intervals or adverse cardiac events have been noted.30,76 Heart rate should be monitored in participants taking semaglutide. Just being aware of your food in this way may help you lose weight -- and make eating more pleasurable to boot. You'll also want to develop some of the other habits proven to help weight loss. Or talk with someone you know who’s lost weight in a healthy way. You might also want to join a weight loss group where you can talk about how it’s going with people who can relate. So ask your family and friends to support your efforts to lose weight. These drugs can be the answer to years of health challenges for many people. Losing weight isn’t always as simple as eating less and exercising more. Cleveland Clinic is a non-profit academic medical center. Sticking with your new lifestyle habits is key to long-term success. The program should provide3,4,5 The amount and type of activity will depend on your personal health and ability. Ask your health care professional whether you should consider these options. Percent initial weight loss at 68 weeks for STEP trials 1–4 With the recent approval of Wegovy, we could expect improvement in patients’ weight loss-related outcomes and quality of life. Another significant benefit of semaglutide is that it can be used for long-term management of weight. Wegovy (semaglutide) is not only superior at reducing body weight compared with other antidiabetic drugs, but it is also cardioprotective. The three trials from the SUSTAIN clinical trial program—SUSTAIN China multiregional clinical trial, SUSTAIN (Japan), and SUSTAIN (Japan, sitagliptin)—were also excluded due to redundancies in the comparators.17–19 This review also includes superficial comparisons of the findings from the SUSTAIN, PIONEER, and STEP trials, as no studies to date have compared the efficacy of subcutaneous and oral semaglutide. Ongoing BE, more than pre-existing BE, impedes weight loss efforts over four years . Choosing water over calorie-rich drinks can reduce overall energy intake (up to 200 kcal), contributing to weight loss efforts . A study from the National Health and Nutrition Examination Survey (NHANES) reported a significant association between elevated body mass index and inadequate hydration after adjusting for confounders . This can negatively affect weight loss targets during an energy deficit. In another study, women eating more calories at breakfast (50%) than at dinner (14%) lost more weight (5.1 kg difference) and reported better satiety than the other group following opposite meal patterns . Comparing the results presented in both trials, we observe that in the primary placebo-controlled trial from the PIONEER program and SUSTAIN 1, around 40% of participants on semaglutide achieved a weight loss of 5% or more.21 31 Thus, these results could suggest that semaglutide is outperformed by phentermine-topiramate and liraglutide as antiobesity medications. Bariatric surgery is recommended as a treatment option to support weight loss for treatment of T2D.1415 A randomised study of people with obesity and T2D were treated with intensive medical therapy with or without bariatric surgery (Roux-en-Y gastric bypass RYGB or sleeve gastrectomy SG).16 Both types of surgery were superior to intensive medical therapy alone in achieving excellent glycaemic control and reducing the use of glucose-, lipid- and blood pressure-lowering medications after 5 years.16 The beneficial effects of RYGB and SG on glycaemic control appear to be related not only to weight loss but to additional metabolic effects.16 In the SELECT trial, patients did not enroll for the specific purpose of weight loss and received standard of care covering management of CV risk factors, including medical treatment and healthy lifestyle counseling, but without a specific focus on weight loss. These data, representing the longest clinical trial of the effects of semaglutide versus placebo on weight, establish the safety and durability of semaglutide effects on weight loss and maintenance in a geographically and racially diverse population of adult men and women with overweight and obesity but not diabetes. A lower energy intake was considered the key factor responsible for bodyweight reduction.8 The Semaglutide Treatment Effect in People with Obesity (STEP) program is a phase III clinical trial program focused on the approval of semaglutide as a weight loss medication in patients with obesity. Of note, most patients (six out of nine) had depression, two anxiety, and one bipolar disorder, with the use of psychotropic medications, mostly selective serotonin reuptake inhibitors, being recorded at the time of study enrollment in seven individuals. In addition, this study could not assess the impact of maintenance semaglutide dose on patient response since the decision for the titration of semaglutide dose greater than 1 mg was