Why People with Overweight and Obesity Are Seeking Care Through Digital Obesity Services: A Qualitative Analysis of Patients from Australia’s Largest Digital Obesity Provider

Abstract

Background:

Increasingly large numbers of people with overweight and obesity (PWOO) are seeking care through digital services. Digital weight-loss service (DWLS) advocates claim that this is due to the modality’s mitigation of obesity care access barriers. However, influential health bodies have consistently argued that DWLSs are solely focused on facilitating access to weight-loss medications—an approach that compromises patient safety. Although modern weight-loss medications have demonstrated unprecedented effectiveness in clinical trials, they should only be prescribed under strict safety guidelines and used as a supplement to lifestyle therapy. Major health institutions have also stressed the importance of continuous multidisciplinary care in the treatment of overweight and obesity. Despite the surging global uptake of DWLSs, scholars are yet to investigate whether such services increase access to quality obesity care or are simply businesses offering an easier pathway to weight-loss medications. A vital preliminary step in addressing this complex question is to understand patient motivations for using DWLSs rather than face-to-face alternatives. The study aimed to qualitatively assess the reasons PWOO subscribe to Australia’s largest DWLS.

Methods:

The study applied a purposive sampling strategy, limiting recruitment to patients who had been approved by a doctor for the Eucalyptus DWLS and paid their first monthly subscription but were yet to receive their first GLP-1 RA order and commence treatment. Recruitment ceased once thematic saturation was attained across a comparable number of male and female patients. All phone interviews were scheduled according to patient preferences and took place between April 8 and May 7, 2024. Transcripts from interviews were thematically analyzed using the Braun and Clarke method to establish reasons for subscription to the Eucalyptus DWLS.

Results:

In total, 4962 patients satisfied the recruitment criteria of whom 197 participated in phone interviews. Most participants were of Caucasian heritage (61%), and the mean age and body mass index were 40.4 (±10.4) years and 34.4 kg/m² (±5.6), respectively. From our analysis, five key themes emerged in relation to the reasons PWOO chose to treat their condition with the Eucalyptus DWLS: failure to achieve weight-loss goal through stand-alone lifestyle interventions, marketing and brand awareness, difficulty accessing comprehensive weight-loss care through local general practitioner, more comfortable receiving weight-loss therapy through digital platforms, and patients value the flexibility of asynchronous DWLS consults.

Discussion:

This study established an important foundation in digital obesity care literature, generating findings that support both sides of the DWLS utility debate. The identified themes should inform future quantitative analyses of patient DWLS motivations.

Introduction

Obesity is widely recognized as one of the most serious global health issues.¹ Recent reports estimate that roughly 2.5 billion adults are overweight, of whom nearly a billion are living with obesity.² Global overweight and obesity incidence among children and adolescents has also risen steadily over the past four decades.² Modern interpretations of this phenomenon emphasize obesity’s status as a complex chronic disease. In other words, whereas unhealthy weight gain was once considered by most stakeholders as a product of insufficient self-control, consensus has emerged around the variety of other determinants of obesity, including its social, economic, environmental, and biological factors.^3–5 As a result of this understanding, most major health institutions stress the importance of continuous multidisciplinary care for people living with overweight and obesity (PWOO) and warn against using the increasingly popular glucose-like peptide-1 receptor agonists (GLP-1 RA) medications as a stand-alone therapy.^6,7 However, a determinant of rising obesity levels that has arguably received disproportionately less attention than others is the difficulty of accessing quality obesity care.⁸ Unlike acute primary care, whose access issues are mostly of a geographical nature, access in the context of continuous multidisciplinary obesity care comprises temporal, social, and—because of the condition’s stigmatization—psychological access barriers.^9,10 Digital weight-loss services (DWLSs) have been presented as a means of overcoming effective obesity care.^8,11 Yet, this claim has not been hitherto supported by any peer-reviewed evidence. Although increasingly large numbers of PWOO are using DWLSs, it remains unclear as to why they are doing so and, therefore, whether DWLSs are mitigating the care access factor of the obesity epidemic.

