The Effect of Lifestyle Coaching Design on Patient Engagement and Weight Loss in Non-diabetic Patients of a Semaglutide-Supported Digital Obesity Program in the UK: A Comparative Retrospective Cohort Study

Digital weight-loss services (DWLSs) that supplement continuous lifestyle coaching with semaglutide therapy have shown promise in delivering continuous and effective obesity care. However, the extent to which lifestyle coaching design influences patient engagement and program effectiveness is unknown. This study retrospectively analysed several engagement markers and weight loss percentage over 16 weeks in a large semaglutide-supported DWLS in the UK (n=154). The comparative analysis found that patients who received lifestyle coaching that was proactive and personalised sent a statistically higher number of messages to their health coach (Mean=19.37 vs Mean=8.55) and opened the program app more frequently (Mean = 49.31 days vs Mean = 40.06 days) than patients whose coaching was reactive and standardised. Mean 16-week weight loss was 10.1% in the proactive group compared to 8.9% in the reactive group, but the difference was not statistically significant. A two-sample t-test found that female patients (Mean = 9.76%) tended to lose more weight than male patients (Mean = 6.88%), (<i>t</i>(152) = 1.89, <i>p</i> = 0.04). The findings add vital layers of nuance to the emerging literature on semaglutide-supported DWLSs, indicating that a proactive, personalised coaching approach leads to better patient engagement, but that such engagement is not correlated with better short-term weight-loss or program adherence outcomes. Moreover, the cohort's comparably higher mean weight loss relative to previous real-world semaglutide studies lend support to the advice of leading global health institutions of using the medication only as an adjunct to multidisciplinary lifestyle therapy. Investigators should expand on this research by conducting comparable studies over a longer period and with medication-only control groups.