The lancet. Diabetes & endocrinologyFeb 8, 2022

Weekly Semaglutide for Weight Loss in East Asian Adults With or Without Type 2 Diabetes

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗

Updated Feb 21, 2026

Abstract

Participants receiving semaglutide 2·4 mg experienced an estimated mean bodyweight reduction of -13·2% after 68 weeks.

Semaglutide 2·4 mg resulted in a significantly greater percentage change in bodyweight compared to placebo, with an estimated treatment difference of -11·1 percentage points.
A higher proportion of participants achieved a reduction of at least 5% of their baseline bodyweight with semaglutide 2·4 mg (83%) and semaglutide 1·7 mg (72%) compared to placebo (21%).
Abdominal visceral fat area decreased by 40·0% in the semaglutide 2·4 mg group and 22·2% in the semaglutide 1·7 mg group, compared to 6·9% in the placebo group.
Adverse events were reported by 86% of participants in the semaglutide 2·4 mg group, with gastrointestinal disorders being the most common.
Discontinuation of the trial product due to adverse events occurred in 3% of participants in both semaglutide groups and 1% in the placebo group.

Simplified

BACKGROUND: Semaglutide 2·4 mg once weekly has been investigated for weight management in global populations. Differences exist between Asian and non-Asian populations in terms of body composition and definitions of obesity. In the Semaglutide Treatment Effect in People with obesity (STEP) 6 trial, we assessed the effect of semaglutide versus placebo for weight management in adults from east Asia with obesity, with or without type 2 diabetes.

METHODS: This randomised, double-blind, double-dummy, placebo-controlled, phase 3a superiority trial was done at 28 outpatient clinics in Japan and South Korea. Eligible participants were adults (aged ≥18 years in South Korea; ≥20 years in Japan) with a BMI of at least 27·0 kg/mwith two or more weight-related comorbidities or a BMI of 35·0 kg/mor more with one or more weight-related comorbidity (one comorbidity had to be either hypertension, dyslipidaemia, or, in Japan only, type 2 diabetes) who had at least one self-reported unsuccessful dietary attempt to lose bodyweight. Participants were randomly assigned (4:1:2:1) to once-weekly subcutaneous semaglutide 2·4 mg or matching placebo, or semaglutide 1·7 mg or matching placebo, plus lifestyle recommendations for 68 weeks. Data for the placebo groups were pooled in statistical analyses. The primary endpoints were percentage change in bodyweight from baseline at week 68 and the proportion of participants who had achieved a reduction of at least 5% of baseline bodyweight at week 68. Change in abdominal visceral fat area was assessed as a supportive secondary endpoint using computed tomography scanning in a subset of participants. Efficacy outcomes were assessed in the full analysis set, which included all randomly assigned participants according to the intention-to-treat principle. Safety was assessed in all participants who received at least one dose of the study drug. This trial was registered with ClinicalTrials.gov, NCT03811574. 2 2

FINDINGS: Between Jan 21, 2019 and June 4, 2019, 437 participants were screened, of whom 401 were randomly assigned to semaglutide 2·4 mg (n=199), semaglutide 1·7 mg (n=101), or placebo (n=101) and included in the intention-to-treat analysis. Estimated mean change in bodyweight from baseline to week 68 was -13·2% (SEM 0·5) in the semaglutide 2·4 mg group and -9·6% (0·8) in the semaglutide 1·7 mg group versus -2·1% (0·8) in the placebo group (estimated treatment difference [ETD] -11·1 percentage points [95% CI -12·9 to -9·2] for semaglutide 2·4 mg vs placebo; -7·5 percentage points [95% CI -9·6 to -5·4] for semaglutide 1·7 mg vs placebo; both p<0·0001). At week 68, a larger proportion of participants had achieved a 5% or higher reduction in baseline bodyweight in the semaglutide 2·4 mg group (160 [83%] of 193 participants) and semaglutide 1·7 mg group (71 [72%] of 98 participants) than in the placebo group (21 [21%] of 100 participants); odds ratio [OR] 21·7 [95% CI 11·3 to 41·9] for semaglutide 2·4 mg vs placebo; OR 11·1 [95% CI 5·5 to 22·2] for semaglutide 1·7 mg vs placebo; both p<0·0001). Abdominal visceral fat area was reduced by 40·0% (SEM 2·6) among participants in the semaglutide 2·4 mg group and 22·2% (3·7) among participants in the semaglutide 1·7 mg group versus 6·9% (3·8) in the placebo group (ETD -33·2% [95% CI -42·1 to -24·2] for semaglutide 2·4 mg vs placebo; -15·3% [95% CI -25·6 to -4·9] for semaglutide 1·7 mg vs placebo). 171 (86%) of 199 participants in the semaglutide 2·4 mg group, 82 (82%) of 100 participants in the semaglutide 1·7 mg group, and 80 (79%) of 101 participants in the placebo group reported adverse events. Gastrointestinal disorders, which were mostly mild to moderate, were reported in 118 (59%) of 199 participants in the semaglutide 2·4 mg group, 64 (64%) of 100 participants in the semaglutide 1·7 mg group, and 30 (30%) of 101 participants in the placebo group. Adverse events leading to trial product discontinuation occurred in five (3%) of 199 participants in the semaglutide 2·4 mg group, three (3%) of 100 participants in the semaglutide 1·7 mg group, and one (1%) of 101 participants in the placebo group.

