Weight Loss and Engagement in a Tirzepatide-Supported Digital Obesity Program: A Four-Arm Patient-Blinded Retrospective Cohort Study

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Background: Obesity is arguably the greatest public health concern in the present day. Digital weight-loss services (DWLSs) that utilize modern medications have demonstrated potential in increasing access to effective obesity treatment. However, the world’s major health institutions emphasize that pharmacotherapy should only ever be used as an adjunct to lifestyle coaching. While recent research has found that patients tend to prefer DWLS lifestyle coaching that is personalized and proactive, the extent to which these preferences impact weight and engagement outcomes is unknown. In addition, previous DWLS studies have only observed interventions supported by Liraglutide and Semaglutide, rather than the most efficacious weight-loss medication, Tirzepatide. Methods: This study retrospectively compared 16-week program engagement and weight-loss outcomes in a cohort of 522 patients from the Juniper UK DWLS who received four variants of Tirzepatide-supported lifestyle coaching. Results: Over the 16-week study period, the entire cohort averaged 12.91 (±21.99) messages to their health coach. Statistical analyses revealed that the proactive coaching group sent a statistically higher number of messages (M = 19.95) to their health coach than patients from the reactive text (M = 9.8), reactive premium (M = 11.2), and control groups (M = 6.09). Mean weight loss for the entire cohort was 13.8% (±5.04%), with an analysis of variance revealing no significant difference between the four coaching groups. Further analyses revealed that the cohort spent a mean of 55.2 (±22.67) days on the Juniper app and 41.7 (±22.56) days viewing their progress tracker, again without a statistical difference between groups. However, cohort-wide weight loss and health coach engagement were significantly associated with body mass index. Discussion: These findings add an important layer to the emerging literature on medication-supported DWLSs. They suggest that app design may be more important than proactive messaging in such services and that Tirzepatide is a more effective supplement to lifestyle coaching than other weight-loss medications in real-world settings.

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