Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have demonstrated substantial weight reduction and cardiometabolic benefit in randomized trials; however, prospective implementation evidence from digital care models and female sex community populations remains limited. Here we report outcomes from an observational study of 8,127 women initiating GLP-1RA therapy (99.8% tirzepatide) through a structured digital program incorporating mandatory biochemical monitoring, weekly video-supported follow-up and clinician-guided dose titration in the UK. Mean weight reduction was 16.1 kg (95% confidence interval 15.9 to 16.2; P < 0.001), representing 15.5% of baseline weight; 83.1% achieved ≥10% and 22.4% achieved ≥20% weight loss, with consistent responses across age, baseline weight and socioeconomic strata. Among participants with paired biomarker data, mean glycated hemoglobin decreased by 3.3 mmol mol-1 (95% confidence interval 3.1 to 3.4; P < 0.001), normalizing in 84.5% of those with baseline diabetes-range values and 96.3% with prediabetes, and lipid parameters improved significantly (reductions in total cholesterol of 0.77 mmol l-1, low-density lipoprotein cholesterol of 0.61 mmol l-1 and triglycerides of 0.47 mmol l-1). Retention was 91.4% at 6 months, with no serious treatment-related adverse events. These findings support the feasibility of delivering structured, digitally enabled obesity pharmacotherapy at scale and provide prospective real-world implementation evidence for this care model. Interpretation is limited by the observational design, absence of a comparator group, self-pay population and 6-month follow-up.
