16.7% average weight loss on GLP-1 micro-dosing of 1.08 mg semaglutide per week

In one of the largest and longest real-world obesity studies to date that tracked nearly 2,700 adults over 64 weeks found patients achieved 16.7% average weight loss using a mean dose of just 1.08 mg of semaglutide per week, substantially lower than the typical 2.4 mg target used in most US treatment models. The results, presented at the European Congress on Obesity 2025, validate a personalised dosing model that pairs clinical oversight with structured coaching and tapering, researchers claim.

In addition, nearly 98% of participants lost at least 5% of their starting body weight, a threshold widely recognised as clinically meaningful, and many sustained results even after tapering off the medication entirely.

As GLP-1 adoption grows among US employers, the study points to a path toward meaningful outcomes without escalating drug costs. It suggests that many patients may be escalated to higher doses by default, and that structured support, dose personalisation, and behavioural coaching could offer a more sustainable model.

The study used an approach to weight loss developed by Embla, a digital weight care solution built for cost-conscious US employers. The approach combines GLP-1 micro-dosing with expert psychology-based coaching. Embla uses a treat-to-target protocol that holds doses steady when patients are progressing, with fewer than 30 percent of users escalating beyond 1 mg per week. Every patient receives ongoing clinical oversight, access to trained human coaches and a structured tapering plan that begins once goals are met, which is a level of behavioural and pharmacologic integration still uncommon in the space. The company is now making its approach available to US employers as an alternative to high-dose GLP-1 programmes.

The study, ‘Treat to Target in Weight Management with Semaglutide: Real-World Evidence from an eHealth Clinic’,  by researchers for the University of Copenhagen, evaluated the effectiveness of an online multidisciplinary weight loss service combining personalized semaglutide doses with intensive behavioural therapy (IBT).

This retrospective cohort study was based on the Danish database of participants treated with semaglutide and IBT including personalized evidence-based recommendations on nutrition, exercise and habits through an online app (The Embla app). The program is available for adult individuals living with overweight or obesity in Denmark. All contact with participants, data collection, and monitoring was conducted via the Embla app during the period December 2022 to September 2024. The primary outcome was percentage change in body weight at week 64. Secondary outcomes were use of semaglutide, proportion of participants achieving ≥5%, ≥10%, ≥15%, or ≥20% weight loss, and percentage change in body weight according to baseline BMI and semaglutide dosing.

The study included 2,694 participants, of which 2100 (78%) were women, mean [SD] age was 46.8 [10·8] years, and mean BMI was 34·3 [4·8]. After 26, 52 and 64 weeks, respectively, 1580, 712 and 465 participants were still included. Participants had a mean weight loss of -16·7% (95%CI, -17·4 to -16·0) after 64 weeks, with a mean semaglutide dose of 1·08 mg/week (SD 0·54). 98% and 83% of the participants achieved weight loss of at least 5% and 10%. The percentage change in body weight was similar across baseline BMI class subgroups and across mean medication doses.

Participants in the Embla online clinic achieved weight loss of a magnitude similar to those reported in confirmatory randomised controlled trials but with less than half of the medication used. Similar mean weight loss was observed across BMI classes and all medication doses.

“These results highlight the effectiveness of a personalized, treat-to-target approach to medical obesity management in combination with individualised coaching,” the researchers concluded.

"GLP-1s are powerful tools, but the tools too often become the treatment. When care is designed around the drug, doses are pushed higher by default. But when care is designed around the patient, lower doses often prove sufficient," said Nicholas Syhler, co-founder and co-CEO, Embla. "Our landmark study confirms that patients can achieve strong outcomes with less medication and underscores the urgency for a more thoughtful and sustainable approach to obesity care. It's time to rethink how we define effective care."

Embla's coaching is grounded in Acceptance and Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT), two evidence-based modalities shown to support lasting behaviour change in weight management. This psychological layer complements the clinical protocol and is central to Embla's effort to make obesity care more durable, accessible, and patient-centred.

"GLP-1s have created a wave of opportunity, but also a wave of confusion, especially in markets like the U.S. where cost, access, and care delivery often pull in different directions," said Laust Wilster Axelsen, co-founder and co-CEO, Embla. "Employers, clinicians, and patients all want better outcomes, but they also want predictability, safety, and a sense of control. Our model is built to deliver that with a clinical framework that supports tapering, reinforces behavior change and makes results more sustainable."