Changes in weight and glycemic control following obesity treatment with semaglutide or tirzepatide by discontinuation status
Open accessAbstract
Objective: The objective of this study was to characterize changes in body weight and glycated hemoglobin (in those with prediabetes at baseline) through 12 months by obesity pharmacotherapy discontinuation status. Methods: This retrospective cohort study used electronic health record data from a large health system in Ohio and Florida to identify adults with overweight or obesity without type 2 diabetes who initiated injectable semaglutide or tirzepatide between 2021 and 2023. Treatment discontinuation was defined by a >90‐day gap between exhaustion of previous supply and next dispense or end of study follow‐up (December 2024) and was classified into early discontinuation (i.e., within 3 months of index date) and late discontinuation (i.e., within 3–12 months). Results: We identified 7881 patients; 6109 received semaglutide, and 1772 received tirzepatide. A total of 80.8% had low maintenance dosages. Mean (SD) percentage weight reduction at 1 year was 8.7% (9.6%); and it was 3.6% (8.1%) with early discontinuation, 6.8% (9.1%) with late discontinuation, and 11.9% (9.2%) with non‐discontinuation ( p < 0.001). The mean (SD) absolute reduction in percent glycated hemoglobin at 1 year was 0.1 (0.4) with early discontinuation, 0.2 (0.4) with late discontinuation, and 0.4 (0.4) with non‐discontinuation ( p < 0.001). Conclusions: The average weight reduction in this cohort was lower than that observed in the main phase 3 trials, likely because of higher rates of discontinuation and lower maintenance dosages.
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TL;DR
In a retrospective cohort of 7881 adults with overweight or obesity without type 2 diabetes who initiated injectable semaglutide or tirzepatide, treatment discontinuation was common and was associated with attenuated 1-year weight reduction and, among those with prediabetes at baseline, attenuated HbA1c reduction. Average weight reduction was lower than in phase 3 trials, likely reflecting higher discontinuation and lower maintenance dosages.
Key findings
- Among 7881 patients, 20.4% discontinued early, 32.0% discontinued late, and 47.6% did not discontinue; 80.8% had low maintenance dosages.
- Mean (SD) 1-year weight reduction was 8.7% (9.6%) overall: 3.6% (8.1%) with early discontinuation, 6.8% (9.1%) with late discontinuation, and 11.9% (9.2%) with non-discontinuation (p < 0.001); by medication, it was 7.7% (9.0%) with semaglutide and 12.4% (10.5%) with tirzepatide.
- Among 895 patients with prediabetes at baseline and 1-year HbA1c data, mean (SD) absolute HbA1c reduction was 0.3% (0.4%) overall: 0.1% (0.4%) with early discontinuation, 0.2% (0.4%) with late discontinuation, and 0.4% (0.4%) with non-discontinuation (p < 0.001); 53.9% converted to normoglycemia and 3.4% progressed to type 2 diabetes.
- In multivariable analysis, odds of ≥10% weight loss at 1 year were higher with non-discontinuation (AOR 4.68, 95% CI 3.97–5.55 vs. early discontinuation), late discontinuation (AOR 1.74, 95% CI 1.45–2.08 vs. early), tirzepatide (AOR 2.46, 95% CI 2.16–2.80 vs. semaglutide), high dosage (AOR 2.39, 95% CI 2.08–2.75 vs. low), and female sex (AOR 1.86, 95% CI 1.62–2.13 vs. male).
Methods
- Retrospective cohort using Cleveland Clinic electronic health record data from Ohio and Florida linked to Surescripts pharmacy dispensation records from January 1, 2021, to December 31, 2024. Adults aged ≥18 years with overweight or obesity without type 2 diabetes who initiated injectable semaglutide or tirzepatide between 2021 and 2023 were included if they had baseline BMI ≥30.0 or BMI ≥27.0 with a weight-related comorbidity, plus baseline and at least one follow-up weight measurement 30–365 days after index.
- Discontinuation was defined as a >90-day gap between exhaustion of previous supply and next dispense or end of follow-up; early discontinuation was within 3 months of index and late discontinuation within 3–12 months. Primary outcomes were percentage body weight reduction and, in patients with prediabetes at baseline, absolute HbA1c reduction through 12 months.
- Analyses summarized weight and HbA1c trajectories in 1-month increments and used multivariable logistic regression for ≥10% weight loss at 1 year, adjusting for discontinuation status, medication, dosage, age, sex, race and ethnicity, primary payer, Area Deprivation Index quartile, baseline BMI, and age-adjusted Charlson Comorbidity Index. Sensitivity analyses excluded patients who switched medications and those with prior FDA-approved obesity medication fills.
Limitations
- Stated: the study included adults from Ohio and Florida in a single large integrated health system, which may limit generalizability; medication shortages during the study period could have contributed to temporary discontinuation; the study did not capture lifestyle interventions, nutritional counseling, or patient- and clinician-related factors such as adverse effects, coverage issues, or inadequate weight reduction.
- Stated: some observed weight reductions may be associated with other interventions, although the studied medications are approved for use in addition to diet and exercise.
- Evident from the text: this was an observational cohort that did not emulate a target trial, so residual confounding cannot be excluded; outcome analyses required available follow-up measurements, and missing data may affect estimates; discontinuation was inferred from pharmacy fill gaps, which may misclassify exposure.