Over the past few years, influential health commentators have consistently raised concerns about the quality and safety of DWLSs.^12,13 A key concern is that many digital programs function solely as pathways to previously unknown doctors who, upon reading patient responses to short patient questionnaires, forward them GLP-1 RA prescriptions without any follow-up care.¹⁴ Although some commentators might be inclined to challenge this view by highlighting the unprecedented weight-loss efficacy of GLP-1 RAs observed in randomized controlled trials and the comparable safety levels across control and intervention groups,^15–17 the trials do not accurately reflect real-world weight-loss experiences.¹⁸ Moreover, they ignore the emerging findings that GLP-1 RA-induced weight loss often leads to disproportionate reductions in vital fat-free mass and is typically regained within several months after discontinuing treatment.^19,20 Essentially, DWLS skeptics are making the reasonable argument that until more knowledge is accumulated on the long-term effects of GLP-1 RAs in weight-loss cohorts, all obesity programs should follow the advice of the World Health Organization and other major health institutions in placing behavioral therapy and continuous multidisciplinary teams (MDTs) at their core. As the United Kingdom National Institute for Health and Care Excellence stresses in their Semaglutide weight-loss guidelines,⁷

“Semaglutide should only be given alongside a suitably sustained programme of lifestyle interventions with multidisciplinary input.”

Although several DWLSs claim to have implemented this kind of care model, such as Eucalyptus—a large multinational service²¹—it is unclear whether patients are using them for their behavioral and care continuity components or simply to facilitate access to GLP-1 RAs.

Despite the recent surge in DWLS uptake, real-world evidence on all aspects of digital obesity programs remains scarce. Most DWLS studies have investigated programs offering stand-alone behavioral therapy.^22,23 Moderate weight-loss outcomes have been reported in a few public programs for type 2 diabetes cohorts.^24,25 Research on real-world DWLSs that utilize GLP-1 RAs on nondiabetic cohorts, that is, services that many stakeholders are skeptical of, appears to be limited to a handful of programs. Two studies have observed meaningful weight-loss outcomes from stand-alone GLP-1 RA interventions on European cohorts.^26,27 Another study reported similar outcomes from a comprehensive obesity program delivered across six Canadian weight-management clinics.²⁸ The only real-world GLP-1 RA-supported DWLS that appears to have been analyzed in multiple studies is Eucalyptus, a nonsubsidized program operating in Australia, Japan, Germany, and the United Kingdom under its brand names Juniper (female patients) and Pilot (male patients).^14,29,30 Although the most recent study of this service found that a large proportion of Eucalyptus patients desire more proactive and personalized health coaching, it did not attempt to investigate whether their perception of the program’s health coaching component was the reason for their subscription.²¹

This study aims to assess the reasons why PWOO decide to use the Eucalyptus DWLS in Australia. Given that no such investigation has been previously conducted on other GLP-1 RA-supported DWLSs, the analysis will be qualitative in order to maximize the potential for capturing the gamut of subscription reasons. The study’s results will establish an important foundation for further research on DWLS utility and the modality’s role in overcoming access barriers to obesity care.

Methods

Study design

The study followed the Consolidated Criteria for Reporting Qualitative Health Research. It consisted of phone interviews between study investigators and a cohort of patients from the Eucalyptus Australia DWLS. Once thematic saturation was reached, interview transcripts were coded and thematically analyzed by all study investigators. The study was approved by the Bellberry Human Ethics Committee on November 22, 2023.

