Treat to target in weight management with semaglutide: Real-world evidence from an eHealth clinic.

AIMS: To evaluate the effectiveness of an online multidisciplinary weight loss service combining individualised semaglutide dosing with intensive behavioural therapy (IBT) in adults living with overweight or obesity. MATERIALS AND METHODS: This retrospective cohort study included data from Danish participants enrolled in a digital weight loss programme via the Embla app between January 2022 and September 2024. The programme offered semaglutide with personalised dosing alongside evidence-based recommendations on nutrition, exercise and habits, delivered through IBT. All data collection and monitoring was conducted via the Embla app. The primary outcome was percentage change in body weight at week 64. Secondary outcomes included semaglutide dose, proportions achieving ≥5%, ≥10%, ≥15%, or ≥20% weight loss, and weight change by baseline BMI and dose. RESULTS: The study included 2694 participants (78% women, mean age 46.8 ± 10.8 years, mean BMI 34.3 ± 4.8). At weeks 26, 52, and 64, the number of participants that remained in the study was: 1580, 712, and 465. Mean weight loss at week 64 was 16.7% (95% CI: -17.4 to -16.0) with a mean semaglutide dose of 1.08 mg/week (SD 0.54). A total of 98% achieved ≥5% and 82% achieved ≥10% weight loss. Weight change was consistent across BMI classes and medication doses. CONCLUSIONS: Participants achieved clinically meaningful weight loss comparable to that seen in randomised trials, despite using lower semaglutide doses. These findings support the effectiveness of a personalised, treat-to-target approach integrating medical and behavioural obesity management in a digital setting. TRIAL REGISTRATION: https://osf.io/86kmc/.