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- Findingown data
Among those who did not discontinue and were on a high maintenance dosage, mean weight loss at 1 year was 13.7% with semaglutide.
“Those who did not discontinue and were on a high maintenance dosage of an OM (n = 967 with available weight at 1 year) lost a mean (SD) 14.7% (9.2%; 95% CI: 14.1%–15.3%) of weight at 1 year, including 13.7% (8.3%; 95% CI: 13.1%–14.3%) with semaglutide and 18.0% (10.8%; 95% CI: 16.6%–19.5%) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Mean percentage weight reduction at 1 year in the cohort was 8.7% (SD 9.6%).
“Mean (SD) percentage weight reduction at 1 year was 8.7% (9.6%)”
Quote in the paperNot a substantial claim - Findingown data
In the multivariable model, the odds of achieving ≥10% weight loss at 1 year were higher in patients who discontinued late versus early (AOR 1.74; 95% CI 1.45-2.08).
“who discontinued late (vs. early, AOR, 1.74; 95% CI: 1.45–2.08)”
Quote in the paperSubstantial claim - Findingown data
Mean absolute reduction in HbA1c at 1 year was 0.1% (SD 0.4) with early discontinuation.
“The mean (SD) absolute reduction in percent glycated hemoglobin at 1 year was 0.1 (0.4) with early discontinuation”
Quote in the paperNot a substantial claim - Findingown data
Mean percentage weight reduction at 1 year was 3.6% (SD 8.1%) with early discontinuation.
“it was 3.6% (8.1%) with early discontinuation”
Quote in the paperNot a substantial claim
- Findingown data
In this cohort of 7881 patients who received semaglutide or tirzepatide for obesity in a routine clinical setting, treatment discontinuation was associated with attenuated weight reduction at 1 year.
“In this cohort study of 7881 patients who received semaglutide or tirzepatide for obesity in a routine clinical setting, treatment discontinuation was associated with attenuated weight reduction and, in patients who had prediabetes at baseline, attenuated glycated hemoglobin reduction at 1 year.”
Quote in the paperSubstantial claim - Findingown data
Among those who did not discontinue and were on a high maintenance dosage, mean weight loss at 1 year was 18.0% with tirzepatide.
“Those who did not discontinue and were on a high maintenance dosage of an OM (n = 967 with available weight at 1 year) lost a mean (SD) 14.7% (9.2%; 95% CI: 14.1%–15.3%) of weight at 1 year, including 13.7% (8.3%; 95% CI: 13.1%–14.3%) with semaglutide and 18.0% (10.8%; 95% CI: 16.6%–19.5%) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Non-discontinuation of obesity pharmacotherapy (vs. early discontinuation) is positively associated with achieving at least 10% weight reduction at 1 year.
“Factors positively associated with achieving at least 10% weight reduction at 1 year included non‐discontinuation of obesity pharmacotherapy or late discontinuation (vs. early), tirzepatide (vs. semaglutide), high dosage of the medication, and female sex.”
Quote in the paperSubstantial claim - Findingown data
Mean weight reduction at 1 year was 12.4% with tirzepatide.
“In terms of the index medication, mean (SD) weight reduction at 1 year was 7.7% (9.0%; 95% CI: 7.4%–7.9%) with semaglutide and 12.4% (10.5%; 95% CI: 11.9%–12.9%) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Percentage weight reduction at 1 year differed significantly by discontinuation status (p < 0.001).
“Mean (SD) percentage weight reduction at 1 year was 8.7% (9.6%); and it was 3.6% (8.1%) with early discontinuation, 6.8% (9.1%) with late discontinuation, and 11.9% (9.2%) with non‐discontinuation (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Among those with available 1-year weight measurements, mean weight reduction was 6.8% for those who discontinued obesity pharmacotherapy late.
“Mean (SD) weight reduction was 3.6% (8.1%; 95% CI: 3.2%–4.1%) and 6.8% (9.1%; 95% CI: 6.3%–7.2%) for those who discontinued obesity pharmacotherapy early and late, respectively.”
Quote in the paperNot a substantial claim - Findingown data
Among patients with available 1-year weight measurements (n=6477), the mean percentage weight reduction at 1 year was 8.7% (95% CI 8.5-9.0).
“Among those with available 1‐year weight measurements (n = 6477), the mean (SD) percentage weight reduction at 1 year was 8.7% (9.6%; 95% confidence interval [CI]: 8.5%–9.0%).”
- Also stated in: § DISCUSSION · plain
“patients lost an average of 8.7% of body weight at 1 year.”
Quote in the paperSubstantial claim - Also stated in: § DISCUSSION · plain
- Findingown data
Mean HbA1c reduction at 1 year was 0.4% with tirzepatide.
“In terms of the index medication, mean (SD) HbA1c reduction at 1 year was 0.3 (0.4; 95% CI: 0.3–0.3) with semaglutide and 0.4 (0.4; 95% CI: 0.3–0.4) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Among patients who did not discontinue obesity pharmacotherapy at year 1 (n=3293), mean weight reduction was 15.3% with tirzepatide.
“Among patients who did not discontinue obesity pharmacotherapy at year 1 (n = 3293 with available data at 1 year), the mean (SD) percentage reduction in weight was 10.9% (8.7%; 95% CI: 10.5%–11.2%) with semaglutide and 15.3% (10.0%; 95% CI: 14.6–16.0) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Late discontinuation (vs. early discontinuation) is positively associated with achieving at least 10% weight reduction at 1 year.