influenced by the magnitude of three-month weight loss, introducing a selection bias. Semaglutide for weight management was prescribed for a total of 43 patients who were overweight or obese, but the analysis included 40 individuals (28 females and 12 males) following the exclusion of three individuals owing to the lack of three-month data. The health benefits of weight loss can vary depending on the individual and the amount of weight lost, often reported as a proportion of body weight.1 Health benefits are seen with low-level weight loss of less than 5% of body weight.12 However, generally more improvements are seen with greater weight loss.Regardless of the type of diet followed, one-year weight loss was greater in most adherent individuals.It was left to the discretion of each individual whether they sought regular dietician input, participated in a structured physical activity program, or received behavioral/psychological therapy.This article clarified misconceptions, highlighted facts, and outlined safe approaches to weight management.During a medical weight loss treatment, your doctor will create a diet plan for weight loss that includes foods lower in calories.The worldwide obesity prevalence, defined by body mass index (BMI) ≥30 kg m−2, has nearly tripled since 1975 (ref. 1).This study reported semaglutide-related percentage weight loss of 6.6% (7.4 kg) and 13.3% (14.9 kg) in three and six months, in line with the mean 6.3% and 11.8% in three and six months, respectively, observed in a similar real-world cohort study in the United States .This study showed the great effectiveness of semaglutide in a real-life setting, leading to a median three-month and six-month weight loss of 6.6% (7.4 kg) and 13.3% (14.9 kg), respectively, with 68% (17 out of 25 individuals) attaining 10% weight loss over six months. Both these factors are studied here about adherence and are identified to be important as either a reinforcer or demotivator for continuing weight loss efforts. Initial weight loss success increases motivation and confidence, which as we have reviewed above, improves adherence and reduces chances of weight loss failure. Lack of adherence also leads to large attrition rates in weight loss studies, often underreported 86, 87. In a study on premenopausal women, subjects who showed higher adherence during past low-calorie diet intervention regained 49.9 ± 8.8% of lost weight in two years follow-up, while the lower adherence tertile showed 96.8 ± 12.8% gain . Regardless of the type of diet followed, one-year weight loss was greater in most adherent individuals. Summary of STEP evidence Your doctor can help give you an estimate for how much weight you can expect to lose. Weight loss is highly variable, as everyone’s body responds differently to treatments. Your BMI is a measurement of your body fat based on your height and weight. If you are not at a healthy weight, even modest weight loss can help improve your blood pressure, cholesterol, and blood sugar levels. Factors, such as medicines, medical conditions, stress, genes, hormones, environment, and age can also affect weight management. Remember, achieving and maintaining a healthy weight is a journey, and Semaglutide therapy can be a valuable tool in your weight loss toolkit. Semaglutide therapy is most effective when combined with a comprehensive weight loss program that includes dietary changes, exercise, and behavioral modifications. Sign up to get tips for living a healthy lifestyle, with ways to lessen digestion problems…keep inflammation under control…learn simple exercises to improve your balance…understand your options for cataract treatment…all delivered to your email box FREE. Patients without type 2 diabetes achieved higher weight loss outcomes than those with type 2 diabetes, which is also shown in our study.19 We included patients who had at least a 3-month follow-up documented in the EMR with a BMI of 27 or more who were prescribed weekly semaglutide subcutaneous injections of 0.25, 0.5, 1, 1.7, and 2.4 mg with the primary goal of weight loss. Secondary end points were the proportion of patients achieving weight loss of 5% or more, 10% or more, 15% or more, and 20% or more after 3 and 6 months and the percentage of weight loss for patients with or without type 2 diabetes after 3 and 6 months. In East Asians, beta cell dysfunction is the primary factor causing type 2 diabetes, while insulin resistance and body fat play a minor role compared with Caucasians. Women accounted for 40%–50% in SUSTAIN 1–10 and PIONEER 1–8 trials, 20%–30% in PIONEER 9 and 10, but the majority of the study population in the STEP trial were women, accounting for around 50%–81%. The safety profile of 2.4 mg semaglutide was found to be similar to 1.0 mg subcutaneous semaglutide and oral semaglutide, with mild to moderate GI symptoms being the predominating complaint among participants (table 6). The trial program was completed in March 2021 with a total of five trials; however, the results are still pending for STEP 5 (table 5). The BMI category change reflects the superior weight loss with semaglutide, which resulted in fewer patients being in the higher BMI categories after 104 weeks. 