Program overview

Eucalyptus is Australia’s largest DWLS, having treated over 55,000 PWOO since the company’s launch in 2021. At the time of writing, the service has only ever been delivered asynchronously through a digital platform and has only offered GLP-1 RA-supported therapy, i.e., diet and exercise coaching supplemented with GLP-1 RA treatment, and thus neither component as a stand-alone treatment option. Doctors determine patient eligibility for the Eucalyptus DWLS through responses to preconsultation questionnaires, which contain up to 100 questions, including requests for test results and photos. Eligible Eucalyptus DWLS patients are allocated a coordinated MDT, including a doctor, a university-qualified dietitian, a pharmacist, and a registered nurse, to guide them through a personalized program. Lifestyle coaching is informed by patient health data, which are collected from preconsultation questionnaires and every subsequent interaction between patients and the MDT. Once MDTs develop personalized diet and exercise plans in consultation with patients, they send through a series of multimodal educational materials to assist them with their care journey. Dietitians message patients at fortnightly intervals to encourage them to upload data to the program progress tracker, and nurses send automated messages to patients every month to assess general health and well-being. Patients are free to solicit advice from any member of their MDT as often as they wish, which MDTs typically respond to within less than 24 h. A box of GLP-1 RA medications is sent to patients every month after payment has been processed. Monthly subscription to the Eucalyptus Australia DWLS costs $285 AUD and covers all aspects of the service, including medication, lifestyle coaching, and platform access. All patient data are stored in the Eucalyptus central data repository on Metabase and are linked to Jira to allow the Eucalyptus clinical auditing team to create alerts for adverse events. The Eucalyptus DWLS is accredited by the Australian Council on Healthcare Standards.

Participants

The study applied a purposive sampling strategy, limiting recruitment to patients who had been approved by a doctor for the Eucalyptus DWLS and already paid their first monthly subscription but were yet to receive their first GLP-1 RA order and commence treatment. This criterion was selected to maximize the probability of soliciting views from patients who were serious about the Eucalyptus DWLS (i.e., not patients who completed the quiz out of curiosity, without the intention of subscribing to the program) and whose reasons for subscribing were yet to be impacted by the program experience. We understand that this approach may have increased positive bias toward the program. However, in the context of the study aim, we felt that this limitation would be less significant than including PWOO who were not intending to subscribe to the program and/or patients who had developed other biases from having experienced the program for a certain period. Patients who satisfied the criterion were sent a text message inviting them to participate in a 10-minute phone interview. Only those who replied “YES” to this message were called. Patients were informed that their responses would be deidentified and used in peer-reviewed research. Recruitment ceased once thematic saturation was attained across a comparable number of male and female patients. All phone interviews were scheduled according to patient preferences and took place between April 8 and May 7, 2024.

Interviews

A trained qualitative researcher conducted semi-structured interviews with all consenting participants during the study window via telephone. Each call followed an interview guide (Supplementary Data) that was prepared by the three investigators in accordance with the study’s main objective and revised after eight pilot interviews. All interviews were transcribed with the Sonix program and then extracted by investigators to conduct individual thematic analyses, applying the Braun and Clarke method.³¹ In adherence to this method, investigators conducted a six-step iterative analysis involving reading, rereading, subcoding, coding, articulating themes, and, finally, comparing interpretations to produce a final set of themes from the sample of transcripts. During the final step of this process, several revisions were made before investigators were satisfied with the reported themes.

Results

4962 patients satisfied the recruitment criteria between March 18 and April 1 and were invited to participate in the phone interview. Subsequently, 283 responded “YES” to the SMS invitation, of whom 214 scheduled a phone interview time slot. In total, 197 Eucalyptus patients ended up participating in phone interviews. Patients who responded “YES” to the SMS but did not schedule or attend their interview were not asked to give a reason for their decision. All patients who were called consented to their responses being used for research purposes. The mean age of the 197 participants was 40.4 (±10.4), and the mean body mass index was 34.4 kg/m² (±5.6; Table 1). Most participants were of Caucasian heritage (61%), and slightly more females (51.7%) were interviewed than males. Interviews lasted for a mean of 8.4 min.

Table 1.