“Factors positively associated with achieving at least 10% weight reduction at 1 year included non‐discontinuation of obesity pharmacotherapy or late discontinuation (vs. early), tirzepatide (vs. semaglutide), high dosage of the medication, and female sex.”
Quote in the paperSubstantial claim - Findingown data
Mean percentage weight reduction at 1 year was 6.8% (SD 9.1%) with late discontinuation.
“6.8% (9.1%) with late discontinuation”
Quote in the paperNot a substantial claim - Findingown data
In the multivariable model, the odds of achieving ≥10% weight loss at 1 year were higher in patients who had a high dosage of the medication versus low (AOR 2.39; 95% CI 2.08-2.75).
“had a high dosage of the medication (vs. low, AOR, 2.39; 95% CI: 2.08–2.75)”
Quote in the paperSubstantial claim - Findingown data
Among those who did not discontinue and were on a high maintenance dosage of an obesity medication (n=967), mean weight loss at 1 year was 14.7%.
“Those who did not discontinue and were on a high maintenance dosage of an OM (n = 967 with available weight at 1 year) lost a mean (SD) 14.7% (9.2%; 95% CI: 14.1%–15.3%) of weight at 1 year, including 13.7% (8.3%; 95% CI: 13.1%–14.3%) with semaglutide and 18.0% (10.8%; 95% CI: 16.6%–19.5%) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
High dosage of the medication is positively associated with achieving at least 10% weight reduction at 1 year.
“Factors positively associated with achieving at least 10% weight reduction at 1 year included non‐discontinuation of obesity pharmacotherapy or late discontinuation (vs. early), tirzepatide (vs. semaglutide), high dosage of the medication, and female sex.”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, mean absolute reduction in HbA1c at 1 year was 0.4% in those who did not discontinue.
“it was 0.1 (0.4; 95% CI: 0.0–0.2) in those who discontinued obesity pharmacotherapy early, 0.2 (0.4; 95% CI: 0.1–0.2) in those who discontinued late, and 0.4 (0.4; 95% CI: 0.4–0.5) in those who did not discontinue (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
In the multivariable model, the odds of achieving ≥10% weight loss at 1 year were higher in patients who received tirzepatide versus semaglutide (AOR 2.46; 95% CI 2.16-2.80).
“received tirzepatide (vs. semaglutide, AOR, 2.46; 95% CI: 2.16–2.80)”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements (n=895), the mean absolute reduction in HbA1c at 1 year was 0.3%.
“Among those with baseline prediabetes and 1‐year HbA1c measurements (n = 895), the mean (SD) absolute reduction in HbA1c at 1 year was 0.3 (0.4; 95% CI: 0.3–0.3);”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, mean absolute reduction in HbA1c at 1 year was 0.2% in those who discontinued obesity pharmacotherapy late.
“it was 0.1 (0.4; 95% CI: 0.0–0.2) in those who discontinued obesity pharmacotherapy early, 0.2 (0.4; 95% CI: 0.1–0.2) in those who discontinued late, and 0.4 (0.4; 95% CI: 0.4–0.5) in those who did not discontinue (p < 0.001).”
Quote in the paperNot a substantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 41.0% of those who discontinued late converted to normoglycemia at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Of the 895 patients with baseline prediabetes and 1-year HbA1c measurements, 53.9% converted to normoglycemia at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Mean absolute reduction in HbA1c at 1 year was 0.2% (SD 0.4) with late discontinuation.
“0.2 (0.4) with late discontinuation”
Quote in the paperNot a substantial claim - Findingown data
Female sex is positively associated with achieving at least 10% weight reduction at 1 year.
“Factors positively associated with achieving at least 10% weight reduction at 1 year included non‐discontinuation of obesity pharmacotherapy or late discontinuation (vs. early), tirzepatide (vs. semaglutide), high dosage of the medication, and female sex.”
Quote in the paperSubstantial claim - Findingown data
Mean weight reduction at 1 year was 7.7% with semaglutide.
“In terms of the index medication, mean (SD) weight reduction at 1 year was 7.7% (9.0%; 95% CI: 7.4%–7.9%) with semaglutide and 12.4% (10.5%; 95% CI: 11.9%–12.9%) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
Among patients who did not discontinue obesity pharmacotherapy at year 1 (n=3293), mean weight reduction was 10.9% with semaglutide.
“Among patients who did not discontinue obesity pharmacotherapy at year 1 (n = 3293 with available data at 1 year), the mean (SD) percentage reduction in weight was 10.9% (8.7%; 95% CI: 10.5%–11.2%) with semaglutide and 15.3% (10.0%; 95% CI: 14.6–16.0) with tirzepatide.”
Quote in the paperSubstantial claim - Findingown data
In patients with prediabetes at baseline, treatment discontinuation was associated with attenuated HbA1c reduction at 1 year.
“In this cohort study of 7881 patients who received semaglutide or tirzepatide for obesity in a routine clinical setting, treatment discontinuation was associated with attenuated weight reduction and, in patients who had prediabetes at baseline, attenuated glycated hemoglobin reduction at 1 year.”
Quote in the paperSubstantial claim - Findingown data
In the multivariable model, the odds of achieving ≥10% weight loss at 1 year were higher in patients who did not discontinue pharmacotherapy versus early discontinuation (AOR 4.68; 95% CI 3.97-5.55).
