Real-World Off-Label Use of Semaglutide for Weight Reduction: User Behavior, Effectiveness, and Satisfaction.

Background: Off-label use of semaglutide as Ozempic® for weight loss has surged in the Arab populations in the absence of structured real-world evaluation. Objective: To assess utilization patterns, effectiveness, and patient satisfaction with off-label Ozempic use for weight reduction across Arab populations. Methods: A cross-sectional survey was conducted using a validated bilingual questionnaire. Data included demographics, source of initiation, dose escalation, treatment duration, weight changes, and satisfaction. Analyses examined associations between demographics, treatment initiation source, dose escalation adherence, weight loss, and satisfaction. Results: Analysis included 626 users. Nearly one-third of users (30.6%) self-initiated Ozempic, most based on independent self-learning and social media. Most (72.4%) used Ozempic solely for weight reduction, with a further 20.1% for both weight loss and diabetes control. About two thirds (69.3%) started at the recommended 0.25 mg dose, significantly more often in users with physician-led initiation (p<0.05). Only 20.3% followed standard dose escalation. Of those who stopped Ozempic, 59.7% discontinued the drug early before reaching 12 weeks of use including 4 weeks at the 1.0 mg dose. Among those who discontinued, treatment duration was longer in users with physician-led initiation. Despite erratic use, reported mean weight loss by 8-12 weeks exceeded 5% in most subgroups, with no statistically significant differences across 0.25, 0.5, and 1.0 mg doses. Satisfaction, reported by 56.5% of users, was positively correlated with weight loss and shifted into the positive satisfaction level at an estimated weight reduction of 11.6%. Conclusion: Off-label Ozempic use in Arab populations is characterized by widespread self-initiation, irregular dosing, and early discontinuation. Nonetheless, clinically meaningful weight loss was achieved in many users. These findings emphasize the need for structured counseling to optimize outcomes.