Participant Characteristics

Gender—no. of participants (% of total)
Female	102 (51.7)
Male	95 (48.3)
Age—mean (SD) years	40.4 (±10.4)
BMI—mean (SD) kg/m²	34.4 (±5.6)
Ethnicity—no. of participants (% of total)
Caucasian	120 (60.9)
Asian (Inc. Subcontinent)	24 (12.2)
First Nations Australian	16 (8.1)
Middle Eastern	15 (7.6)
Pacific Islander or Māori	12 (6.1)
Latino Hispanic	4 (2.0)
Not listed	6 (3.0)

BMI, body mass index; SD, standard deviation.

From our analysis, five key themes emerged in relation to the reasons PWOO chose to treat their condition with the Eucalyptus DWLS: failure to achieve weight-loss goal through stand-alone lifestyle interventions, marketing and brand awareness, difficulty accessing comprehensive weight-loss care through local general practitioner (GP), more comfortable receiving weight-loss therapy through digital platforms, and patients value the flexibility of asynchronous DWLS consults.

Failure to achieve weight-loss goal through stand-alone lifestyle interventions

Many patients (43.7%) expressed their frustration at not being able to lose a meaningful amount of weight through previous attempts at stand-alone diet and exercise regimes. In such cases, it can be reasonably assumed that the Eucalyptus DWLS appeal lay mainly in its provision of GLP-1 RA medications:

“I’ve been training 5 times a-week for ages, and I’ve barely lost any weight.”

“I’m 57 and I've tried everything … I exercise a lot … but the weight just seems to be slowly creeping up.”

“I thought I’d try something different for a change after trying lots of different diets that have never worked.”

For some patients (8.1% of this subgroup), stand-alone lifestyle therapy is constrained by weight-related comorbidities:

“I was recently diagnosed with a condition that does not allow me to exercise properly anymore and I can feel the extra weight on me.”

Marketing and brand awareness

Eucalyptus’ marketing was commonly mentioned (31.0% of participants) as a reason for subscribing to the DWLS. In most cases (83.6% of this subgroup), patients referred to advertisements that appeared on their social media:

“It kept popping up on Facebook and decided to give it a try as I want to lose weight.”

“I had lots of ads on social media and I just did it – I need to lose weight.”

“I saw your ads and they were pretty eye-catching.”

However, other marketing platforms were also influential (16.4% of the subgroup), including television, radio, and Google searches.

“I’ve seen a few ads on TV and wanted to see what else might help me lose a few more kilos.”

“I heard about it on the radio, had a look at the website, and decided to go for it.”

“I googled Ozempic and I chose Pilot because it was the first option that came up, and I recognized the brand.”

The final clause of the latter quote reflects a brand awareness that appears to have also been cultivated through word of mouth.

“Someone my mum was working with used your company and she said it was good for her.”

“One of my friends has been doing Juniper and she had that food noise as well … and she’s said since joining that has really subsided.”

“My husband is on Pilot and he recommended I get on it as well.”

Difficulty accessing comprehensive weight-loss therapy through local GP

The perceived difficulty of accessing comprehensive weight-loss care through a local GP clinic was identified by multiple participants (54.3%) as a key reason for their Eucalyptus DWLS subscription. In several cases (79.4% of this subgroup), this was framed in general terms:

“I really liked the idea of having everything on an app. I wouldn’t have stuff like a weight-tracker, food diary or health coach if I just went to my local medical center or GP.”

“I thought about going to my GP but knew I wouldn’t receive as much support as I will from you guys.”

A number of patients (12.1% of the subgroup) also specified the aspect of comprehensive weight-loss therapy that was neglected in previous consults with their local GP, that is, either lifestyle or pharmacological treatment.

“I spoke to my GP about it [desire to lose weight] and they just gave me an Ozempic prescription. I’ve read up on these medications. I know they’re not a magic pill.”

“I’ve been to the GP in the past and he basically told me ‘No, don’t take medications – you don’t need them. Just go to the gym and eat better. You can do it!’ And I was like, ‘Okay, well, I’ve been doing that … I really tried with the gym but it never seemed to last long.’”