4, which depicts in-trial patients receiving semaglutide and placebo. A, Categorical weight loss from baseline at week 104 for semaglutide and placebo. These waterfall plots show the variation in weight-loss response that occurs with semaglutide and placebo and show that weight loss is more prominent with semaglutide than placebo. Semaglutide should not be prescribed in patients with a history of suicidal attempts or active suicidal ideation. Pregnancy is a contraindication for use of semaglutide, and semaglutide should be discontinued at least 2 months before a planned pregnancy due to the long half-life. However, the clinical significance of anti-semaglutide antibodies appears to be low in most people. We performed a retrospective review of the electronic medical records (EMRs) of patients in the Mayo Clinic Health System using semaglutide between January 1, 2021, and March 15, 2022. Patients with a history of bariatric procedures, taking other antiobesity medications, and with an active malignant neoplasm were excluded. A total of 408 patients with a body mass index (BMI) of 27 or more were prescribed weekly semaglutide subcutaneous injections for 3 months or more. Effect of semaglutide treatment or placebo on waist circumference from baseline… Change in BMI category (healthy, overweight, class I obesity, class II obesity and… Reaching weight loss goals isn’t as simple as eating less and exercising more. We can help. Therefore, semaglutide has become the first AOM that results in a greater than 10% average weight loss over that attributable to lifestyle interventions , generating widespread public interest and leading to global supply shortages. In 2021, semaglutide was approved by both the US Food and Drug Administration (FDA) and the European Medicines Agency (EMA) for chronic weight management in patients with either a BMI greater than 30 kg/m2 or a BMI greater than 27 kg/m2 and at least one weight-related condition. This retrospective study demonstrated the significant effectiveness of semaglutide for weight loss, even at lower than approved maintenance doses, combined with a good safety profile. Among 25 patients with six-month data, 22 (88%), 17 (68%), and eight (32%) patients exceeded 5% (5.6 kg), 10% (11.2 kg), and 15% (16.8 kg) weight loss, respectively. Starvation diets or extreme calorie restriction plans have no place in legitimate medical weight loss care. Medical weight loss takes a more customized approach, helping you lose weight in a way that fits your lifestyle and budget. As a top medical weight loss clinic in Atlanta, we want to clear up some of the most common medical weight loss myths floating around out there. This causes lots of myths and misconceptions about medical weight loss specifically. The abundance of weight loss advice can be confusing for anyone seeking a healthier lifestyle. Last, we analyzed the differences in baseline characteristics between those with missing 5-year weight data and those without missing 5-year weight data. There were no clinically substantive changes between the average weights at baseline and follow-up with or without the use of multiple imputation methods (data furnished on request). Sensitivity analyses were undertaken to assess the effect of multiple imputation, as well as limiting analyses to those with available baseline and 5-year weight data. In the world of weight loss, it's easy to get entangled in a web of myths and misconceptions. Our body needs healthy fats for various functions, including the absorption of certain vitamins and the regulation of hormones. Fat has long had a bad reputation when it comes to weight loss. Armed with scientific evidence, we debunk the myths about weight loss in this article and reveal what truly works. This cohort study assesses weight loss outcomes of semaglutide at doses used in randomized clinical trials for patients with overweight or obesity. Some medical weight loss programs may be covered by insurance, especially if they are recommended for managing a medical condition like diabetes or hypertension. The first step in any medical weight loss program is a thorough evaluation of your health. In one landmark study, people with obesity who used semaglutide in combination with lifestyle interventions lost about 15% percent of their body weight in 68 weeks. In which 5 European countries are people the fattest? Dr Ian Baxter – Surgical ConsultationIn your first appointment with Dr Baxter, you’ll discuss your weight-loss goals and find out which procedures may be suitable. It’s a permanent