A Remotely Delivered, Semaglutide-Supported Specialist Weight Management Program: Preliminary Findings From a Retrospective Service Evaluation

What Are the Experiences, Views and Perceptions of Patients, Carers and Clinicians of Glucagon-like Peptide-1 Receptor Agonists (GLP-1 RAs)? A Scoping Review

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) are a pharmacological treatment option for both diabetes and weight loss. Qualitative evidence is vital in providing greater understanding of patients, practitioners and carers experience of taking or delivering GLP-1 RAs. This evidence can inform the current or future configuration and delivery of services. We conducted a scoping review to better understand the quantity, nature and key characteristics of qualitative primary evidence which explores the experiences, views and perceptions of patients, carers and clinicians regarding the use of GLP-1 RAs.

METHODS

Four bibliographic databases were searched on 10 July 2024: MEDLINE, APA PsycInfo via Ovid, CINAHL Ultimate via EBSCOhost, ProQuest Dissertations and Theses Global via ProQuest. We also searched Google Scholar, two clinical trials registries, the pre-print server medRxiv and conducted citation searches. We sought qualitative research about the experiences of patients, carers and practitioners about any aspect of taking or prescribing GLP-1RAs, for any indication. Study selection and data extraction were performed by two independent reviewers. The included studies were collated, and their characteristics were described.

RESULTS

After de-duplication 1545 titles and abstracts were screened for relevance, with 77 full-text articles assessed for eligibility, resulting in 25 included studies. More studies were focused on type 2 diabetes (n = 12) than weight loss (n = 9) or any indication (n = 4). The experiences of carers were not represented. No one area of experience (e.g. different indications or viewpoints) was well represented, either due to the absence or narrow focus of studies or lack of an in-depth analytical approach.

CONCLUSION

Whilst primary qualitative evidence exploring patient and clinician experience of GLP-1 RAs was identified in this scoping review, the findings highlight a need for more robust qualitative research to be conducted across all user groups, in particular involving carers, and especially for the indication of weight loss within service settings. This evidence gap needs to be urgently addressed to ensure GLP-1 RAs are appropriately prescribed and patients and carers receive support from services suited to their needs.

PATIENT OR PUBLIC CONTRIBUTION

Seventeen public collaborators contributed to the search by suggesting additional search terms, helping define the population for inclusion and contributing to protocol development. Their thoughts on the findings of the review helped form the basis for the discussion of this paper.

Impact of Digital Engagement on Weight Loss Outcomes in Obesity Management Among Individuals Using GLP-1 and Dual GLP-1/GIP Receptor Agonist Therapy: Retrospective Cohort Service Evaluation Study

BACKGROUND

Obesity is a global public health challenge. Pharmacological interventions, such as glucagon-like peptide-1 (GLP-1) receptor agonists (eg, semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (eg, tirzepatide), have led to significant weight loss among users. Digital health platforms offering behavioral support may enhance the effectiveness of these medications.

OBJECTIVE

This retrospective service evaluation investigated the impact of engagement with an app-based digital weight loss program on weight loss outcomes among individuals using GLP-1 receptor agonists (semaglutide) and dual GLP-1/gastric inhibitory polypeptide receptor agonists (tirzepatide) in the United Kingdom over 5 months.

METHODS

Data were collected from the Voy weight loss digital health platform between February 2023 and August 2024. Participants were adults aged 18-75 years with a BMI ≥30 or ≥27.5 kg/m2 with the presence of obesity-related comorbidities who initiated a weight management program involving semaglutide or tirzepatide. Engagement was defined based on attendance at coaching sessions, frequency of app use, and regular weight tracking. Participants were categorized as "engaged" or "nonengaged" accordingly. Weight loss outcomes were assessed over a period of up to 5 months. Statistical analyses included chi-square tests, independent t tests, Kaplan-Meier survival analysis, and calculations of Cohen d for effect sizes.

RESULTS

A total of 57,975 participants were included in the analysis, with 31,407 (54.2%) classified as engaged and 26,568 (45.8%) as nonengaged. Engaged participants achieved significantly greater weight loss at each time point. At month 3, engaged participants had a mean weight loss of 9% (95% CI 9% to 9.1%) compared with 5.9% (95% CI 5.9% to 6%) in nonengaged participants (P<.001), representing a mean difference of 3.1 percentage points (95% CI 3.1% to 3.1%). A Cohen d effect size of 0.89 indicated a large effect. At month 5, engaged participants had a mean weight loss of 11.53% (95% CI 11.5% to 11.6%) compared with 8% (95% CI 7.9% to 8%) in the nonengaged participants (P<.001). A Cohen d effect size of 0.56 indicated a moderate effect. Participants using tirzepatide achieved more significant weight loss than those using semaglutide at month 5 (13.9%, 95% CI 13.5% to 14.3% vs 9.5%, 95% CI 9.2% to 9.7%; P<.001). The proportion of engaged participants achieving ≥5%, ≥10%, and ≥15% weight loss was significantly higher than the nonengaged group at corresponding time points from months 3 to 5 respectively (P<.001).

CONCLUSIONS

Engagement with a digital weight management platform significantly enhances weight loss outcomes among individuals using GLP-1 receptor agonists. The combination of pharmacotherapy and digital behavioral support offers a promising strategy to promote the supported self-care journey of individuals seeking clinically effective obesity management interventions.

Physiopathology and Treatment of Obesity and Overweight: A Proposal for a New Anorectic

The "new epidemic," as WHO calls obesity, is caused by overeating, which, having exceeded the body's actual needs, accumulates in the form of health-damaging fat deposits. Moving more and eating less is the main remedy, but eating belongs to vital instincts, which are beyond the control of reason. In this sense, eating is different from drinking and breathing because without food it is possible to survive for a few weeks, without water for a few days, without oxygen for a few minutes. The first part of this article provides an overview of obesity and its treatment, focusing on the new anorectic anticipated in the title. The second part focuses on compulsive obesity, typically represented by constitutional obesity and food addiction. The article concludes with a discussion of the pharmacological treatment of compulsive diseases, to which some forms of obesity belong.