Richards Rebecca, Whitman Michael, Wren Gina, Campion Peta
Second Nature, London, United Kingdom.
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom.
JMIR Form Res. 2025 Jun 30;9:e72577. doi: 10.2196/72577.
Limited access to specialist weight management services restricts the implementation of novel pharmacotherapies for obesity such as glucagon-like peptide-1 receptor agonists (GLP-1RAs) in the UK National Health Service (NHS). Second Nature, a commercial digital health company, offers a remotely delivered program combining a GLP-1RA medication (semaglutide) with digital behavioral support, potentially providing a scalable solution. However, evidence for long-term effectiveness in this real-world context is limited.
This study aimed to evaluate the 12-month effectiveness, feasibility, acceptability, and potential cost-effectiveness of the remotely delivered, semaglutide-supported weight management program by Second Nature.
This retrospective service evaluation analyzed data from participants who initiated the program between September and December 2023. The primary outcome was weight change at 12 months among participants with available data (completers). Secondary outcomes included retention, program engagement (measured by views of the Home screen in the app), behavioral changes, side effects, participant experience (qualitative analysis), and a comparative cost analysis against an NHS specialist weight management service. An "active subscription" was defined as maintaining a paid subscription for the full 12-month period. Descriptive statistics and paired 2-tailed t tests evaluated outcomes.
Data from 341 participants were included at baseline (282/341, 82.7% women; mean age 49, SD 11.1 years; mean baseline BMI 37.9, SD 6.9 kg/m). At 12 months, 39.6% (135/206) maintained an active subscription, while 60.4% (206/341) became inactive. Weight data at 12 months were available for 179 participants (52.5% of the baseline cohort; 100% of active and 19.4% of inactive participants). Among completers who maintained an active subscription, the mean weight loss was 20.0 kg (SD 8.7 kg; P<.001), representing 19.1% of starting weight. Overall, 77.7% (139/179) of completers achieved ≥10% weight loss and 61.5% (110/179) achieved ≥15%. Program engagement declined over time. Side effects also decreased, with 69.6% (81/116) of respondents reporting none by month 12. Most participants completing the 12-month survey reported positive (41/120, 34.2%) or neutral (68/120, 56.7%) experiences.
This evaluation suggests that remotely delivered GLP-1RA-supported weight management can achieve significant weight loss in participants remaining engaged for 12 months. However, the high rate of withdrawal limits generalizability. The program appears feasible, acceptable, and potentially cost-effective for completers. Further research, ideally in public health care settings using intent-to-treat analyses, is needed to confirm clinical outcomes, assess sustained results, and understand factors influencing retention.
在英国国家医疗服务体系（NHS）中，获得专科体重管理服务的机会有限，这限制了新型肥胖药物疗法（如胰高血糖素样肽-1受体激动剂（GLP-1RAs））的应用。商业数字健康公司Second Nature提供了一个远程提供的项目，该项目将GLP-1RA药物（司美格鲁肽）与数字行为支持相结合，有可能提供一种可扩展的解决方案。然而，在这种实际应用场景中，关于长期有效性的证据有限。
本研究旨在评估Second Nature远程提供的、司美格鲁肽支持的体重管理项目的12个月有效性、可行性、可接受性及潜在成本效益。
这项回顾性服务评估分析了2023年9月至12月启动该项目的参与者的数据。主要结局是有可用数据的参与者（完成者）在12个月时的体重变化。次要结局包括留存率、项目参与度（通过应用程序主屏幕的浏览量衡量）、行为变化、副作用、参与者体验（定性分析）以及与NHS专科体重管理服务的成本对比分析。“有效订阅”定义为在整个12个月期间维持付费订阅。描述性统计和配对双尾t检验用于评估结局。
341名参与者的基线数据纳入分析（282/341，82.7%为女性；平均年龄49岁，标准差11.1岁；平均基线体重指数37.9，标准差6.9kg/m²）。在12个月时，39.6%（135/206）维持有效订阅，而60.4%（206/341）不再订阅。12个月时的体重数据可用于179名参与者（占基线队列的52.5%；有效订阅者的100%，不再订阅者的19.4%）。在维持有效订阅的完成者中，平均体重减轻20.0kg（标准差8.7kg；P<0.001），占起始体重的19.1%。总体而言，77.7%（139/179）的完成者体重减轻≥10%，61.5%（110/179）的完成者体重减轻≥15%。项目参与度随时间下降。副作用也有所减少，到第12个月时，69.6%（81/116）的受访者表示无副作用。完成12个月调查的大多数参与者报告了积极（41/120，34.2%）或中性（68/120，56.7%）的体验。
该评估表明，远程提供的GLP-1RA支持的体重管理可使持续参与12个月的参与者实现显著体重减轻。然而，高退出率限制了其普遍性。该项目对完成者而言似乎可行、可接受且具有潜在成本效益。需要进一步研究，理想情况下是在公共卫生保健环境中采用意向性分析，以确认临床结局、评估持续效果并了解影响留存的因素。
