Real-world semaglutide: dose and dropout

A July 2026 retrospective study in Diabetes, Obesity and Metabolism examined how semaglutide is actually used in a Danish general practice setting: how quickly patients reach the approved maintenance dose, how many discontinue within 12 months, and what weight changes look like in those who stay on treatment^[1]. The findings differ from the tightly controlled conditions of registration trials.

The study and who it included

Skandov and colleagues analysed records from a single Danish general practice over roughly 17 months, from December 2022 to May 2024^[1]. The 206 participants were 76% female, with a mean age of 48 years and a mean baseline weight of 105 kg. This is a general-practice population, not a specialist obesity clinic, so the sample reflects the broader group of people receiving semaglutide outside of trial conditions.

Dose titration in practice

The approved schedule for Wegovy (subcutaneous semaglutide 2.4 mg for weight management) involves a 16-week gradual dose escalation to reduce gastrointestinal side effects^[2]. In the STEP-1 registration trial, the 2.4 mg maintenance dose was the target and the mean weight loss at 68 weeks was 14.9% against 2.4% on placebo^[3].

In the Danish general practice, the picture was different. Among patients who were still using semaglutide at 12 months, 40% were on doses at or below 1.0 mg per week^[1]. A further 30% were using 1.7 mg per week, and only 30% had reached the 2.4 mg target dose. In other words, most continuing patients in this setting were using less than the approved maximum.

The likely driver is tolerability. Gastrointestinal side effects (nausea, vomiting, constipation) are the main reason patients slow or pause escalation. In a general-practice setting without specialist support, staying on a lower, tolerated dose rather than pushing toward the approved maximum is a common clinical adaptation.

How many stopped treatment

Discontinuation rates were high. At 12 months, 38% of participants had permanently stopped semaglutide and a further 15% had temporarily paused^[1]. That means only around half of patients who started were still on treatment without interruption at the one-year mark.

This is not unusual for weight-management medications in general practice. Studies of other anti-obesity medicines report similar or higher discontinuation at 12 months. What the Danish study adds is a granular picture of dose at the point of stopping, which is harder to find in claims-database analyses.

Weight outcomes in continuers

Patients who remained on semaglutide without gaps at 12 months lost a mean 13.6% of their starting body weight (95% CI: 15.0% to 12.2%)^[1]. That is clinically meaningful and consistent with the lower end of what STEP-1 showed at 68 weeks in a trial setting, where 14.9% was the mean loss on 2.4 mg^[3]. Given that 70% of continuers in the Danish practice were on doses below 2.4 mg, a 13.6% mean is a notable outcome.

What real-world data adds to the trial picture

Registration trials are optimised for efficacy under closely monitored conditions. They select participants, control adherence, and titrate to target doses. Real-world observational studies fill in what happens outside those conditions. The gap between the STEP-1 mean weight loss of 14.9% at 2.4 mg^[3] and the Danish mean of 13.6% at doses where 40% of continuers were below 1.0 mg is smaller than one might expect, which is encouraging. But the 53% of patients who either stopped permanently or paused within 12 months represents a substantial real-world limitation of the therapy.

The authors are Danish clinicians at a single practice. Their data covers a short observation window (the Danish national semaglutide prescribing for obesity began in earnest from late 2022 following EMA authorisation of Wegovy^[2]). Extrapolating to other countries, healthcare systems, or patient populations requires caution.

What this study does not tell us

The study is observational and retrospective, based on one Danish general practice. It does not randomise patients, does not control for confounders, and cannot establish why patients discontinued (patient choice, clinician decision, side effects, cost, or supply problems are all possible). The 12-month horizon does not capture longer-term weight trajectory. And because it is a single practice, the results may not reflect other practices even within Denmark. Prospective cohorts with richer data on reasons for discontinuation would strengthen the picture considerably.

For readers in specific countries, access to semaglutide for weight management varies by approval status and prescribing criteria. The regulatory situation for semaglutide differs across jurisdictions. This article is for educational purposes and does not constitute medical advice. If you are considering semaglutide for weight management, discuss your individual situation with a qualified healthcare professional.