Low-Dose Semaglutide for Weight Loss in Obese Non-Diabetic Pakistani Adults

Obesity is a growing public health concern worldwide and is increasingly prevalent in Pakistan, contributing significantly to cardiovascular disease, metabolic syndrome, non-alcoholic fatty liver disease, hypertension, dyslipidemia, and reduced quality of life. Despite the rising burden of obesity in South Asian populations, access to evidence-based pharmacological treatment remains limited, and locally generated clinical data on anti-obesity medications in non-diabetic individuals are scarce. Semaglutide, a glucagon-like peptide-1 (GLP-1) receptor agonist, has demonstrated significant weight reduction and cardiometabolic benefits in multiple international clinical trials; however, most available evidence comes from Western populations and higher-dose formulations. In Pakistan, locally available lower-dose semaglutide formulations are increasingly being used in clinical practice, but their real-world effectiveness and safety in non-diabetic obese adults have not been systematically evaluated. This study aims to generate locally relevant clinical evidence to support the safe and effective use of semaglutide for obesity management in the Pakistani population. This prospective, open-label, single-arm, single-center pilot interventional trial will be conducted at the Asian Institute of Medical Sciences (AIMS), Hyderabad, Sindh, Pakistan. The study will enroll 60 obese adults aged 18 years or older with a body mass index (BMI) of 27.5 kg/m² or greater according to World Health Organization Asian cutoffs and without type 2 diabetes mellitus, confirmed by fasting blood glucose less than 126 mg/dL and HbA1c less than 6.5% within three months prior to enrollment. Participants with a history of pancreatitis, medullary thyroid carcinoma, multiple endocrine neoplasia type 2, pregnancy or lactation, severe renal or hepatic impairment, current use of other anti-obesity medications, or known hypersensitivity to semaglutide will be excluded to ensure participant safety and minimize confounding factors. Eligible participants will receive once-weekly subcutaneous low-dose semaglutide following a standardized dose titration schedule consisting of 0.25 mg weekly for the first four weeks, 0.5 mg weekly for the next four weeks, and 1.0 mg weekly for the remaining 16 weeks, for a total treatment duration of 24 weeks (six months). The medication will be administered under medical supervision, and participants will be educated on proper injection technique and adherence to the treatment regimen. In addition to pharmacological treatment, all participants will receive standardized lifestyle counseling, including a hypocaloric diet with a daily caloric deficit of 500-750 kcal and at least 150 minutes of moderate-intensity physical activity per week, in accordance with international obesity management guidelines. The primary objective of the study is to evaluate the percentage change in body weight from baseline to 24 weeks following low-dose semaglutide treatment. Secondary objectives include evaluating changes in body mass index, waist circumference, systolic and diastolic blood pressure, lipid profile (total cholesterol, low-density lipoprotein, high-density lipoprotein, and triglycerides), liver enzymes (alanine aminotransferase and aspartate aminotransferase), and quality of life over the study period. Safety and tolerability will be assessed through continuous monitoring of adverse events and adverse drug reactions, with causality assessment using the Naranjo Adverse Drug Reaction Probability Scale. Clinical and laboratory assessments will be conducted at baseline, 12 weeks, and 24 weeks to evaluate treatment response and safety outcomes. Data will be collected using standardized case report forms and securely stored in a password-protected database. Statistical analysis will be performed using IBM SPSS Statistics software. Descriptive statistics will summarize baseline demographic and clinical characteristics. Continuous variables will be expressed as mean with standard deviation or median with interquartile range, and categorical variables will be expressed as frequencies and percentages. Changes in primary and secondary outcomes from baseline to follow-up visits will be analyzed using paired t-tests or non-parametric equivalents depending on data distribution, and repeated measures analysis will be used to assess trends across time points. A p-value of less than 0.05 will be considered statistically significant. As a pilot trial, the sample size of 60 participants is intended to assess feasibility, estimate treatment effect, and generate preliminary data for future multicenter randomized controlled trials. The study will be conducted in accordance with the Declaration of Helsinki and Good Clinical Practice guidelines. Ethical approval will be obtained from the Institutional Review Board of the Asian Institute of Medical Sciences prior to study initiation. Written informed consent will be obtained from all participants before enrollment, and participant confidentiality will be maintained through de-identification and secure data handling. The results of this study are expected to provide important real-world clinical evidence on the effectiveness and safety of low-dose semaglutide for obesity management in non-diabetic Pakistani adults and support future larger-scale clinical research in the region.