BACKGROUND The advent of tirzepatide has transformed obesity care, yet real-world weight-loss outcomes necessarily depend on patient engagement with behavioral support. Digital platforms offering coaching, self-monitoring, and automated feedback have the potential to further augment pharmacological efficacy. OBJECTIVE To determine whether digital engagement enhances weight loss among adults prescribed tirzepatide in routine care over 12 months, and to identify baseline predictors of engagement. METHODS In this retrospective cohort study, we included adults (18-75 years; body mass index (BMI) ≥ 30 kg/m² or ≥ 27.5 kg/m² with comorbidities) who initiated tirzepatide between February 2024 and August 2025 via a UK digital weight-loss service (DWLS). Engagement was defined by attendance at ≥ 1 coaching session, ≥ 1 weekly weight log, and ≥ 1 app login over 12 months. Percent weight loss was analyzed at months 2, 4, 6, 8,10 and 12 using mixed-model repeated measures (MMRM) adjusted for age, sex, baseline BMI, and comorbidities. Time-to-event analyses (Kaplan-Meier) assessed attainment of ≥ 5%, ≥ 10%, ≥ 15%, and ≥ 20% weight-loss thresholds. Multivariable logistic regression identified predictors of engagement, reporting ORs per decade of age and per 5 kg/m² BMI. RESULTS Among 126,553 participants, 6,746 (5.3%) were maximally engaged. Cohort demographics: mean age 42.3 ± 12.4 years, 78.9% female, mean BMI 35.3 ± 6.2 kg/m². Engaged users achieved greater adjusted weight loss at month 12 (-22.9%; 95% CI -23.2 to -22.6) versus non-engaged users (-17.5%; 95% CI -17.7 to -17.4), an absolute difference of 5.3 pp (P CONCLUSIONS Digital engagement substantially amplifies and accelerates tirzepatide-associated weight loss in real-world practice. Integrating structured digital support with pharmacotherapy represents a promising strategy for optimizing obesity management.
Johnson et al. (Sun,) studied this question.