12-Month Weight Loss and Adherence in a Real-World Tirzepatide-Supported Digital Obesity Service

Background: Obesity management is evolving with the integration of dual GIP/GLP-1 receptor agonists (Tirzepatide) into comprehensive Digital Weight-Loss Services (DWLSs). While clinical trials demonstrate high efficacy, real-world data are necessary to evaluate long-term adherence and identify predictive markers for patient persistence in these scalable care models. This study retrospectively assessed the 12-month effectiveness and adherence of a Tirzepatide-supported DWLS and identified demographic, clinical, and behavioral predictors of weight loss and program attrition. Methods: Data from 19,693 patients enrolled in the Juniper UK DWLS were analyzed. Adherence was defined by a minimum of 10 medication orders and 12-month weight submission. Weight loss in the full cohort was evaluated using the Last Observation Carried Forward (LOCF) method. Binary logistic and multiple linear regression models identified predictors of adherence and weight loss, respectively. Results: The 12-month adherence rate was 27%. The adherent sub-cohort (n=5,322) achieved a mean weight loss of 22.60 (±7.46) percent, compared to 13.62 (±10.85) percent in the full cohort (LOCF). Long-term adherence and weight loss were positively associated with weekly weight tracking consistency and health coach communication. Conversely, intensive tracking frequency and high weight loss velocity in the first month were sig-nificant inverse predictors of 12-month adherence. Reporting side effects was positively correlated with adherence, suggesting a reporting bias among engaged patients. Conclusion: The DWLS model facilitates maximum therapeutic efficacy for adherent patients. However, patient persistence remains the primary translational challenge. Clinical strategies should prioritize promoting sustainable, moderate behavioral pacing to mitigate attrition risk and optimize the public health effectiveness of medicated DWLSs.