procedure with a significant cost, and most people only consider it after a long road of diets, gym memberships and programs that haven’t worked. Watch a video of NIDDK Director Dr. Griffin P. Rodgers explaining the importance of participating in clinical trials. There is some evidence to suggest a negative association between air pollution and intentional weight loss and weight loss after bariatric surgery . As shown in several studies 171–174, extreme temperatures and ongoing precipitation may lead to a reduction in physical activity and slower weight loss. In a survey including the internet weight loss community, themes such as encouragement and motivation, sharing of experience and information, recognition of success and friendly competition were valued and reported to be beneficial by the members . Studies conducted by reported that in-person or internet-based community support can also aid in weight loss 169, 170. You may be more at risk for certain types of cancer if you take this medication. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Talk to your care team about the use of this medication in children. Analysis of covariance with treatment and baseline values was used to estimate the treatment difference. Numbers shown below each panel represent the number of patients contributing to the means. Supplementary Table 1 outlines SELECT patients according to baseline BMI categories. BMI is a good surveillance measure for population changes over time, given its strong correlation with body fat amount on a population level, but it may not accurately indicate the amount or location of body fat at the individual level2. Impact of Overweight on the Risk of Developing Common Chronic Diseases During a 10-Year Period. It was granted an exemption from requiring ethical approval since it was a clinical audit designed to capture the clinical outcomes of patients commenced on semaglutide within its licensed use for weight loss and all the procedures being performed were part of the routine care.Variation in weight loss response…We provide an integrated approach that includes primary care, immunizations, and CLIA-waived testing to assess and maintain your health profile.Medical weight loss combines clinical expertise with your personal needs and preferences - not the other way around!A retrospective study involving 14,256 patients revealed that weight loss success depends on follow-up frequency, initial BMI and initial weight loss.For semaglutide-treated participants without known pre-existing diabetic retinopathy at baseline, the risk of diabetic retinopathy was low and not statistically different than placebo.80 Early worsening of pre-existing diabetic retinopathy was most evident in the initial 16 weeks, during which there was a rapid improvement in glycemic control.The inclusion of ultra-processed foods can drastically impact weight loss outcomes, particularly regarding sugar and fiber content.In East Asians, beta cell dysfunction is the primary factor causing type 2 diabetes, while insulin resistance and body fat play a minor role compared with Caucasians.Studies suggest that some virtual programs may work if they include the key features described above.3,7 But researchers are still studying whether virtual weight-loss programs are effective, especially in the long term. A known hypersensitivity to semaglutide or any of its excipients is a contraindication for use of the medication. However, some patients may be “non-responsive” to semaglutide, which using CMS guidelines is considered a Further research is needed to determine the optimal frequency of lifestyle counseling required with semaglutide 2.4 mg. In our cohort, patients lost approximately 6.7 kg at 3 months and 12.3 kg at 6 months, equivalent to 5.9% of weight lost at 3 months and 10.9% of weight lost at 6 months. Mild adverse effects did not affect dose escalation; moderate adverse effects prevented dose escalation; and severe adverse effects resulted in medication termination. Of the 28 patients with type 2 diabetes, 11 (39.3%) were using a combination of insulin with metformin, empagliflozin, and/or glipizide. However, a systematic review of 14 lifestyle intervention studies (933 participants) found no statistically significant difference in weight loss between women with and without PCOS . A study revealed a 17% reduction in resting energy expenditure with a serum TSH increase (0.1–10 mU/L) from levothyroxine medication , hindering weight loss attempts and promoting weight gain. A retrospective study involving 14,256 patients revealed that weight loss success depends on follow-up frequency, initial BMI and initial weight loss. In light of the above observations, the present study has been framed with the research question—What could be the reasons for not losing weight even after following a weight loss program? More than one in three adults in