Observational studyJournal of medical Internet research2026
Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study.
Observational study in Journal of medical Internet research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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13 authors.
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Abstract
Background: Real-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. Objective: This 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. Methods: 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. 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. Results: Of 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%; Conclusions: Baseline 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.
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