A retrospective real-world study on semaglutide effectiveness in patients with obesity: differences between patients with and without food craving

Background Food craving (FC) is an established predictor of obesity. However, its role in weight management is insufficiently addressed in routine clinical practice. Methods This retrospective study included adults with obesity, stratified by FC status, to compare the effectiveness of semaglutide plus hypocaloric diet (semaglutide group) versus hypocaloric diet alone (control group) in reducing body weight (BW). Assessments were conducted at baseline (T0), 3 months (T3), and 6 months (T6). The primary outcome was the between-group comparison of changes in BW from baseline at T3 and T6, also stratified by FC status. Secondary outcomes included changes in body mass index (BMI) and waist circumference (WC). Results 120 patients with obesity (mean age ± SD: 51.0 ± 15.9 years; 70% female) were included. Of these, 67 (56%) received semaglutide plus hypocaloric diet and 53 (44%) diet alone. FC was present in 53% of patients and was more frequent in women and younger individuals. BW, BMI, and WC significantly decreased in both semaglutide and control group over time (all p <0.0001). However, at 6 months, semaglutide group achieved greater reductions in BW (-3.3 kg; p=0.0004), BMI (-1.8 kg/m 2 ; p=0.0015), and WC (-2.3 cm; p=0.03) compared with controls. Differences in BW reduction were maintained across patients with FC (-3.1 kg, p=0.03) and without FC (-3.4 kg; p=0.007). Conclusion Semaglutide plus hypocaloric diet treatment is more effective than hypocaloric diet alone for weight reduction in real-world clinical practice, even in the presence of FC. Assessing FC may support more individualized obesity management strategies.