“the odds of achieving ≥10% weight loss at 1 year were higher in patients who did not discontinue pharmacotherapy (vs. early discontinuation, adjusted odds ratio [AOR], 4.68; 95% CI: 3.97–5.55)”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, mean absolute reduction in HbA1c at 1 year was 0.1% in those who discontinued obesity pharmacotherapy early.
“it was 0.1 (0.4; 95% CI: 0.0–0.2) in those who discontinued obesity pharmacotherapy early, 0.2 (0.4; 95% CI: 0.1–0.2) in those who discontinued late, and 0.4 (0.4; 95% CI: 0.4–0.5) in those who did not discontinue (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Mean percentage weight reduction at 1 year was 11.9% (SD 9.2%) with non-discontinuation.
“11.9% (9.2%) with non‐discontinuation”
Quote in the paperSubstantial claim - Findingown data
Mean HbA1c reduction at 1 year was 0.3% with semaglutide.
“In terms of the index medication, mean (SD) HbA1c reduction at 1 year was 0.3 (0.4; 95% CI: 0.3–0.3) with semaglutide and 0.4 (0.4; 95% CI: 0.3–0.4) with tirzepatide.”
Quote in the paperNot a substantial claim - Findingown data
In the multivariable model, the odds of achieving ≥10% weight loss at 1 year were higher in female versus male patients (AOR 1.86; 95% CI 1.62-2.13).
“were female (vs. male, AOR, 1.86; 95% CI: 1.62–2.13; Table 2)”
Quote in the paperNot a substantial claim - Findingown data
A total of 80.8% of patients in the cohort had low maintenance dosages of semaglutide or tirzepatide.
“A total of 80.8% had low maintenance dosages.”
Quote in the paperNot a substantial claim - Findingown data
Mean absolute reduction in HbA1c at 1 year was 0.4% (SD 0.4) with non-discontinuation.
“0.4 (0.4) with non‐discontinuation”
Quote in the paperNot a substantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 33.1% of those who discontinued early converted to normoglycemia at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Absolute reduction in HbA1c at 1 year differed significantly by discontinuation status (p < 0.001).
“The mean (SD) absolute reduction in percent glycated hemoglobin at 1 year was 0.1 (0.4) with early discontinuation, 0.2 (0.4) with late discontinuation, and 0.4 (0.4) with non‐discontinuation (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Among those with available 1-year weight measurements, mean weight reduction was 3.6% for those who discontinued obesity pharmacotherapy early.
“Mean (SD) weight reduction was 3.6% (8.1%; 95% CI: 3.2%–4.1%) and 6.8% (9.1%; 95% CI: 6.3%–7.2%) for those who discontinued obesity pharmacotherapy early and late, respectively.”
Quote in the paperSubstantial claim - Findingown data
Tirzepatide (vs. semaglutide) is positively associated with achieving at least 10% weight reduction at 1 year.
“Factors positively associated with achieving at least 10% weight reduction at 1 year included non‐discontinuation of obesity pharmacotherapy or late discontinuation (vs. early), tirzepatide (vs. semaglutide), high dosage of the medication, and female sex.”
Quote in the paperSubstantial claim - Findingown data
Those who did not discontinue treatment lost a mean 11.9% of weight at 1 year.
“Those who did not discontinue treatment lost a mean (SD) 11.9% (9.2%; 95% CI: 11.6%–12.2%) of weight (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 67.9% of those who did not discontinue converted to normoglycemia at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 1.7% of those who never discontinued progressed to type 2 diabetes at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
Of the 895 patients with baseline prediabetes and 1-year HbA1c measurements, 3.4% progressed to type 2 diabetes at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
In this study, 20.4% of patients discontinued their obesity pharmacotherapy early.
“In this study, 20.4% of patients discontinued their obesity pharmacotherapy early, and 32.0% discontinued late, which is considerably higher than the rates of discontinuation at ~1 year in the main phase 3 trials (including 17.1% for semaglutide 2.4 mg injection [STEP 1] and 14.3%–16.4% for tirzepatide 5–15 mg [SURMOUNT‐1] [3, 4]).”
Quote in the paperSubstantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 4.4% of those who discontinued late progressed to type 2 diabetes at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperNot a substantial claim - Findingown data
Among those with baseline prediabetes and 1-year HbA1c measurements, 6.5% of those who discontinued early progressed to type 2 diabetes at 1 year.
“Of those 895 patients, 53.9% (482) converted to normoglycemia at 1 year, including 33.1% (56) of those who discontinued early, 41.0% (102) of those who discontinued late, and 67.9% (324) of those who did not discontinue treatment; only 3.4% (30) progressed to T2D, including 6.5% (11) who discontinued early, 4.4% (11) who discontinued late, and 1.7% (8) who never discontinued (p < 0.001).”
Quote in the paperSubstantial claim - Findingown data
In this study, 32.0% of patients discontinued their obesity pharmacotherapy late.
“In this study, 20.4% of patients discontinued their obesity pharmacotherapy early, and 32.0% discontinued late, which is considerably higher than the rates of discontinuation at ~1 year in the main phase 3 trials (including 17.1% for semaglutide 2.4 mg injection [STEP 1] and 14.3%–16.4% for tirzepatide 5–15 mg [SURMOUNT‐1] [3, 4]).”
Quote in the paperSubstantial claim - Premisecitation
Discontinuation with these obesity medications is common.