The care continuity aspect of comprehensive weight-loss was also mentioned (8.4% of the subgroup) as a challenge in local face-to-face (F2F) GP clinics:

“My GP prescribed me some Ozempic and I lost a bit of weight but then started feeling nauseous. I couldn’t wait a week to schedule another appointment, so I just stopped taking it. Juniper say they give round-the-clock support, so I’m hoping that’s the case.”

More comfortable receiving weight-loss therapy through digital platforms

Another reason for subscribing to the Eucalyptus DWLS that came through consistently (28.4% of participants) across the sample was the comfort of receiving weight-loss therapy via a digital platform rather than F2F services. In most cases (96.4% of this subgroup), patients indicated that this discomfort in F2F settings stemmed from their perception that overweight and obesity were stigmatized conditions.

“Sitting in a room with someone – even an experienced doctor – and talking to them about your eating habits is really confronting. And I get that that’s a society construction thing, but that doesn’t make it any easier for me.”

“I spoke about my weight with my GP a few times and they were really good about it – really supportive. But I just felt so uncomfortable. I guess it was shame. So I thought I’d try something online where I don’t have to look at the doctor.”

“I became overweight for the first time in my life after I had a baby and the thought of speaking to someone (about it) made me anxious. Doing it (therapy) through an app should help me. It worked when I needed to see a doctor about a mental health issue I had.”

Patients value the flexibility of asynchronous DWLS consults

Finally, a significant proportion of participants (22.8%) expressed that their perceived flexibility of digital asynchronous consults was a key factor in their decision to subscribe to the Eucalyptus program. Although not all patients directly compared their perception of DWLS flexibility with their experiences or perceived experiences in F2F services, it could be reasonably inferred from such responses that a comparison between the two care modalities was being drawn, given their fundamental differences. Nearly all responses related to this theme (95.5%) made reference to work or family commitments.

“I work from 9 to 5 and have two kids. The only time I can see my GP is on the weekend and those are packed with my boys’ footy and little Aths (athletics) events. My friend told me Juniper was good because she could speak to her doctor and dietitian whenever she got a spare moment.”

“My job involves a lot of travel, so I can’t really commit to anything that requires me to be somewhere specific at a specific time.”

“I’ve gotten used to doing everything online and don’t think I have the patience anymore to wait for my medical center to find a (time)slot that fits my schedule. I reckon this (Pilot subscription) will give me a better chance of sticking to a program.”

Discussion

Increasingly large numbers of PWOO are seeking care through DWLSs. Providers of these services and certain scholars have framed this as a positive development in the context of overloaded national health care systems and the global obesity epidemic, suggesting that digital modalities represent the only feasible means through which PWOO can access quality obesity care.^8,32 However, many influential stakeholders have publicly rejected this perspective, arguing that most DWLSs simply increase access to GLP-1 RA medications without providing a suitable level of care continuity.³³ An assessment of patient reasons for using large DWLSs represents an important component in the determination of the veracity of the above arguments.

This study identified five themes around patient reasons for subscribing to Australia’s largest DWLS. Three of these themes appear to somewhat support the view of DWLS advocates that such services increase obesity care access: difficulty accessing comprehensive weight-loss therapy through local GP, valuing the flexibility of asynchronous DWLS consults, and more comfortable receiving weight-loss therapy through digital platforms. Many patients felt that weight-loss therapy at their local GP clinic was too rudimentary or unidimensional. Commentary around DWLS flexibility indicated that GP waiting times may also be a significant barrier to obesity care for modern patients who have grown accustomed to a fast-paced world. The third theme consistent with increased obesity care access arguments was arguably the most novel. Although the positive impact of digital modalities on stigmatized conditions has been reported in comparable chronic care settings,^34,35 DWLS advocates seldom advance this point. Many participants in this study suggested that obesity stigma is a significant barrier to quality F2F care.

