Real‐world titration, persistence & weight loss of semaglutide and tirzepatide in an academic obesity clinic
Open accessAbstract
Aims: Trials of the Glucagon‐like Peptide‐1 Receptor Agonists (GLP1RAs) found mean weight losses of 15%–21%, yet realworld dose titration and persistence remain suboptimal, limiting effectiveness. This study aims to determine real‐world titration, persistence and effectiveness of GLP1RAs in patients managed within a multidisciplinary obesity clinic. Materials and Methods: This is a singlecentre, retrospective cohort study of patients seen in a multidisciplinary obesity clinic at an academic medical centre from January 2022 to December 2024. Consecutive patients aged 18–75 years enrolled in a ‘no cost to patient’ Medical Weight Loss Bundle program who received ≥1 prescription fill of semaglutide or tirzepatide. Of 2855 enrollees, 2306 (81%) received at least one GLP1RA prescription. The primary outcome was persistence with GLP1RA therapy (continuous prescription fills without a gap ≥84 days). Secondary measures included titration adherence and percentage change in body weight. Results: Among 2306 patients (median age 46.0 years, Interquartile Ratio [IQR] 38.0–55.0; 85% female; 68% White, 28% Black, 4% Hispanic), with median persistence 10.7 months (IQR 5.4–16.3). Semaglutide was used by 1614 (70%), tirzepatide by 117 (5%), and both agents by 575 (25%). Of semaglutide users, 81% escalated to ≥1 mg and 23% to 2.4 mg; of tirzepatide users, 75% received ≥10 mg and 28% received 15 mg. Among patients persistent for ≥6 months, median weight loss was 9.4% (IQR 6.0%–13.4%); for those persistent for ≥12 months, median weight loss was 14.4% (IQR 9.5%–20.5%). Conclusions: GLP1RA persistence and dosetitration adherence were moderate but weight loss approximated that seen in clinical trials, supporting real‐world effectiveness.
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In a landscape where long-term stability costs between USD 12,000 and 16,000 annually, metabolic health effectively becomes a subscription-based service.
“In a landscape where long-term stability costs between USD 12,000 and 16,000 annually (Barrett et al., 2025; Samuels et al., 2025), metabolic health effectively becomes a subscription-based service.”
From IS OBESITY PHARMACOTHERAPY A LIFETIME COMMITMENT? A STRUCTURED REVIEW OF WEIGHT REGAIN AND STRATEGIES FOLLOWING INCRETIN CESSATION (2026) · cites this paper as Samuels et al., 2025
The Discussion describes GLP-1 receptor agonists as having a heightened cost, and the Methods describe a 12-month weight-loss care bundle. Neither passage gives an annual cost of USD 12,000–16,000 or establishes the cost of long-term weight stability. The subscription analogy is the citing authors’ own framing. (LLM, conf=0.79)
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- Authors
- Samuels, J. M., Ye, F., Irlmeier, R., Silver, H., Srivastava, G., & Spann, M.
- Affiliations
- Vanderbilt University Medical Center (US)
- University of Miami (US)
- United States Department of Veterans Affairs (US)
- Vanderbilt University (US)
- Corresponding author
- Samuels, Jason M.
- Venue
- Diabetes, Obesity and Metabolism
- Publisher
- Wiley
- Published
- 2025-08-05
- Volume
- 27
- Issue
- 11
- Pages
- 6200-6209
- ISSN
- 1462-8902 (ISSN-L)
- 1463-1326
- PMC
- PMC12515774
- OpenAlex
- W4412952595
- Cited by
- 35
- References
- 28
- Citations by year
- 2026: 31 · 2025: 4
- FWCI
- 19.79
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Diabetes Obesity and Metabolism (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Funders
- National Center for Advancing Translational Sciences (UL1 TR002243)
- 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, GLP-1 receptor agonists, obesity, weight loss, dose titration, treatment persistence, real-world effectiveness, obesity clinic
- MeSH terms
- Academic Medical Centers, Glucagon-Like Peptide-1 Receptor Agonists, Tirzepatide, Semaglutide, Adolescent, Adult, Aged, Glucagon-Like Peptides, Female, Humans, Hypoglycemic Agents, Male, Middle Aged, Obesity, Retrospective Studies, Weight Loss, Treatment Outcome, Anti-Obesity Agents, Glucagon-Like Peptide 1, Young Adult
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