“Emerging data suggest that discontinuation with these OMs is common [6, 7, 10, 11]”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [6] Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, et al. Semaglutide vs tirzepatide for weight loss in adults with overweight or obesity. JAMA Intern Med. 2024; 184: 1056‐ 1064. doi: 10.1001/jamainternmed.2024.2525 38976257 PMC11231910 source
Not checked in the free run.
- cites [7] Gasoyan H, Pfoh ER, Schulte R, Le P, Butsch WS, Rothberg MB. One‐year weight reduction with semaglutide or liraglutide in clinical practice. JAMA Netw Open. 2024; 7(9): e2433326. doi: 10.1001/jamanetworkopen.2024.33326 39269703 PMC11400221 source
Not checked in the free run.
- cites [10] Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early‐ and later‐stage persistence with antiobesity medications: a retrospective cohort study. Obesity (Silver Spring). 2024; 32(3): 486‐ 493. doi: 10.1002/oby.23952 38053443 source
Not checked in the free run.
- cites [11] Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual‐labeled GLP‐1 receptor agonists among US adults with overweight or obesity. JAMA Netw Open. 2025; 8(1): e2457349. doi: 10.1001/jamanetworkopen.2024.57349 39888616 PMC11786232 source
Not checked in the free run.
- Premisecitation
In randomized controlled trials, semaglutide and tirzepatide have demonstrated greater weight reduction in patients with obesity without type 2 diabetes compared to other FDA-approved obesity medications.
“In randomized controlled trials, the long‐acting glucagon‐like peptide‐1 receptor agonist (GLP‐1RA) semaglutide and glucose‐dependent insulinotropic polypeptide (GIP) and GLP‐1 dual receptor agonist tirzepatide have demonstrated greater weight reduction in patients with obesity without T2D compared to other obesity medications (OMs) previously approved by the Food and Drug Administration (FDA) [3,”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [3] Wilding JPH, Batterham RL, Calanna S, et al. Once‐weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021; 384(11): 989‐ 1002. doi: 10.1056/NEJMoa2032183 33567185 source
Not checked in the free run.
- cites [4] Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022; 387(3): 205‐ 216. doi: 10.1056/NEJMoa2206038 35658024 source
Not checked in the free run.
- cites [5] Gudzune KA, Kushner RF. Medications for obesity: a review. JAMA. 2024; 332(7): 571‐584. doi: 10.1001/jama.2024.10816 39037780 source
Not checked in the free run.
- Interpretationown data
Treatment discontinuation and use of lower maintenance dosages might reduce the likelihood of achieving clinically meaningful weight reduction in patients who initiate obesity pharmacotherapy with semaglutide or tirzepatide.
“Our findings indicate that treatment discontinuation and use of lower maintenance dosages might reduce the likelihood of achieving clinically meaningful weight reduction in patients who initiate obesity pharmacotherapy with semaglutide or tirzepatide.”
Quote in the paperSubstantial claim- Rests on an assumption: The phase 3 trial populations and the current cohort are comparable enough that differences in weight reduction can be attributed to discontinuation and dosage.
- Study design and conductown data
The findings were supported by sensitivity analyses that excluded patients who had a different obesity medication in the first versus last fill within the first year and those with a prescription fill for an FDA-approved obesity medication up to 12 months prior to the index fill.
“These findings were supported by the sensitivity analyses that excluded 1) patients who had a different OM in the first versus last fill within the first year and 2) those with a prescription fill for an FDA‐approved OM up to 12 months prior to the index fill of semaglutide or tirzepatide (Tables S5–S7 and Figures S3 and S4 ).”
Quote in the paperSubstantial claim - Premisecitation
Outside of randomized clinical trial settings, there is a paucity of long-term data on weight reduction and glycemic control with tirzepatide or semaglutide.
“Outside of randomized clinical trial settings, there is a paucity of long‐term data on weight reduction and glycemic control with tirzepatide or semaglutide [6, 7].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [6] Rodriguez PJ, Goodwin Cartwright BM, Gratzl S, et al. Semaglutide vs tirzepatide for weight loss in adults with overweight or obesity. JAMA Intern Med. 2024; 184: 1056‐ 1064. doi: 10.1001/jamainternmed.2024.2525 38976257 PMC11231910 source
Not checked in the free run.
- cites [7] Gasoyan H, Pfoh ER, Schulte R, Le P, Butsch WS, Rothberg MB. One‐year weight reduction with semaglutide or liraglutide in clinical practice. JAMA Netw Open. 2024; 7(9): e2433326. doi: 10.1001/jamanetworkopen.2024.33326 39269703 PMC11400221 source
Not checked in the free run.
- Interpretationown data
Weight reduction and change in HbA1c varied significantly by treatment discontinuation status.
“Weight reduction and change in HbA1c varied significantly by treatment discontinuation status.”
Quote in the paperSubstantial claim - Premisecitation
Relatively little real-world data are available on the relationship between discontinuation of obesity pharmacotherapy and long-term weight outcomes.
“As clinicians and policy makers pay closer attention to the issue of treatment discontinuation of these highly effective medications, relatively little real‐world data are available on the relationship between discontinuation and long‐term weight outcomes [10, 20, 21].”
Quote in the paperSubstantial claim0 of 3 sources checked- cites [10] Gasoyan H, Pfoh ER, Schulte R, Le P, Rothberg MB. Early‐ and later‐stage persistence with antiobesity medications: a retrospective cohort study. Obesity (Silver Spring). 2024; 32(3): 486‐ 493. doi: 10.1002/oby.23952 38053443 source
Not checked in the free run.
