Weight Changes With Lower Doses of Semaglutide in Clinical Practice: Findings From the Chinese HARMONY Cohort

INTRODUCTION: To evaluate 24-week weight changes with lower-dose semaglutide in routine care among Chinese adults with obesity and to examine whether diabetes and ectopic fat in the liver and pancreas are associated with heterogeneity in weight-loss response. MATERIALS AND METHODS: Adults with obesity were enrolled from the HARMONY study, a real-world observational cohort in China. Participants received once-weekly subcutaneous semaglutide, titrated to a maintenance dose (0.5 or 1.0 mg) based on clinical response and tolerability, alongside lifestyle counselling and periodic metabolic monitoring. The primary endpoint was the percentage change in body weight from baseline at weeks 12 and 24. Subgroup analyses were conducted according to baseline type 2 diabetes status and ectopic fat status in the liver and pancreas. RESULTS: Overall, 143 participants were included at week 12 and 113 at week 24. Mean percent weight change was -7.3% at week 12 and -9.9% at week 24, corresponding to mean absolute weight losses of 6.7 and 9.1 kg, respectively. By week 24, 76.1% of participants achieved 5% weight loss or more. At week 24, participants with type 2 diabetes experienced lower weight change than those without diabetes (-7.4% vs. -12.4%, p < 0.001). Weight loss also differed by baseline intrapancreatic fat deposition (IPFD) status, with attenuated weight change among patients with baseline IPFD (-9.0% with IPFD vs. -11.6% without IPFD, p = 0.043). DISCUSSION: In routine clinical care, lower doses of semaglutide were associated with clinically meaningful 24-week weight loss in Chinese adults with obesity.