Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study
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%; 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). 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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BibTeX
@article{tournayre2026digital,
title = {{Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study}},
author = {Sarah Tournayre and Jean-Baptiste Bonnet and Jean Anitcheou and Marion Faivre and Catherine Boegner and Abdulkader Jalek and Dominique Jullien and Camille Le Rouzic and Vincent Attalin and Justine Myzia and Youadigue Kemba and Ariane Sultan and Antoine Avignon},
journal = {Journal of Medical Internet Research},
year = {2026},
month = aug,
doi = {10.2196/80119},
url = {https://hal.science/hal-05738758v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study
AU - Sarah Tournayre
AU - Jean-Baptiste Bonnet
AU - Jean Anitcheou
AU - Marion Faivre
AU - Catherine Boegner
AU - Abdulkader Jalek
AU - Dominique Jullien
AU - Camille Le Rouzic
AU - Vincent Attalin
AU - Justine Myzia
AU - Youadigue Kemba
AU - Ariane Sultan
AU - Antoine Avignon
PY - 2026
DA - 2026/08/26
JO - Journal of Medical Internet Research
DO - 10.2196/80119
UR - https://hal.science/hal-05738758v1
AB - 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%; 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). 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.
SN - 1438-8871
ER -