Post-Initiation Care Patterns and Weight Loss With Semaglutide and Tirzepatide for Obesity in Clinical Practice
- Design
- Retrospective cohort · 743153 participants · Intermediate outcome
- Match to healthy normal-weight adults aged 55–75
- Different populationINDIRECT: all participants had obesity (without diabetes); mean age 48.5 years, 72.5% female.
- Could weight loss explain it?
- Not applicableNot applicable: the outcomes are weight loss and care patterns.
- Study tier
- PreliminaryPRELIMINARY: preprint, not peer reviewed; a descriptive observational cohort with no comparator.
- Assessment
- Version 3 · Two independent AI reviews agreed · Oct 19, 2026
Study facts come from the paper. Population match, weight-loss explanation and study tier are our judgments, made against the reference group of healthy normal-weight adults aged 55–75. This item has not been peer reviewed.
This preprint describes 743,153 US adults with obesity and without diabetes (mean age 48.5 years) who started semaglutide or tirzepatide in 2024, using health-record data. Most did not stay on treatment for a year: 29.9% and 35.9% were still prescribed the drug at 12 months, and about half had no recorded 12-month weight. Weight loss of at least 5% was recorded in 25.6% (semaglutide) and 30.4% (tirzepatide) of all starters, more often in those who stayed on a maintenance dose; with no comparison group, this is a description, not a treatment effect.
01Findings
What the study reported
- Drugs
- Semaglutide, Tirzepatide
- Comparator
- not reported in abstract
- Primary outcome
- first-year care patterns (prescribing persistence, maintenance-dose attainment, weight documentation) and total body weight loss
- Effect
- 12-month prescribing persistence 29.9% (semaglutide) and 35.9% (tirzepatide); maintenance-dose attainment 28.3% and 55.0%; 5% or greater weight loss documented in 25.6% and 30.4% of all initiators, 51.9% and 61.9% of those with a recorded weight, and 82.9% and 87.3% of those also persistent and at a maintenance dose
- 95% confidence interval
- Not extracted
- Follow-up
- 12 months
- Adverse events
- not reported in abstract
- Limitations
- Preprint, not peer reviewed; descriptive retrospective health-record cohort with no comparator, and about half of initiators lacked a 12-month weight, so weight-loss figures in the restricted groups are selected.
Who was studied
- Mean age
- 48.5 years
- Sex distribution
- 72.5% female
- Obesity status
- obesity required (no BMI threshold given)
- Diabetes status
- excluded
- Cvd status
- not reported in abstract
- Ckd status
- not reported in abstract
- Baseline condition
- obesity
- Sample size
- 743153
- Inclusion exclusion
- adults with obesity and without diabetes who initiated injectable semaglutide or tirzepatide in 2024
Study quality details
- Study design
- Retrospective cohort
- Sample size
- 743153
- Randomization
- no
- Blinding
- n/a
- Comparator
- not reported in abstract
- Follow up duration
- 12 months
- Outcome type
- intermediate
- Replication
- not assessed
- Consistency with other evidence
- not assessed
- Population applicability
- INDIRECT
- Statistical precision
- no CI reported; descriptive percentages in 743,153 adults
- Risk of bias
- not assessed
- Funding conflicts
- unclear
- Peer review status
- no
02Funding
Funding and conflicts
- Funding
- not reported in abstract
- Industry funded
- Unclear
- Manufacturer
- not stated in source
- Sponsor role
- not reported in abstract
- Author conflicts
- not reported in abstract
- Independent replication
- unknown
Funding is shown on every study and never used to score it.
04Source
The source, as retrieved
Abstract
BackgroundRandomized trials show substantial weight loss with semaglutide and tirzepatide under structured care, but little is known about whether patients in routine practice continue therapy, reach a maintenance dose, and have their weight measured. ObjectivesTo describe the first year after initiation of semaglutide or tirzepatide for obesity, including care patterns, maintenance-dose attainment, weight documentation, and total body weight loss (TBWL). MethodsThis retrospective cohort study used Epic Cosmos, an electronic health record network of >350 US health systems, to identify adults with obesity and without diabetes who initiated injectable semaglutide or tirzepatide in 2024. Outcomes over 12 months included prescribing persistence, discontinuation, switching, add-on therapy, and reinitiation; attainment of Food and Drug Administration (FDA)-labeled maintenance doses; availability of follow-up weight; and TBWL across progressively restricted populations. ResultsAmong 743,153 adults (60.1% semaglutide; mean age, 48.5 years; 72.5% female), 12-month prescribing persistence was 29.9% for semaglutide and 35.9% for tirzepatide. FDA-labeled maintenance-dose attainment was 28.3% and 55.0%, respectively, and only 8.8% and 16.4% remained prescribing persistent at a maintenance dose with a recorded weight at 12 months. About half of initiators lacked a 12-month weight. Among all initiators, [≥]5% TBWL was documented in 25.6% (semaglutide) and 30.4% (tirzepatide), rising to 51.9% and 61.9% among those with recorded weight, 66.1% and 79.5% among those also prescribing persistent, and 82.9% and 87.3% among those further at a maintenance dose. ConclusionsIn routine practice, most patients initiating semaglutide or tirzepatide did not remain on therapy, reach a maintenance dose, and have weight documented through the first year. Documented weight loss was greatest among those completing each step of care, suggesting continuation, dose escalation, and monitoring as targets for improvement. CENTRAL ILLUSTRATIONCare Cascade and Weight-Loss Outcomes Among Semaglutide and Tirzepatide Initiators, Standardized to 100 Initiators. Numbers are per 100 initiators and were rounded so that categories at each step sum to the preceding step. At the 12-month dose step, prescribed dose was missing for 1 per 100 semaglutide initiators and <1 per 100 tirzepatide initiators. O_FIG O_LINKSMALLFIG WIDTH=200 HEIGHT=122 SRC="FIGDIR/small/26364715v1_ufig1.gif" ALT="Figure 1"> View larger version (27K): org.highwire.dtl.DTLVardef@18db7ceorg.highwire.dtl.DTLVardef@11e3c55org.highwire.dtl.DTLVardef@b1b14org.highwire.dtl.DTLVardef@11ef262_HPS_FORMAT_FIGEXP M_FIG C_FIG
Where this record came from
| Source | Retrieved | Identifier |
|---|---|---|
| medrxiv:medrxiv | Oct 11, 2026 | 10.64898/2026.10.04.26364715 first ingestion |
| medrxiv:medrxiv | Oct 18, 2026 | 10.64898/2026.10.04.26364715 duplicate matched on doi |