- cites [20] Khan SS, Ndumele CE, Kazi DS. Discontinuation of glucagon‐like peptide‐1 receptor agonists. JAMA. 2025; 333(2): 113‐114. doi: 10.1001/jama.2024.22284 39535741 source
Not checked in the free run.
- cites [21] Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP‐1 receptor agonist discontinuation among patients with obesity and/or type 2 diabetes. JAMA Netw Open. 2024; 7(5): e2413172. doi: 10.1001/jamanetworkopen.2024.13172 38787563 PMC11127113 source
Not checked in the free run.
- Study design and conductcitation
The study integrated prescription dispensation data from Surescripts with clinical information.
“Strengths of this study include its large and contemporaneous sample, integration of prescription dispensation data from Surescripts with clinical information [12, 13], and inclusion of all patients who received the medication, regardless of whether they discontinued treatment.”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [12] Blecker S, Adhikari S, Zhang H, et al. Validation of EHR medication fill data obtained through electronic linkage with pharmacies. J Manag Care Spec Pharm. 2021; 27(10): 1482‐ 1487. doi: 10.18553/jmcp.2021.27.10.1482 34595945 PMC8759289 source
Not checked in the free run.
- cites [13] Surescripts dispensed prescription data service now covers nearly 240 million patients to advance population health. Press release. Surescripts; May 22, 2017. Accessed October 30, 2024. https://surescripts.com/news‐center/press‐releases/detail/surescripts‐dispensed‐prescription‐data‐service‐now‐covers‐nearly‐240‐million‐patients‐to‐advance‐population‐health
Not checked in the free run.
- Interpretationown data
Discontinuation rates in this study were considerably higher than the rates of discontinuation at approximately 1 year in the main phase 3 trials (17.1% for semaglutide 2.4 mg injection in STEP 1 and 14.3-16.4% for tirzepatide 5-15 mg in SURMOUNT-1).
“In this study, 20.4% of patients discontinued their obesity pharmacotherapy early, and 32.0% discontinued late, which is considerably higher than the rates of discontinuation at ~1 year in the main phase 3 trials (including 17.1% for semaglutide 2.4 mg injection [STEP 1] and 14.3%–16.4% for tirzepatide 5–15 mg [SURMOUNT‐1] [3, 4]).”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Wilding JPH, Batterham RL, Calanna S, et al. Once‐weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021; 384(11): 989‐ 1002. doi: 10.1056/NEJMoa2032183 33567185 source
Not checked in the free run.
- cites [4] Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022; 387(3): 205‐ 216. doi: 10.1056/NEJMoa2206038 35658024 source
Not checked in the free run.
- Interpretationown data
The stability of weight trajectories after discontinuation in this study is in contrast to what has been observed after medication discontinuation at the end of randomized trials.
“This is in contrast to what has been observed after medication discontinuation at the end of randomized trials [9, 23].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [9] Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT‐4 randomized clinical trial. JAMA. 2024; 331(1): 38‐ 48. doi: 10.1001/jama.2023.24945 38078870 PMC10714284 source
Not checked in the free run.
- cites [23] Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity. JAMA. 2021; 325(14): 1414‐ 1425. doi: 10.1001/jama.2021.3224 33755728 PMC7988425 source
Not checked in the free run.
- Study design and conductnone given
The study included all patients who received the medication, regardless of whether they discontinued treatment.
“Strengths of this study include its large and contemporaneous sample, integration of prescription dispensation data from Surescripts with clinical information [12, 13], and inclusion of all patients who received the medication, regardless of whether they discontinued treatment.”
Quote in the paperSubstantial claim - Interpretationcitation
The discontinuation rates in this study are lower than previously reported rates based on claims data (64.8% at 1 year), albeit for a different combination of obesity medications.
“These discontinuation rates are also lower than previously reported rates based on claims data (64.8% at 1 year), albeit for a different combination of OMs [11].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [11] Rodriguez PJ, Zhang V, Gratzl S, et al. Discontinuation and reinitiation of dual‐labeled GLP‐1 receptor agonists among US adults with overweight or obesity. JAMA Netw Open. 2025; 8(1): e2457349. doi: 10.1001/jamanetworkopen.2024.57349 39888616 PMC11786232 source
Not checked in the free run.
- Interpretationreasoning
The average weight reduction in this cohort was lower than that observed in the main phase 3 trials of semaglutide 2.4 mg (STEP 1) and tirzepatide 5 to 15 mg (SURMOUNT-1).
“The average weight reduction in this cohort was lower than that observed in the main phase 3 trials of semaglutide 2.4 mg (STEP 1) and tirzepatide 5 to 15 mg (SURMOUNT‐1), in which 14.9% and 15.0% and 20.9% weight reduction, respectively, was demonstrated in patients with overweight or obesity (without T2D) plus a lifestyle intervention [3, 4].”
Quote in the paperSubstantial claim0 of 2 sources checked- cites [3] Wilding JPH, Batterham RL, Calanna S, et al. Once‐weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021; 384(11): 989‐ 1002. doi: 10.1056/NEJMoa2032183 33567185 source
Not checked in the free run.
- cites [4] Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022; 387(3): 205‐ 216. doi: 10.1056/NEJMoa2206038 35658024 source
Not checked in the free run.
