The US Preventive Services Task Force (USPSTF) recommends that weight loss patients try a six-month behavioral intervention that includes first calorie-restricted diet, moderate to intense physical activity each week, self-monitoring of food intake, and removal of unhealthy foods. However, many patients fail to correct their behavior, even with regular health counseling.
A study published last month Natural Medicinethe researchers found that patients who performed a one-month behavioral modification rather than six months before starting weight loss medications had doubled their weight loss when they added obesity medication to the mixture. This study showed that many patients who struggle to lose weight with lifestyle modification alone can benefit from primary care physicians who prescribe obesity medications more quickly.
“Weight and Eating Disorders Center for the University of Pennsylvania Perelman School of Medicine in Philadelphia,” said Ina Shaw Tronieri, PhD, director of clinical services at the Center for Weight and Eating Disorders at the University of Pennsylvania Perelman School of Medicine in Philadelphia.
Lifestyle changes are not sufficient for many patients
Whether a patient adds glucagon-like peptide 1 (GLP-1) drugs really depends on whether they are successful in weight loss, Tronieri said. If patients were successful due to potential side effects, they would not want to add patients, but the majority of patients would not experience clinically meaningful weight loss without adding drugs. These patients can be determined fairly early in the process.
Dr. Thomas A. Wadden, professor of psychiatry at Perelman School of Medicine, said:
Recommendations from the USPSTF still suggest that patients should continue to modify their behavior for six months, but the study showed that 35% to 40% of patients do not significantly decrease within six months without using obesity medication, Wadden said.
Changes in behavior are even more difficult as many patients do not show counseling in this study, as they try to change their own diet and lifestyle habits. This is especially true for patients who are on the crisis of potential comorbidities such as diabetes or heart disease, and if they see the scale being etched faster, it could turn the tide.
GLP-1 allows for much higher weight loss
It is important to note that this study used an older obesity drug called phentermine, a prescription drug used to reduce appetite that is much less effective than GLP-1 drugs. The expected weight loss for phentermine is 5% to 7%, while the expected weight loss for GLP-1 drugs is about 10% to 15%.
“If GLP-1 was used in research, we can imagine it would have been even more effective than this weight loss drug,” said Ziyad al-Aly, an assistant professor in the Department of General Medicine and Geriatric Medicine at Washington University at St. Louis School of Medicine in St. Louis.
The study attempts to do behavioral intervention for around a month and then it doesn’t work, says Al-Aly. For many patients, spending the extra five months struggling to lose weight is a waste of time, he said.
David and Goliath are fighting on scale
Drivers for conducting behavioral interventions are not only dependent on individuals, but also on the environment, including relationships, social habits and the food environment that exists, Al-Aly said.
“In our society, all of those things can be headwinds against you,” he said.
People are trying to push with individual will and their own behavior changes, but it’s not so easy in a country where ultra-processed food culture, huge food pieces in restaurants, long working hours, and where many people sit all day long at desk work.
“It’s often the struggle between David and Goliath, and that’s why so many behavioral interventions ultimately fail. You’re a small factor in the ecosystem that’s pushing you to constantly consume you, exercise less, drive more,” Al Aly said.
For many Americans, the GLP-1 helps them repel the tide.
Supriya Rao (MD), director of medical weight loss and clinical assistant professor at Tufts University School of Medicine in Boston, said the length of time patients continue to modify their behavior could also depend on insurance coverage.
This may not change until the results of such studies are replicated in larger studies using GLP-1S and recommendations from the USPSTF have also been changed. While some insurers only need a BMI of 30 or more or 27 or more BMI with at least one weight-related comorbidity, such as diabetes or hypertension, to cover GLP-1 drugs, “others need patients to maintain behavioral modifications for longer periods of time to cover the cost of the drug,” Rao said.
While behavioral changes are an important aspect of living a healthier life with GLP-1, many patients have found that they are inspired to eat healthy diets and exercise once they start taking medications. Research published in the March 2024 issue International Journal of Obesity GLP-1 has been found to change patients’ food preferences and feed less high-fat and high-sugar foods.
When food noise is gone and you can eventually concentrate on something other than your next meal, exercise will be easier and healthy eating will be easier. “Lossing weight can encourage you, so you may become more physically active. If you lose 10 or 15 pounds, you may be more excited to go to the gym or workout,” says Wadden.
This is a positive feedback cycle for many patients. In other words, just because you add more medication doesn’t mean you’re giving up the correction. It’s important that you do both and these drugs may make it easier to do just that.
“When you succeed, it creates more success,” Wadden said.
