Patient Outcomes Under Varying Engagement Patterns on Real-World Lifestyle-Supported Pharmacological Weight-Loss Therapy

Overweight and obesity represent a significant global health challenge, requiring comprehensive, long-term approaches. Digital weight-loss services (DWLSs) have emerged as promising obesity care models, as they facilitate access to continuous multidisciplinary care. This study aimed to evaluate 12-month weight-loss and adherence patterns in a large unsubsidized DWLS in the UK, which combined lifestyle therapy with semaglutide treatment. A retrospective cohort design was used to analyze data from 7279 patients who initiated treatment between 1 January 2023, and 1 May 2024. Of these patients, 1678 (23.05%) met all criteria for inclusion in the efficacy estimand, which included receiving a minimum of 8 medication orders and submitting weight data within 341–379 days after program initiation. The efficacy estimand achieved a mean weight loss of 15.67%, with 92.49% losing a clinically meaningful amount of weight (≥5%). A strong positive association was found between weight tracking frequency and weight loss, to the extent that a percentage discrepancy of 8.41 points was observed between patients who tracked on less than 20 occasions (Median = 11.83%) and those who tracked at least 100 times (Median = 20.24%). A significant association between weight loss and semaglutide orders was also observed, with a clear distinction existing between patients who received less than 12 orders, and those who received 12 or more orders. Patients whose DWLS experience was supplemented with Wegovy recorded significantly higher mean weight loss than those who were treated with Ozempic (17.68% vs. 14.72%). The findings highlight the importance of program engagement in DWLS outcomes and suggest the need for a comparative analysis of unsubsidized and subsidized services. The study is limited by its real-world observational design and reliance on self-reported data; future research should compare outcomes between unsubsidized and subsidized DWLS cohorts.