- Interpretationown data
The lower average weight reduction in this cohort compared with phase 3 trials is likely because of higher rates of discontinuation and lower maintenance dosages of these obesity medications.
“This is likely because of higher rates of discontinuation and lower maintenance dosages of these OMs in our cohort; patients who did not discontinue obesity pharmacotherapy and received a high maintenance dosage had comparable weight reduction, including 13.7% with semaglutide and 18.0% with tirzepatide.”
Quote in the paperSubstantial claim - Interpretationown data
In patients who had prediabetes at baseline, treatment discontinuation was associated with attenuated HbA1c reduction at 1 year.
“In patients who had prediabetes at baseline, treatment discontinuation was also associated with attenuated HbA1c reduction at 1 year.”
Quote in the paperSubstantial claim
- May combine two claims. 12
- The quote only partly states this claim. 1
- Classified as probably not a substantial claim. 2
May combine two claims. The quote only partly states this claim.
Findingown dataThe study identified 7881 patients who initiated injectable semaglutide or tirzepatide for obesity between 2021 and 2023, of whom 6109 received semaglutide and 1772 received tirzepatide.
“We identified 7881 patients; 6109 received semaglutide, and 1772 received tirzepatide.”
Quote in the paperNot a substantial claimMay combine two claims.
Findingown dataDuring the first year, 31.4% of patients who initiated semaglutide and 34.1% of those with tirzepatide discontinued obesity pharmacotherapy late.
“whereas 31.4% (1917) with semaglutide and 34.1% (605) with tirzepatide discontinued later”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDuring the first year, 47.0% of patients who initiated semaglutide and 49.4% of those with tirzepatide did not discontinue obesity pharmacotherapy.
“47.0% (2874) and 49.4% (876) of patients on semaglutide and tirzepatide, respectively, did not discontinue”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataDuring the first year, 21.6% of patients who initiated semaglutide and 16.4% of those with tirzepatide discontinued obesity pharmacotherapy early.
“During the first year, 21.6% (1318) of patients who initiated treatment with semaglutide and 16.4% (291) of those with tirzepatide discontinued obesity pharmacotherapy early”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataIn this retrospective cohort study of 7881 patients treated with injectable semaglutide or tirzepatide for obesity in a routine clinical setting, treatment discontinuation and lower maintenance dosages were common.
“In this retrospective cohort study of 7881 patients treated with injectable forms of semaglutide or tirzepatide for obesity in a routine clinical setting, treatment discontinuation and lower maintenance dosages were common.”
Quote in the paperSubstantial claimMay combine two claims.
Findingown dataAlthough patients who discontinued obesity pharmacotherapy lost significantly less weight compared to those who persisted, weight trajectories remained surprisingly stable after discontinuation throughout the study follow-up period.
“Interestingly, although patients who discontinued obesity pharmacotherapy lost significantly less weight compared to those who persisted, weight trajectories remained surprisingly stable after discontinuation throughout the study follow‐up period.”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationIn the STEP 1 trial extension study, patients on average regained two-thirds of their lost weight and cardiometabolic improvements reversed following discontinuation of semaglutide and lifestyle intervention.
“In the Semaglutide Treatment Effect in People with Obesity (STEP) 1 trial extension study, patients, on average, regained two‐thirds of their lost weight and cardiometabolic improvements reversed following the discontinuation of semaglutide and lifestyle intervention [8].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [8] Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the step 1 trial extension. Diabetes Obes Metab. 2022; 24(8): 1553‐ 1564. doi: 10.1111/dom.14725 35441470 PMC9542252 source
Not checked in the free run.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe Surescripts prescription data service captures prescriptions paid for through insurance benefits, cash, coupons, or other methods from nearly all major pharmacies and pharmacy benefit managers in the United States.
“The Surescripts prescription data service captures prescriptions paid for through insurance benefits, cash, coupons, or other methods from nearly all major pharmacies and pharmacy benefit managers in the United States [13].”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [13] Surescripts dispensed prescription data service now covers nearly 240 million patients to advance population health. Press release. Surescripts; May 22, 2017. Accessed October 30, 2024. https://surescripts.com/news‐center/press‐releases/detail/surescripts‐dispensed‐prescription‐data‐service‐now‐covers‐nearly‐240‐million‐patients‐to‐advance‐population‐health
Not checked in the free run.
May combine two claims.
PremisecitationIn the SURMOUNT-4 trial, discontinuation of tirzepatide resulted in substantial regain of lost weight, with only 17% of participants maintaining at least 80% of the weight loss achieved.
“Similarly, discontinuation of tirzepatide resulted in a substantial regain of lost weight in the SURMOUNT‐4 trial, with only 17% of participants maintaining at least 80% of the weight loss achieved [9].”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9] Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT‐4 randomized clinical trial. JAMA. 2024; 331(1): 38‐ 48. doi: 10.1001/jama.2023.24945 38078870 PMC10714284 source
Not checked in the free run.
May combine two claims.
InterpretationreasoningThe average weight reduction in this cohort was lower than that observed in the main phase 3 trials, likely because of higher rates of discontinuation and lower maintenance dosages.
“The average weight reduction in this cohort was lower than that observed in the main phase 3 trials, likely because of higher rates of discontinuation and lower maintenance dosages.”
Quote in the paperSubstantial claim- Rests on an assumption: The phase 3 trial populations and the current cohort are comparable enough that differences in weight reduction can be attributed to discontinuation and dosage.
