Introduction and Objective: Polycystic ovary syndrome (PCOS) is associated with weight loss resistance, potentially limiting GLP-1 receptor agonist (GLP-1RA) efficacy. We investigated whether comprehensive digital health engagement improves weight loss trajectories in women with PCOS initiating GLP-1RA therapy. Methods: This retrospective cohort included women (18-75 years; BMI ≥30 kg/m² or ≥27.5 kg/m² with comorbidities) initiating tirzepatide or semaglutide through a UK digital weight management service (2022-2025). Patients were stratified by engagement. Full engagement required remote coaching participation, ≥4 monthly weight entries, and app use. Percentage weight change over 12 months was modelled using MMRM adjusted for age, baseline weight, and comorbidities. Kaplan-Meier and Cox regression assessed time to ≥10%, ≥15%, and ≥20% weight loss with hazard ratios (HR). Results: Among 193,059 women (age 43.4±12.7 years; BMI 34.7±6.2 kg/m²), 13,384 (6.9%) had PCOS and 19,796 (10.3%) were fully engaged. Twelve-month adjusted weight loss was −22.5% (95% CI −22.7, −22.2) in engaged non-PCOS, −22.1% (−22.9, −21.3) in engaged PCOS, −16.9% (−17.1, −16.7) in not-engaged non-PCOS, and −15.5% (−16.1, −14.9) in not-engaged PCOS groups; all p0.001. Engagement was strongly associated with milestone attainment: ≥10% HR 2.50 (95% CI 2.45-2.56), ≥15% HR 2.17 (2.11-2.22), ≥20% HR 1.95 (1.88-2.02); all p0.001. PCOS was associated with slower attainment at higher thresholds: ≥15% HR 0.83 (0.79-0.88), ≥20% HR 0.74 (0.69-0.80). Conclusion: Women with PCOS achieved equivalent weight loss to those without PCOS when fully engaged with digital support, demonstrating that structured digital programmes can overcome PCOS-related weight loss resistance during GLP-1RA treatment. Disclosure H. Johnson: Employee; Current; Voy t/a Menwell LTD. D. Reisel: Employee; Current; Voy t/a Menwell LTD. D. Huang: Employee; Current; Voy t/a Menwell LTD.
JOHNSON et al. (Fri,) studied this question.