JMIR Publications

ABSTRACT

Background:

Real-world adherence to anti-obesity pharmacotherapy remains suboptimal, limiting treatment effectiveness. Digital health platforms may offer opportunities to support treatment engagement and optimize outcomes, but their impact in routine obesity care remains poorly documented.

Objective:

To evaluate whether digital engagement via a structured platform (Aviitam®) is associated with semaglutide treatment continuation and weight loss over 48 weeks in adults with severe obesity. Secondary objectives included assessing clinical and behavioral predictors of weight loss and dose attainment.

Methods:

We conducted a 48-week prospective observational study in a French university hospital. Adults (≥18 years) with a BMI ≥40 kg/m² and at least one obesity-related complication were initiated on semaglutide 2.4 mg/week as part of a national early-access program. Digital engagement was defined as full baseline completion of the Aviitam® platform, which collects standardized self-reported data on lifestyle, nutrition, sleep, and mental health. Primary outcome was treatment continuation at 48 weeks. Secondary outcomes included weight loss and full-dose attainment (2.4 mg/week). A behavioral subgroup (n=91) was defined among digital platform users who completed 48 weeks of treatment and all behavioral questionnaires.

Results:

Of 191 participants (mean age 51.7 ± 13.6 years; 31.9% male; mean BMI 45.7 ± 6.8 kg/m²), 122 (63.9%) completed the Aviitam® baseline questionnaires. Treatment was continued at 48 weeks by 74.3% (142/191) of the cohort. In multivariate analysis, Aviitam® completion was independently associated with lower odds of treatment discontinuation (OR 0.47, 95% CI 0.23–0.94, P = .03). Full-dose attainment (2.4 mg/week) was achieved by 87.3% of completers and was strongly associated with greater weight loss. At 48 weeks, mean weight loss was 14.6 ± 10.4 kg (11.8% ± 8.4%) in the full cohort and 18.0 ± 9.1 kg (14.6% ± 7.3%) in treatment completers. In the behavioral subgroup, higher scores on the Intuitive Eating Scale-2 (β = +1.03% weight loss per point, P = .007) and the Epworth Sleepiness Scale (β = +0.14% per point, P = .005) were positively associated with weight loss. Treated obstructive sleep apnea (OSA), family history of diabetes, and higher lowest reported adult weight were independently associated with reduced weight loss. Socio-professional status differed between Aviitam® users and non-users but was not associated with treatment continuation in univariate analysis.

Conclusions:

Digital engagement, as assessed by completion of a structured health platform, was independently associated with higher treatment persistence in patients receiving semaglutide for severe obesity. These findings support the integration of digital tools in routine pharmacologic obesity care to enhance adherence and personalize treatment strategies.