the United States are considered to have medical obesity. FactDr does not provide medical opinion, advice, diagnosis or treatment. Want to live a healthy lifestyle? The following laboratory examinations are necessary to analyze the causes of weight loss- Within the SELECT population with BMI −2 at baseline, 15.0% and 14.3% of the semaglutide and placebo groups, respectively, were below the sex- and race-specific WC cutoff points. The trajectory of WC change mirrored that of the change in body weight. Each patient’s percentage change in body weight is plotted as a single bar. ETD, estimated treatment difference; sema, semaglutide. The SELECT study enrolled 17,604 patients (72.3% male) from 41 countries between October 2018 and March 2021, with a mean (s.d.) age of 61.6 (8.9) years and BMI of 33.3 (5.0) kg m−2 (ref. 21). Studies have also investigated the gastrointestinal (GI) side effects, namely nausea and vomiting, reported by trial participants and whether or not these have contributed to the weight loss effects of GLP-1 RAs in any manner. There are four Food and Drug Administration (FDA)-approved medications on the market for weight loss, namely phentermine-topiramate (Qsymia), orlistat (Xenical), naltrexone-bupropion (Contrave), and the glucagon-like peptide-1 receptor agonist (GLP-1 RA) liraglutide (Saxenda).1 3 Lorcaserin (Belviq) was previously given FDA approval but was recalled at the beginning of 2020 due to an increased risk of malignancies.6 Wegovy (semaglutide), the GLP-1 RA discussed in this article, received FDA approval in 2021.7 Guidelines for treating overweight and obesity in the USA place lifestyle modifications, including moderate to vigorous exercise, decreased caloric intake, and behavioral therapy, as the first steps in the intervention.1 Lifestyle modifications can reduce the risk of developing cardiovascular complications, but patients do not easily maintain any accomplished weight loss.1 If no significant changes occur through lifestyle modifications, adding pharmacotherapeutics may help to promote weight loss.1 Extrapolating across the results of STEP 1 and STEP 3, the addition of IBT appeared to increase the rate of weight loss with semaglutide during the first 12–16 weeks, but this combination was no more effective at week 68 than semaglutide combined with the less intensive (and less costly) diet and activity counseling provided in STEP 1. The intensive behavioral therapy (IBT) intervention succeeded at week 28 in inducing a mean loss of approximately 8% of baseline weight in placebo-treated participants, a loss that declined to 5.7% at week 68, most likely because of the decreased number of counseling visits during the second part of the intervention. An important finding of STEP 2 was that individuals with type 2 diabetes can expect to lose approximately one-third less weight than those without this condition. Changes in these values were generally similar in the two semaglutide-treated groups, although the data were not submitted to formal statistical analysis. Fully 86.4% of the semaglutide group lost 5% or more on baseline weight, compared with 31.5% for placebo. Some skeptics out there might have you believing medical weight loss requires giving up everything tasty for sad celery sticks and plain chicken breast forever. Critics also blast medical weight loss for only generating temporary results. Some myths paint medical weight loss clinics as militant bootcamps run by drill sergeant doctors. Moderation and variety helps patients lose weight safely while developing sustainable lifestyle habits. Effective medical weight loss takes a moderate, balanced approach to nutrition. Data will be shared with bona fide researchers who submit a research proposal approved by the independent review board. All authors contributed to data interpretation, review, revisions and final approval of the manuscript. D.H.R. was responsible for data analysis and manuscript preparation. The category ‘Other’ for CV inclusion criteria includes patients where it is unknown if the patient fulfilled only one or several criteria and patients who were randomized in error and did not fulfill any criteria. Data are represented as number and percentage of patients. Sometimes, health care professionals may not address issues such as the benefits of choosing healthy food and drinks, physical activity, and weight during a general office visit. Talking with a health care professional about your weight is an important first step. If you’ve been thinking about trying a weight-loss program, you’re not alone. It does not replace professional medical advice, diagnosis, or treatment. No direct comparison of 2.4 mg semaglutide with other FDA-approved weight loss medications was made during STEP 1 through 5. The results from STEP 1 through 4 showed that semaglutide is superior at weight reduction when compared with