INTERPRETATION: Adults from east Asia with obesity, with or without type 2 diabetes, given semaglutide 2·4 mg once a week had superior and clinically meaningful reductions in bodyweight, and greater reductions in abdominal visceral fat area compared with placebo, representing a promising treatment option for weight management in this population.

FUNDING: Novo Nordisk.

TRANSLATIONS: For the Korean and Japanese translations of the abstract see Supplementary Materials section.

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Declaration of interests TK is President of Toranomon Hospital; and reports lecture fees from Abbott Japan, Astellas Pharma, AstraZeneca, Teijin Healthcare, Eli Lilly Japan, Mitsubishi Tanabe Pharma Corporation, MSD, Nippon Boehringer Ingelheim, Novo Nordisk Pharma, Ono Pharmaceutical, Sanofi, Sumitomo Dainippon Pharma, Terumo Corporation, and Takeda Pharmaceutical Company; grants from AstraZeneca, Takeda Pharmaceutical Company, and Daiichi Sankyo; donations for research from Astellas Pharma, Daiichi Sankyo, Kissei Pharmaceutical, Mitsubishi Tanabe Pharma, Novo Nordisk Pharma, Ono Pharmaceutical, Sanofi, Taisho Pharma, Sumitomo Dainippon Pharma, and Takeda Pharmaceutical Company; and donations for research laboratories from Asahi Mutual Life Insurance Company, Kowa Company, Mitsubishi Tanabe Pharma, MSD, Nippon Boehringer Ingelheim, Novo Nordisk Pharma, Ono Pharmaceutical, and Takeda Pharmaceutical Company. JI and UK are employees of Novo Nordisk. TN is an employee and shareholder of Novo Nordisk Pharma. WO has received lecture fees from Dainippon-Sumitomo Pharma, Novartis, Nippon Boehringer Ingelheim, Takeda Pharmaceutical, Mitsubishi Tanabe Pharma, and Abbott Japan; research funding from Noster, Nippon Boehringer Ingelheim, Boehringer Ingelheim Pharma GmbH, Nippon Eli-Lilly, Novo Nordisk Pharma, Abbott Japan, Abbott Diabetes Care UK, Dainippon-Sumitomo Pharma; and subsidies or donations from Kowa Pharmaceutical, Novo Nordisk Pharma, Astellas, Dainippon-Sumitomo Pharma, Ono Pharmaceutical, Takeda Pharmaceutical, Abbott Japan, Novartis, Daiichi Sankyo, Nippon Eli-Lilly, Mitsubishi Tanabe Pharma, and Nippon Boehringer Ingelheim. KT has received lecture fees from MSD, Novo Nordisk Pharma, Kowa Pharmaceutical; grants from Daiichi Sankyo, Ono Pharmaceutical, Takeda Pharmaceutical, Nippon Boehringer Ingelheim, MSD, Mitsubishi Tanabe Pharma, Teijin Pharma, Eli Lilly Japan, Asahi Kasei Pharma, The Mitsubishi Foundation, and Suntory Global Innovation Center. IN and SU are employees of Astellas Pharma. TY reports lecture fees from Mitsubishi Tanabe, Covidien Japan, Takeda, Novo Nordisk, Astellas, AstraZeneca, Ono, Novartis, Boehringer Ingelheim, Kyowa Kirin, Kowa, MSD, Sanofi, Daiichi Sankyo, Taisho, Eli Lilly, Kissei, Sanwa Chemistry Laboratory, Shionogi, Sumitomo Dainippon, FUJIFILM Toyama Chemical, Covidien Japan (Medtronic Japan) Nippon Becton Dickinson, Dojindo Laboratories, Kyorin Pharmaceutical, Abbott Japan, and Teijin Healthcare; and donations for research and research laboratories from Mitsubishi Tanabe, Takeda, Novo Nordisk, Astellas, AstraZeneca, Ono, Novartis, Boehringer Ingelheim, Kyowa Kirin, Kowa, MSD, Sanofi, Daiichi Sankyo, Tosoh, Sanwa Chemistry Laboratory, Shionogi, Minophagen, NTT DoCoMo, Mitsubishi Corporation Life Sciences, Aero Switch Therapeutics, Nipro, Asahi Mutual Life Insurance, and Bayer AG. SL is an advisory board member for Novo Nordisk and AstraZeneca; has received honoraria from Novo Nordisk, Sanofi, Boehringer Ingelheim, AstraZeneca and MSD; and has received research funding from CKD and Eli Lilly. SYL declares no competing interests.

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Weekly Semaglutide for Weight Loss in East Asian Adults With or Without Type 2 Diabetes

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