Game changers: do new medications make lifestyle‐based treatment of obesity obsolete?

Abstract

Historically, obesity was viewed as a lifestyle disease, with an associated lifestyle solution, and approaches that embody the “eat less, move more” idea have dominated obesity treatment recommendations for over half a century. Meanwhile, the prevalence and severity of obesity continue to increase globally. Enter the so‐called “game changers”: glucagon‐like peptide‐1 receptor agonists. In the media frenzy around these and other new antiobesity medications in the pipeline, lifestyle‐based treatment researchers and practitioners may find themselves wondering whether behavioral approaches to obesity will become obsolete in this new therapeutic era. In this Perspective, the authors contend that medical approaches impact physiologic pathways to support the success of behavioral approaches. Similarly, behavioral approaches can improve weight loss‐adjacent outcomes that are not addressed by medication. Thus, the two approaches are complementary and must coexist if we are to make a significant, population‐level impact on the obesity epidemic.

Lifestyle Interventions for Obesity in the Era of GLP-1 Receptor Agonists

“…This personalized approach to first-line treatment selection could eliminate the practice of requiring all patients to not respond to a behavioral therapy before granting access to more effective obesity treatment options. 15 What patients are most likely to respond to low-intensity behavioral interventions? These approaches may be ideal for patients hesitant to engage with more intensive lifestyle therapy, medical or surgical treatment, those with recent weight gain, those who recently exceeded a BMI threshold (eg, BMI of 30), or those with episodic weight gain due to a timelimited event (eg, postpartum weight retention, medicationinduced weight gain, postinjury weight gain).…”

“…The ability to identify people most likely to respond to low-intensity interventions and implement individualized strategies to promote healthful weight management would be highly desirable and cost-effective. This personalized approach to first-line treatment selection could eliminate the practice of requiring all patients to not respond to a behavioral therapy before granting access to more effective obesity treatment options …”