Background
Adherence to obesity pharmacotherapy is essential for achieving meaningful weight and health benefits, yet remains a challenge in the real world. Discontinuation rates for GLP-1 receptor agonist therapy range from 40–75% within the first 3–6 months, and were approximately 50% in a previous prospective review of two outpatient obesity clinics in Ireland between 2021 and 2023. Discontinuation reflects a combination of patient, medication-related and clinician or system factors, occurring across different phases of adherence. In the prior study, side effects (36%), limited access to follow-up (24%), and cost (23%) were the most commonly reported reasons for discontinuation.
This study assessed whether a messaging-based behavioral support intervention could improve early adherence, engagement, and care experience among individuals with obesity receiving pharmacotherapy.
Methods
Adults receiving obesity pharmacotherapy at an outpatient clinic were enrolled in a digital messaging-based support program from March to December 2025 and used it for ≥3 months. Active users were defined as those who consented and did not pause or discontinue the program. The intervention delivered proactive, phase-specific behavioral and educational support addressing medication use, side effects, appetite regulation, nutrition, physical activity, expectation management, and re-engagement after lapses. Engagement was defined as ≥2 bidirectional messages per month and categorized as minimal (1), light (<5), regular (6–20), or power user (≥21). Outcomes included three-month self-reported medication adherence, program engagement, discontinuation rates, message frequency, and thematic and sentiment analyses of conversational data. Natural language processing techniques were used to analyze conversation content and timing.
Results
Of 186 individuals enrolled, 138 (74%) engaged with the intervention. After three months, 83% of engaged participants remained adherent to pharmacotherapy. Participants exchanged 3,059 messages across 840 conversations, with an average of 22.2 messages per user. 37.7% of users were classified as power users, and 34.1% demonstrated regular engagement. Conversations primarily occurred around clinically significant events, including treatment initiation, dose escalation, onset of side effects, appetite changes, weight plateaus, travel, and psychosocial stressors. Many users re-engaged after 3–6 weeks of inactivity, indicating more frequent touchpoints than standard care. Conversations captured symptom and appetite-related concerns within 24–48 hours of treatment initiation, highlighting high-risk moments for discontinuation not typically addressed during scheduled visits. Sentiment analysis showed predominantly positive experiences, including improved confidence, motivation, and perceived support.
Conclusion
A messaging-based behavioral support intervention in outpatient obesity care was associated with high early adherence, sustained engagement, and positive patient experiences. Digital messaging may address care gaps by meeting event-driven needs and delivering timely support between visits. Further research is needed to evaluate long-term outcomes.
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