Comparative Efficacy of Semaglutide and Tirzepatide in Chinese Adults with Obesity without Diabetes: A Real-World Observational Study.

OBJECTIVE: To conduct a direct comparison of the effects of Semaglutide and Tirzepatide among adults with obesity but without diabetes. METHODS: From January 2024 to February 2026, a total of 183 Chinese adults were enrolled from the obesity clinic at our hospital in a single-center, retrospective observational cohort study. All participants received either once-weekly Semaglutide (1.7mg) or Tirzepatide (5mg) for a duration of three months. The primary outcome was the change in body weight from baseline to month 3. Secondary outcomes included changes in visceral fat mass, appetite, and key metabolic parameters. Body weight, waist circumference, body fat composition, and metabolic parameters were assessed at baseline and at follow-up. Eating behaviors and appetite were evaluated using the Control of Eating Questionnaire (CoEQ) and the Simplified Nutritional Appetite Questionnaire (SNAQ). RESULTS: Both treatments yielded clinically meaningful improvements in body weight, fat mass, and metabolic parameters. Tirzepatide was associated with greater reductions in body weight [-2.87 kg (95% CI, -4.41 to -1.32), p < 0.001)] and higher proportion of patients achieving more than 10% weight loss [21.50% (95% CI, 7.45 to 35.55), p = 0.003]. Moreover, Tirzepatide demonstrated superior efficacy in reducing total fat mass and visceral adiposity, achieving greater total weight loss (TWL%) and excess weight loss (EWL%) percentages, and ameliorating insulin resistance. By contrast, the effects on food cravings and appetite regulation were comparable between the two medications. The overall safety profiles were generally similar between groups. CONCLUSION: Tirzepatide demonstrates superior efficacy to Semaglutide in obesity management among Chinese adults. Larger-scale and longer-term studies based on real-world clinical practice are warranted to validate and generalize these findings.