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Do weight loss outcomes differ across different lifestyle coaching styles?

A recent study published in Telemedicine Reports reveals promising outcomes in weight loss and patient engagement from the Juniper UK digital weight-loss service (DWLS).

On average, the entire cohort achieved an average weight loss of 13.79% body weight within 16 weeks. The study also generated several interesting findings around patient engagement with the Juniper program.

The entire cohort achieved an average weight loss of 13.79% of their initial body weight within 16 weeks, with 97.13% of participants reaching the clinically meaningful milestone of 5% weight loss.

The study design

The study included 522 patients who enrolled in the Juniper DWLS between February and June 2024 and were prescribed tirzepatide to support their lifestyle coaching. Weight loss and engagement outcomes were compared across the following four different lifestyle coaching styles:

Control Group: Patients followed the standard DWLS model, which includes an app with structured components across exercise, nutrition and weight tracking, without additional engagement prompts.
Reactive Text: Patients received the standard DWLS model, plus check-in via text message.
Reactive Premium: Patients received the standard DWLS model, but were also given a personalised video message from health coaches after 1 week, plus an advanced lifestyle quiz.
Proactive Coaching: Patients had access to a unique program which included an introductory video, the advanced lifestyle quiz, message prompts every 3 days with accountability dates, and a complete fortnightly check-in questionnaire.

All 4 groups had their lifestyle coaching supplemented with weight loss treatment with tirzepatide. Over 16 weeks, the study measured weight loss outcomes, the number of patient-coach messages, and app and weight tracker engagement.

Understanding the results

The study demonstrated that tirzepatide-supported DWLSs can achieve significant weight-loss outcomes across coaching styles. Firstly, substantial weight loss was achieved throughout the study population: the entire cohort achieved an average weight loss of 13.79% of their initial body weight within 16 weeks, with 97.13% of participants reaching the clinically meaningful milestone of 5% weight loss.

Over the 16-week study period, patients averaged 55.2 (±22.67) days of Juniper app engagement, 41.7 (±22.56) days of goal tracker engagement, and 36.94 ±23.04) days of weight data submissions. These figures translate to app usage more than every other day, and tracker usage and weight data submissions more than every third day. In terms of patient messages to their health coach, the cohort average of 12.91(±21.99) messages over 16 weeks (111.78 days) converts to 1 message every 8.66 days.

Despite the different coaching methods, no significant weight-loss differences were observed between any of the four coaching groups. However, rates of engagement with the program suggest patients tend to prefer proactive and highly personalised lifestyle coaching rather than the more reactive and standardised models, which are becoming an industry norm.

Patients in the proactive coaching group sent an average of 1 message every 5.6 days whilst the control group averaged 1 message every 18.35 days.

Significance of this research

Tirzepatide will soon become the most widely used medication in medicated obesity services. WHO and NICE stress the importance of continuous multidisciplinary care in the delivery of such services, which has historically been a challenge in face-to-face settings. This was the first study to report real-world weight-loss and engagement outcomes in a digital tirzepatide-supported intervention. These results add to the emerging evidence of the effectiveness of DWLSs, and suggest that app design may be more important to their effectiveness than messaging frequency.