Poster Presentation Australian and New Zealand Obesity Society Annual Scientific Conference 2024

The evidence behind all the hype: A retrospective study of the efficacy of semaglutide 1 mg for the treatment of obesity in adults with prediabetes or normoglycaemia (#235)

Akash Konantambigi 1 , Ramy Bishay 1 2 , Tensae Mekonnen 3 , Golo Ahlenstiel 4 5 6 , Mark Mclean 1 7 8
  1. School of Medicine, University of Western Sydney, Sydney, NSW, Australia
  2. Endocrine & Metabolic Clinic, The Ashley Centre, Westmead, NSW, Australia
  3. Blacktown Hospital, Metabolic & Weight Loss Program, Blacktown, NSW, Australia
  4. Storr Liver Centre, Westmead Millennium Institute, Westmead Hospital, University of Sydney, Sydney, NSW, Australia
  5. Department of Gastroenterology and Hepatology, Westmead Hospital, Sydney, NSW, Australia
  6. School of Medicine, University of Sydney, Sydney, NSW, Australia
  7. Research Education Network, Western Sydney Local Health District, Westmead, NSW, Australia
  8. Department of Endocrinology, Westmead Hospital, Westmead, NSW, Australia

BACKGROUND: Semaglutide, a potent glucagon-like peptide 1 receptor agonist (GLP-1 RA), represents a significant advancement in diabetes pharmacotherapy. Although semaglutide 1mg is not indicated for obesity management, global prescribing patterns suggest its effectiveness for weight loss as 'off-label' therapy. However, current evidence for this practice in non-diabetic populations is limited.

METHODS: We retrospectively analysed records from a large private multidisciplinary clinic in Western Sydney. Non-diabetic adults with obesity (BMI > 30 kg/m²) who started semaglutide therapy from July 2020 to December 2022 were included. Patients followed a very low/low energy diet (800-1200 Kcal/day), time-restricted eating, physical activity targets, and received lifestyle coaching. Outcomes included 12-month changes in weight, BMI, waist circumference (WC), blood pressure, liver function tests, and lipid profile.

RESULTS: We identified 171 patients, the majority (n=113) receiving weekly semaglutide for 12 months, and 58 continuing for 3-6 months. At baseline, mean age was 44.8 ± 1.05 years, 78.9% female. Medical comorbidities included prediabetes (8.8%), hyperlipidaemia (32.2%), fatty liver disease (32.2%), hypertension (25.1%), GORD (24.6%), OSA (21.1%), PCOS (21.1%), osteoarthritis (17.5%), and cardiovascular disease (10.5%).  Mean weight was 105.02 ± 2.25 kg, BMI 37.95 ± 0.61 kg/m2, and WC 112.81 ± 1.37 cm. After 12 months, there was mean reductions in body weight of -13.28 kg (95% CI, 12.01 to 14.55, p<0.0001), BMI -4.77 kg/m2 (95% CI, 4.36 to 5.19, p<0.0001), and WC -13.97 cm (95% CI, 11.30 to 16.44, p<0.0001). Proportional weight loss of ≤ 5% loss was achieved by 10.5% of the cohort, 5.1-10% loss in 28.1%, 10.1-15% loss in 25.7%, and >15% in 35.7%. All secondary outcomes including BP, liver enzymes, and lipid profile saw global improvements (p<0.001).

CONCLUSION: Weekly semaglutide 1mg in non-diabetic patients with obesity was effective for significant weight loss when combined with a multidisciplinary approach. Further evaluation of long-term outcomes is warranted.