May combine two claims.
InterpretationreasoningThe study included adult patients from Ohio and Florida in a single, large integrated health system, which may limit the generalizability of the findings.
“We included adult patients from Ohio and Florida in a single, large integrated health system. Patient characteristics and health care delivery patterns vary across the United States, which may limit the generalizability of our findings.”
Quote in the paperNot a substantial claimMay combine two claims.
Study design and conductown dataThe study did not capture participation in lifestyle interventions and nutritional counseling or patient- and clinician-related factors, and the impact of these factors could not be examined.
“This study did not capture participation in lifestyle interventions and nutritional counseling or patient‐ and clinician‐related factors (such as discontinuation of the medication therapy owing to inadequate weight reduction, adverse effects, or coverage issues), and the impact of these factors could not be examined in this study.”
Quote in the paperSubstantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe effectiveness of these medications for prediabetes has been reported earlier.
“The effectiveness of these medications for prediabetes has been reported earlier [24, 25].”
Quote in the paperNot a substantial claim0 of 2 sources checked- cites [24] Perreault L, Davies M, Frias JP, et al. Changes in glucose metabolism and glycemic status with once‐weekly subcutaneous semaglutide 2.4 mg among participants with prediabetes in the STEP program. Diabetes Care. 2022; 45(10): 2396‐ 2405. doi: 10.2337/dc21-1785 35724304 PMC9862484
Not checked in the free run.
- cites [25] Hankosky ER, Wang H, Neff LM, et al. Tirzepatide reduces the predicted risk of developing type 2 diabetes in people with obesity or overweight: post hoc analysis of the surmount−1 trial. Diabetes Obesity Metab. 2023; 25(12): 3748‐ 3756. doi: 10.1111/dom.15269 37700443 source
Not checked in the free run.
May combine two claims.
Study design and conductnone givenThe study had a large and contemporaneous sample.
“Strengths of this study include its large and contemporaneous sample, integration of prescription dispensation data from Surescripts with clinical information [12, 13], and inclusion of all patients who received the medication, regardless of whether they discontinued treatment.”
Quote in the paperSubstantial claim
The paper relies on this without support.
Little is known regarding how discontinuation and its timing affect outcomes in clinical practice.
“but little is known regarding how discontinuation and its timing affect outcomes in clinical practice.”
The paper relies on this without support.
The phase 3 trial populations and the current cohort are comparable enough that differences in weight reduction can be attributed to discontinuation and dosage.
“The average weight reduction in this cohort was lower than that observed in the main phase 3 trials, likely because of higher rates of discontinuation and lower maintenance dosages.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Many patients on GLP-1 based therapies do not receive appropriate nutrition advice and struggle to maintain or achieve their intended weight reduction.
“However, despite their impressive weight reduction capabilities, many patients on GLP-1 based therapies do not receive appropriate nutrition advice and struggle to maintain their weight reduction.”
From Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions (2025) · cites this paper as [25]
Data from two retrospective cohort studies reported a positive association between achieving at least 10% weight reduction at 1 year and non-discontinuation or late discontinuation of GLP-1 based therapy.
“data from two retrospective cohort studies reported a positive association with achieving at least 10 % weight reduction at 1 year and non-discontinuation of GLP-1 based therapy or late discontinuation (i.e. within 3–12 months of treatment initiation versus early discontinuation i.e. within 3 months of treatment initiation) [25,121].”
From Application of nutrition interventions with GLP-1 based therapies: A narrative review of the challenges and solutions (2025) · cites this paper as [25]
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Coverage is the Key to Realizing the Promise of Semaglutide
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- Authors
- Gasoyan, H., Butsch, W. S., Schulte, R., Casacchia, N. J., Le, P., Boyer, C. B., Griebeler, M. L., Burguera, B., & Rothberg, M. B.
- Affiliations
- Cleveland Clinic (US)
- Corresponding author
- Gasoyan, Hamlet
- ORCID
- Venue
- Obesity
- Publisher
- Wiley
- Published
- 2025-06-10
- Volume
- 33
- Issue
- 9
- Pages
- 1657-1667
- ISSN
- 1930-7381 (ISSN-L)
- 1930-739X
- PMC
- PMC12381620
- OpenAlex
- W4411190461
- Semantic Scholar
- 329e5f5a74019604b9617b74441012beaac66c56
- Cited by
- 54
- References
- 23
- Citations by year
- 2026: 45 · 2025: 9
- FWCI
- 30.54
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Obesity (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- Funders
- Cleveland Clinic
- Topics
- Health Sciences › Medicine › Pharmacology › Pharmacology and Obesity Treatment
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Surgery › Bariatric Surgery and Outcomes
- Keywords
- semaglutide, tirzepatide, obesity pharmacotherapy, treatment discontinuation, weight loss, HbA1c, glycemic control, prediabetes, overweight, GLP-1 receptor agonists, SGLT2 inhibitors, maintenance dose, real-world outcomes
- MeSH terms
- Glycemic Control, Tirzepatide, Semaglutide, Adult, Aged, Blood Glucose, Body Weight, Diabetes Mellitus, Type 2, Glucagon-Like Peptides, Female, Glycated Hemoglobin, Humans, Hypoglycemic Agents, Male, Middle Aged, Obesity, Ohio, Retrospective Studies, Weight Loss, Glucagon-Like Peptide 1
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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