Lifestyle interventions for weight loss
May 24, 2024
The GLP-1 drugs have focused our attention on treatments for obesity, and many employers have arranged, or are considering, lifestyle modification programs. Some employers are considering such programs in conjunction with GLP-1 coverage, and others are considering such programs because they do not cover anti-obesity medications. Last week, JAMA (Journal of the American Medical Association) published two well-designed studies of lifestyle modifications which shed some light on the success and limits of such programs.
One set of researchers offered a text message program to promote weight loss, and randomized half of the participants to be eligible for up to a $490 incentive if they lost 10% of their body weight and sustained their weight loss. The study was performed in the United Kingdom, and all participants were racially and economically diverse men. They found that those who got text messages alone lost an average of 3.0 kg, which was not statistically different from the 1.5 kg of weight loss in the control group. Those who had access to the financial incentive had 5.7 kg weight loss (3.2% of body weight), which was statistically significantly different than the control group.
Source: Hoddinott, et al JAMA May 14, 2024 LINK
The second set of researchers provided all participants with a Wi-Fi connected scale which gave daily feedback, and randomized half of them to also get access to live coaches. Those in the coaching arm of this trial lost 4.8 kg on average; those who got the scale without coaching lost 2 kg on average.
Both trials showed statistically significant weight loss with the interventions. However, the weight loss was relatively small; neither trial achieved a 5% weight loss. This is consistent with decades of experience showing limited effectiveness of behavioral modification programs to promote weight loss, particularly over time.
Implications for employers:
Behavioral modification programs can help plan members lose weight, although total weight loss from behavioral modification was modest. These programs are important because many obese people will not take GLP-1 drugs or get bariatric surgery even if covered by their insurance plans.
Neither of these trials achieved 5% weight loss, which is often associated with decreased medical risk.
I don’t know of a study (yet) that demonstrates whether modern multimodal behavioral modification programs will either enhance the weight loss associated with GLP-1 medications or help members come off of GLP-1 medications prescribed for obesity.
Great stuff as always Jeff