A Half Dose of Semaglutide Yields Weight Loss Equivalent to Clinical Trial Doses in Combination with Online Support Program

Adults with obesity lost an average of 16.7% of their baseline body weight over 64 weeks using an online weight-loss program that combined individualized doses of semaglutide with behavioral, dietary, and psychological support—matching the weight loss seen in clinical trials with the glucagon-like peptide-1 receptor-1 agonist (GLP-1 RA) but using less than half the medication.1

Henrik Güdbergsen, MD, PhD, MPA

Courtesy of the University of Copenhagen

The results, presented at the 2025 European Congress on Obesity and slated for publication in The Lancet Digital Health, offer real-world validation of an online platform’s ability to optimize outcomes while minimizing medication burden. The average semaglutide dose used was about 1 mg/week; only 28.8% of participants exceeded that amount. In contrast, roughly 90% of patients in semaglutide clinical trials reached the full 2.4 mg/week dose, according to the findings.1

“Achieving the same weight loss in day-to-day life as in the tightly controlled conditions of a clinical trial, while also using lower doses of drugs, has many potential benefits, from lower costs and fewer side-effects for patients, to ensuring that stocks of the drug go further,” lead researcher Henrik Gudbergsen, MD, PhD, MPA, associate professor at the University of Copenhagen and chief medical officer at Embla, an online weight loss platform, said in a statement.2

The observational cohort study included 2,694 participants in Denmark (78% women, mean age 47 years, mean body mass index [BMI] 34.3 kg/m²) who enrolled in the Embla app-based weight management program. The intervention combined GLP-1 therapy with personalized behavioral strategies, including cognitive behavioral therapy (CBT), exercise guidance, dietary coaching, and access to clinicians and mental health professionals via the app.1

The dosing followed an individualized “treat-to-target” strategy: patients started on low doses, which were increased only if they failed to maintain a weight reduction of more than 0.5% per week or experienced persistent hunger or side effects. Treatment continued until patients either reached their goal weight or a BMI of 25 kg/m².2

The standard semaglutide dosing schedule begins with a low initial dose of 0.25 mg once weekly that is increased every 4 weeks for 16 weeks to a maximum dose of 2.4mg, which the patient remains on until treatment ends, was tailored to individual patients.

Of the initial cohort, 1,580 remained in the program at week 26, 712 at week 64, and 465 at week 76. Reported weight loss averaged 12.2% at week 26, 16.2% at week 52, and 16.7% (16.8 kg) at week 64.1 Gudbergsen and colleagues cite data demonstrating that their outcomes closely align with the 15–16% weight loss observed in clinical trials involving full-dose semaglutide plus lifestyle intervention.3-5

“By combining diet and exercise advice with psychological coaching and personalising [participants'] doses of semaglutide it was possible to achieve the same amount of weight loss with lower doses of the drug,” Gudbergsen said.2

Among 515 participants with data at weeks 52–64, 98% achieved weight loss of at least 5%, and 82%, 51%, and 23% reached 10%, 15%, and 20% weight loss, respectively. Women lost more weight on average than men (17.6% vs 13.4%), and higher app engagement correlated with greater weight loss. Efficacy did not vary by starting BMI, age, or semaglutide dose.1

Side effects, primarily gastrointestinal (eg, nausea, vomiting, abdominal pain), were generally mild and transient.1

Limitations include the lack of a control group and reliance on self-reported data. Still, the researchers argue that the findings highlight the clinical promise of combining digital health tools with flexible pharmacologic strategies, pointing out that theirs is "the first study of the effectiveness of a personalized treat-to-target approach for weight loss through tailored obesity medication doses in participants living with overweight or obesity."1

“Our results show that by giving personalised doses of semaglutide along with diet, exercise and psychological support, it is possible for patients to achieve clinical trial-level weight loss in their day-to-day lives,” Gudbergsen stated.2 He added that the treat-to-target approach not only permitted the lowest possible dosing, it should also mean "lower costs and fewer side-effects" for individuals in the real world.

References

1. Seier S, Stamp-Larsen K, Birk Kjær S, Torekov SS, Gudbergsen H. Treat to target in weight management with semaglutide: real-world evidence from an eHealth clinic. Preprint from The Lancet. Available at SSRN: https://ssrn.com/abstract=5207768 or http://dx.doi.org/10.2139/ssrn.5207768

2. Patients of an online obesity clinic achieved the same weight loss as those in clinical trials of semaglutide – but with much lower doses of the drug. News release. European Association for the Study of Obesity. May 12, 2025. Accessed May 13, 2025. https://www.eurekalert.org/news-releases/1083554

3. https://jamanetwork.com/journals/jama/fullarticle/2777025

4. https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

5. https://jamanetwork.com/journals/jama/fullarticle/2787907