The two remaining themes, however, appear more supportive of the DWLS-sceptic view. The first of these, failure to achieve weight-loss goal through stand-alone lifestyle interventions, closely aligns with the common criticism that many patients subscribe to DWLSs simply to facilitate their access to GLP-1 RAs. Although most participants who gave such responses did not specifically reveal a limited concern for the lifestyle component of their Eucalyptus program, it was clear that they primarily subscribed to the service for its provision of GLP-1 RA medications. The second theme that supported DWLS skepticism was that concerning marketing and brand awareness. Such responses did not support primary skeptic concerns around DWLS safety, yet they appear to align with supplementary concerns that many DWLSs use “relentless marketing” to hook patients.³³ Indeed, some commentators have even framed the Eucalyptus DWLS as a marketing business rather than a patient-first health care company.¹³ The marketing and brand awareness theme identified in this study adds credence to that argument; however, a dedicated investigation of the service’s care model and safety protocols would need to be conducted before any strong conclusions are drawn about its marketing strategy. In general, the two themes that align with DWLS criticisms appear concerning enough to balance out the modality’s potential obesity care access benefits identified by other patients. Stated differently, it appears that the proportion of PWOO who subscribe to the Eucalyptus DWLS primarily as a means of facilitating their access to GLP-1 RAs is comparable with those who use it for its perceived care continuity and comprehensiveness benefits.

The study contained several limitations. First, study findings were all based on patient perceptions of the Eucalyptus DWLS. Although the recruitment strategy was well considered, limiting the sample to patients who were committed to the program but not yet impacted by the program experience itself (e.g., presenting reasons for subscription that were not influenced by disgruntlement or elation with an aspect of the program), concrete conclusions about DWLS utility in a care access sense can only be drawn from a collection of quantitative analyses of DWLS care models, user profiles, and longitudinal patient experience data. Thus, in the complex tapestry of the obesity care access debate, patients’ reasons for subscribing to a large DWLS represent only a component of the assessment. Second, patients’ perceptions of the Eucalyptus DWLS that are ultimately reflected in their reasons for subscribing to the service are shaped by biased material rather than complete knowledge of the program offering. Nearly all details of the service are available on the company and subsidiary (Juniper and Pilot) websites; however, patients have to conduct thorough searches to retrieve information on vital care continuity features, including MDT interaction, program design, and the use of monitoring and educational tools. Although the Pilot homepage gives prospective patients a reasonably rounded view of the program with bold titles such as “A complete coaching program that works’, ‘One-on-one goal setting’, and ‘Biometric & health tracking,” the Juniper homepage directs patients to the program’s “Medical pathway” in its headline. Moreover, the analysis revealed that perceptions of the service are shaped as “eye-catching” marketing material and media coverage, sources that typically omit significant details. Furthermore, although the sample was relatively large and came from Australia’s largest DWLS, which also operates in three other countries, it only represents views of one DWLS from what is a broad care spectrum. Finally, it is possible that the study sample contained a disproportionate number of patients who have strong opinions about digital health or obesity care and/or feel comfortable sharing their views over the phone. Consequently, it may have failed to capture the views of more dispassionate or reserved DWLS users.

Conclusion

Despite these limitations, this study established an important foundation in digital obesity care literature. It identified five themes related to the reasons PWOO subscribe to Australia’s largest DWLS. Three themes indicated that comprehensive DWLSs such as Eucalyptus can mitigate obesity care access barriers. However, the other two themes offered support to the common criticism that DWLSs are marketing-based companies that simply facilitate access to GLP-1 RAs. These findings do not generate anywhere near enough information to enable strong conclusions about the care access effect of DWLSs. They do, however, provide a vital level of clarity from which to commence further research on the subject. Future projects should consider quantitative analyses of patient reasons for using DWLSs, both at program initiation and after significant program experience. Other researchers might look to compare DWLS marketing content with program outcomes and patient experiences.

Footnotes

Acknowledgment

The authors would like to thank all study participants for their time and input during phone interviews.

