{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T21:21:11Z","timestamp":1787779271666,"version":"build-2784847793"},"reference-count":32,"publisher":"JMIR Publications Inc.","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Med Internet Res"],"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Real-world persistence with antiobesity pharmacotherapy is suboptimal: only 32% to 50% of patients persist with glucagon-like peptide-1 receptor agonists at 12 months, and fewer than 15% reach the 2.4 mg\/week target dose. Digital platforms may support engagement, but their role remains poorly characterized.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n \n This study aimed to evaluate whether baseline engagement with a structured digital assessment platform (Aviitam\n \n ) predicts 48-week persistence and mediates weight-loss outcomes in adults with severe obesity initiating semaglutide 2.4 mg\/week and to identify clinical and behavioral predictors of pharmacological response.\n <\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n \n In this prospective 48-week single-center observational cohort, all consecutive adults (\u226518 y) with a BMI \u226540 kg\/m\u00b2 initiating semaglutide 2.4 mg\/week through the French early-access program were enrolled. Baseline engagement with the Aviitam\n \n digital assessment platform was operationalized as a 3-level ordinal variable (never used, partial use, and full completion of validated questionnaires), reflecting the patient\u2019s responses to a nonenforced preclinical request. The primary outcome was 48-week persistence; secondary outcomes were full-dose attainment, percentage weight change, and dose-response. Adjusted logistic and linear regressions estimated the engagement-persistence and engagement-weight-loss associations. A Baron-Kenny mediation analysis with bootstrap CIs decomposed the engagement-weight-loss association. Missing 48-week weights were imputed using multiple imputation (m=20) as a sensitivity analysis. Among persistent participants who completed all 7 baseline questionnaires (n=91), behavioral-scale associations with weight change were analyzed using Benjamini-Hochberg false-discovery-rate correction.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Of 191 participants (mean age 51.7, SD 6.8 y; 61\/191, 31.9% male; mean BMI 45.7, SD 6.8 kg\/m\u00b2), 37 (19.4%) had never used the platform, 32 (16.8%) used it partially, and 122 (63.9%) fully completed the questionnaires. At 48 weeks, 142 (74.3%) remained on semaglutide, and 124 (87.3%) of them reached the 2.4 mg\/week dose. Persistence followed a monotonic gradient across engagement levels (22\/37, 59.5%; 23\/32, 71.9%; 97\/122, 79.5%;\n P<\/jats:italic>\n =.02), and each engagement increment was associated with higher odds of persistence (adjusted odds ratio 1.62, 95% CI 1.05\u20102.50;\n P<\/jats:italic>\n =.03), unchanged under multiple imputation. Mean weight loss was 11.8% (SD 8.4%) in the full cohort and 14.6% (SD 7.3%) among persistent participants, with a steep dose-response (mean 3.9%, SD 5.8% in discontinuers to mean 15.3%, SD 7.2% at 2.4 mg\/week;\n P<\/jats:italic>\n <.001). Mediation analysis showed 48-week persistence mediated approximately 69% of the engagement\u2013weight-loss association; the direct effect was nonsignificant. The Intuitive Eating Scale-2 was the only behavioral predictor surviving false-discovery-rate correction (\n q<\/jats:italic>\n =0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Baseline engagement with a structured digital assessment platform predicts 48-week semaglutide persistence in a graded manner; low-engagement patients can be identified at initiation and supported with targeted strategies to maintain persistence and achieve full-dose titration.<\/jats:p>\n <\/jats:sec>","DOI":"10.2196\/80119","type":"journal-article","created":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T20:53:31Z","timestamp":1787777611000},"page":"e80119-e80119","source":"Crossref","is-referenced-by-count":0,"title":["Digital Engagement and Predictors of Semaglutide Persistence and Weight Loss in Severe Obesity: 48-Week Observational Study"],"prefix":"10.2196","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4168-917X","authenticated-orcid":false,"given":"Sarah","family":"Tournayre","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5830-8962","authenticated-orcid":false,"given":"Jean-baptiste","family":"Bonnet","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9184-0393","authenticated-orcid":false,"given":"Jean","family":"Anitcheou","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-1524-8279","authenticated-orcid":false,"given":"Marion","family":"Faivre","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6839-4531","authenticated-orcid":false,"given":"Catherine","family":"Boegner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7800-4859","authenticated-orcid":false,"given":"Abdulkader","family":"Jalek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-7448-4410","authenticated-orcid":false,"given":"Dominique","family":"Jullien","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-1406-7835","authenticated-orcid":false,"given":"Camille","family":"Le Rouzic","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2606-1840","authenticated-orcid":false,"given":"Vincent","family":"Attalin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-9259-5845","authenticated-orcid":false,"given":"Justine","family":"Myzia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5290-5253","authenticated-orcid":false,"given":"Youadigue","family":"Kemba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9540-8222","authenticated-orcid":false,"given":"Ariane","family":"Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0197-132X","authenticated-orcid":false,"given":"Antoine","family":"Avignon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,26]]},"reference":[{"key":"R1","unstructured":"World obesity atlas 2023. 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