placebo.11–14 STEP 2 compared 2.4 mg semaglutide with 1.0 mg semaglutide and found 2.4 mg semaglutide to cause more significant weight loss than 1.0 mg semaglutide.12 STEP 4 investigated the discontinuation of semaglutide treatment and found that those who were started on placebo after 20 weeks of treatment with the experimental dose of semaglutide experienced weight gain of around 6 kg14 (table 5). The primary goal of the program was to evaluate semaglutide’s efficacy as a solely weight loss medication. Regarding safety, oral semaglutide was reported as being non-inferior to treatment with placebo at lowering incidences of major adverse cardiovascular events.28 38 Safety of oral semaglutide in patients with moderate renal impairment (glomerular filtration rate (GFR) between 30% and 59%) was also established during PIONEER 5,32 with no significant renal changes observed throughout the trial. There were 127 results received but only SUSTAIN (Semaglutide Unabated Sustainability in Treatment of Type 2 Diabetes), PIONEER (Peptide Innovation for Early Diabetes Treatment), and STEP (Semaglutide Treatment Effect in People with Obesity) trials were reviewed because these were original, randomized, controlled clinical trials done before approval of semaglutide for management of diabetes and obesity. Further research is needed to address several aspects of chronic semaglutide use for weight management, such as the durability of semaglutide-induced weight loss beyond two years , the optimal duration of treatment, and strategies to prevent or, at least, ameliorate weight regain occurring after semaglutide discontinuation 8,28. Fourth, the exclusion of individuals without three-month data and the significant rate of patients discontinuing semaglutide after the first three months may introduce a selection bias, potentially overestimating its impact on body weight. Nevertheless, this study has several limitations, with the first one being the absence of a comparator arm due to its observational nature, not allowing us to quantify the extent to which semaglutide and lifestyle intervention contributed to weight loss. Due to its substantial and durable weight loss effect, semaglutide may herald a new era in the management of obesity, using percentage weight loss as a biomarker and applying a treat-to-target approach, in line with other chronic diseases, to prevent and treat weight-related complications . In contrast to the tortuous history of AOMs littered with numerous drug withdrawals due to adverse events, the mounting evidence for the good safety profile of semaglutide and its much greater magnitude of weight loss could change dramatically the landscape of obesity management, encompassing the widespread use of pharmacotherapy . Because of these side effects, these medications will typically be used to complement other weight loss behaviors and will not be the only method of weight loss used. During a medical weight loss treatment, your doctor will create a diet plan for weight loss that includes foods lower in calories. Understanding how to lose weight can seem daunting, but collaborating with a doctor on a medical weight loss plan can provide an ideal way to lose weight. Another medical weight loss myth is the idea that all medical weight loss programs are identical. One of the most persistent medical weight loss myths is that skipping meals will help you lose weight. CIs were not adjusted for multiplicity and should therefore not be used to infer definitive treatment effects. The fit model is used to impute values for all patients with missing data at week 104 to create 500 complete data sets. Body weight was measured without shoes and only wearing light clothing; it was measured on a digital scale and recorded in kilograms or pounds (one decimal with a precision of 0.1 kg or lb), with preference for using the same scale throughout the trial. All patients provided written informed consent before beginning any trial-specific activity. Semaglutide 2.4 mg safely and effectively produced clinically significant weight loss in all subgroups based on age, sex, race, glycemia, renal function and anthropometric categories. B,c, Percentage change in body weight for individual patients from baseline to week 104 for semaglutide (b) and placebo (c). Bars depict the proportion (%) of patients receiving semaglutide or placebo who achieved ≥5%, ≥10%, ≥15%, ≥20% and ≥25% weight loss. For those in the semaglutide group, the weight-loss trajectory continued to week 65 and then was sustained for the study period through week 208 (−10.2% for the semaglutide group, −1.5% for the placebo group; treatment difference −8.7%; 95% CI −9.42 to −7.88; P 35 days). The SELECT trial (Semaglutide Effects on Heart Disease and Stroke in Patients with Overweight or Obesity) studied patients with established CVD and overweight or obesity but without diabetes.