Authors’ Contributions

L.T.: Conceptualization, methodology, validation, formal analysis, investigation, data curation, writing—original draft, and writing—reviewing and editing. M.V.: Conceptualization, writing—reviewing and editing, formal analysis, validation, and project administration. S.L.: Project administration, resources, and formal analysis.

Author Disclosure Statement

L.T., M.V., and S.L. are all paid a salary by Eucalyptus.

Funding Information

This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Supplementary Material

Abbreviations Used

References

Ferrari

, Santomauro

, Aali

, et al. Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and health life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990–2021: A systematic analysis for the global burden of disease study 2021. Lancet, 2024; 403(10440):2133–2161.

World Health Organization. Obesity and overweight. 1 March 2024. Available from: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight#:∼:text=In%202022%2C%2043%25%20of%20adults,who%20were%20living%20with%20obesity.

Hall

, Heymsfield

, Kemnitz

, et al. Energy balance and its components: Implications for body weight regulation. Am J Clin Nutr, 2012; 95(4):989–994.

Javed

, Valero-Elizondo

, Maqsood

, et al. Social determinants of health and obesity: Findings from a national study of US adults. Obesity (Silver Spring), 2022; 30(2):491–502.

Verde

, Frias-Toral

, Cardenas

. Editorial: Environmental factors implicated in obesity. Front Nutr, 2023; 10:1171507.

World Health Organization. Health service framework for prevention and management of obesity. Geneva, 2023.

National Institute for Health and Care Excellence. Semaglutide for managing overweight and obesity, September 2023.

Irvin

, Madden

, Marshall

, et al. Digital health solutions for weight loss and obesity: A narrative review. Nutrients, 2023; 15(8):1858.

Naslund

, Deng

. Addressing mental health stigma in low-income and middle-income countries: A new frontier for digital mental health. Ethics, Medicine and Public Health, 2021; 19:e100719.

10.

Jung Song

, Dennis

, Levesque

J-F

, et al. What matters to people with chronic conditions when accessing care in Australian general practice? A qualitative study of patient, carer, and provider perspectives. BMC Fam Pract, 2019; 20(1):79.

11.

Lei

, Medina Inojosa

, Kumar

, et al. Effectiveness of a weight loss program using digital health in adolescents and preadolescents. Child Obes, 2021; 17(5):311–321.

12.

Tsirtsakis

. Debate over ‘doctor-approved’ weight loss drugs obtained online. Royal Australian College of General Practitioners. 30 March, 2023. Available from: https://www1.racgp.org.au/newsgp/clinical/debate-over-doctor-approved-weight-loss-drugs-obta.

13.

Bonyhady

. ‘Pill mills’ or the future of medicine? The rise of the telehealth industry. Sydney Morning Herald. January 11, 2023. Available from: https://www.smh.com.au/technology/pill-mills-or-the-future-of-medicine-the-rise-of-the-telehealth-industry-20230117-p5cdb3.html.

14.

Talay

, Alvi

. Digital healthcare solutions to better achieve the weight-loss outcomes expected by payors and patients. Diabetes Obes Metab, 2024; 26(6):2521–2523.

15.

Wilding

, Batterham

, Calanna

, et al. Once-weekly Semaglutide in adults with overweight or obesity. N Engl J Med, 2021; 384(11):989–1002.

16.

Jastreboff

, Aronne

, Ahmad

, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med, 2022; 387(3):205–216.

17.

Pi-Sunyer

, Astrup

, Fujioka

, et al. A radnomised controlled trial of 3.0mg of Liraglutide in weight management. N Engl J Med, 2015; 373(1):11–22.

18.

Carls

, Tuttle

, Tan

, et al. Understanding the gap between efficacy in randomized controlled trials and effectiveness in real-world use of GLP-1 RA and DPP-4 therapies in patients with type 2 diabetes. Diabetes Care, 2017; 40(11):1469–1478.

