People using tirzepatide for weight loss in the real world reported big drops in weight, felt more confident about controlling their eating, and noticed better sleep, energy, mood, and confidence. Side effects were mostly mild stomach issues that went away quickly. The benefits were strongest early on and were higher for those who could afford the drug and had some behavioral support.

<b>Background:</b> Obesity confers substantial cardiometabolic risk. Tirzepatide, a once-weekly dual GIP/GLP-1 receptor agonist, produces dose-dependent weight loss in trials, but real-world patient-reported experiences are under-described. We evaluated real-world self-efficacy and experiences with tirzepatide in community settings. <b>Methods:</b> Explanatory sequential mixed-methods study of adults aged 18-59 years using tirzepatide for weight management. We collected a quantitative survey (demographics; medication use; 20-item Weight Efficacy Lifestyle Questionnaire [WEL]) followed by purposive semi-structured interviews. Associations between WEL and participant characteristics were tested a priori (two-tailed &#x3b1; = 0.05). <b>Results:</b> Among 120 participants (50.8% male; mean age 42 &#xb1; 13 years), 91.7% reported weight loss and 85.8% had &lt;6 months' exposure. WEL total was 91 &#xb1; 34. Higher WEL was observed in females, employed participants, those with insurance coverage versus self-pay, during early months of therapy, and among those with prior weight-loss attempts (all <i>p</i> &lt; 0.05). Interviews (n = 15) indicated high satisfaction, improved sleep/energy, mood, and confidence; gastrointestinal effects were usually mild/transient. <b>Interpretation:</b> In routine care, tirzepatide use was associated with high eating self-efficacy and positive patient-reported outcomes. Variation by coverage and duration suggests value in pairing pharmacotherapy with behavioral support and addressing affordability to sustain benefits.