19.

Lowe

, Wu

, Rohdin-Bibby

, et al. Effects of time-restricted eating on weight loss and other metabolic parameters in women and men with overweight and obesity: The TREAT randomised clinical trial. JAMA Intern Med, 2020; 180(11):1491–1499.

20.

Wilding

, Batterham

, Davies

, et al. Weight regain and cardiometabolic effects after withdrawal of Semaglutide: The STEP 1 trial extension. Diabetes Obesity Metabolism, 2022; 24(8):1553–1564.

21.

Talay

, Vickers

, Wu

. Patient satisfaction with an Australian digital weight-loss service: A comparative retrospective analysis. Telemedicine Reports, 2024 (in press).

22.

Gemesi

, Winkler

, Schmidt-Tesch

, et al. Efficacy of an app-based multimodal lifestyle intervention on bodyweight in persons with obesity: Results from a randomised controlled trial. Int J Obes, 2023; 48(1):118–126.

23.

Kupila

, Joki

, Suojanen

, et al. The effectiveness of eHealth interventions for weight loss and weight loss maintenance in adults with overweight and obesity: A systematic review of systematic reviews. Curr Obes Rep, 2023; 12(3):371–394.

24.

White

, Shu

, Rometo

, et al. Real-world weight loss effectiveness of GLP-1 agonists among patients with type 2 diabetes: A retrospective cohort study. Obesity (Silver Spring), 2023; 31(2):537–544.

25.

Weiss

, Yang

, Carr

, et al. Real-world weight change, adherence, and discontinuation among patients with type 2 diabetes initiating glucagon-like peptide-1 receptor agonists in the UK. BMJ Open Diabetes Res Care, 2022; 10(1):e002517.

26.

Schultes

, Timper

, Cavadini

, et al. Weight loss and treatment patterns in a real-world population of adults receiving liraglutide 3.0 mg for weight management in routine clinical practice in Switzerland (ADDRESS study). Diabetes Obesity Metabolism, 2023; 26(3):1023–1032.

27.

Gorgojo-Martinez

, Basagoiti-Carreño

, Sanz-Velasco

, et al. Effectiveness and tolerability of orlistat and liraglutide in patients with obesity in a real-world setting: The XENSOR Study. Int J Clin Pract, 2019; 73(11):e13399.

28.

Wharton

, Liu

, Pakseresht

, et al. Real-world clinical effectiveness of liraglutide 3.0 mg for weight management in Canada. Obesity, 2019; 27(6):917–924.

29.

Talay

, Vickers

. Effectiveness and care continuity in an app-based, GLP-1 RA-supported weight-loss service for women with overweight and obesity in the UK: A real-world retrospective cohort analysis. Diabetes Obes Metab, 2024; 26(7):2984–2987.

30.

Talay

, Vickers

. Patient adherence to a digital real-world GLP-1 RA-supported weight-loss program in the UK: A retrospective cohort study. J Community Med Public Health, 2024

31.

Braun

, Clarke

. Thematic Analysis: A practical guide. Sage Publications, 2021.

32.

Kmietowicz

. Weight-loss drugs: Digital services will improve access, says NICE. BMJ, 2023; 382:1882.

33.

Robinson

. ‘Cowboys’ of telehealth pushing copycat Ozempic on the vulnerable. The Australian, May 11, 2024. Available from: https://www.theaustralian.com.au/inquirer/cowboys-of-telehealth-pushing-copycat-ozempic-on-the-vulnerable/news-story/fac729dba705c627eff0a9fb301fd2d9.

34.

Rush

, Hatt

, Janke

, et al. The efficacy of telehealth delivered educational approaches for patients with chronic diseases: A systematic review. Patient Educ Couns, 2018; 101(8):1310–1321.

35.

Snoswell

, Stringer

, Smith

, et al. An overview of the effect of telehealth on mortality: A systematic review of meta-analyses. J Telemed Telecare, 2021; 29(9):659–668.

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