Why Some Physicians Nonetheless Lead With Lifestyle-First Obesity Care Regardless of the GLP-1 Revolution

The fast adoption of GLP-1 receptor agonists has basically altered weight problems administration, with these medicines now prescribed to hundreds of thousands of sufferers searching for important weight reduction. Yet a considerable variety of physicians proceed to prioritize way of life interventions as their major strategy, at the same time as skilled tips more and more emphasize pharmacologic choices and sufferers arrive with particular remedy requests.

What drives this medical philosophy in an period the place injectable medicines promise double-digit weight reduction? The reply lies not in resistance to innovation however in a nuanced understanding of what produces lasting ends in real-world apply.

Guidelines Support Combination Therapy, Not Medication Replacement

Current medical steerage displays the rising proof base for antiobesity medicines whereas sustaining emphasis on behavioral foundations. As famous within the National Institutes of Health’s Endotext chapter on weight problems pharmacotherapy, present tips suggest that people who’ve tried way of life enhancements and proceed to have a BMI of ≥ 30 or ≥ 27 with an obesity-related comorbidity could also be eligible for weight-loss remedy therapy.

The steerage emphasizes that antiobesity medicines “are indicated in combination with lifestyle modification for the management of overweight and obesity,” much like approaches used for different persistent ailments.

These tips signify a big evolution from earlier suggestions that positioned medicines as last-resort choices. However, they persistently emphasize pharmacotherapy as an adjunct to, fairly than a alternative for, structured behavioral interventions. This distinction proves essential for physicians who keep lifestyle-first approaches. They’re not ignoring present steerage however deciphering it by way of the lens of medical expertise and affected person outcomes.

Real-World Data Reinforces Lifestyle Foundations

Real-world outcomes spotlight the restrictions of remedy with out sustained adherence. This could assist clarify why some clinicians proceed to steer with way of life interventions.

A Cleveland Clinic study of 7881 sufferers with weight problems printed within the journal Obesity revealed important gaps between medical trial efficacy and on a regular basis apply outcomes. More than 50% of sufferers discontinued GLP-1 medicines inside 1 12 months — 20% inside 3 months and 32% between 3 and 12 months. Additionally, greater than 80% remained on subtherapeutic upkeep dosages.

The weight-loss outcomes various dramatically based mostly on adherence and dosing. Patients who discontinued early achieved solely 3.6% weight reduction, whereas those that discontinued late misplaced 6.8%. Patients who continued therapy misplaced 11.9% on common, however those that each continued therapy and achieved excessive upkeep dosing misplaced 13.7% with semaglutide and 18.0% with tirzepatide — outcomes approaching medical trial outcomes.

Dexter Shurney, MD, MPH, MBA, chief medical officer at ModifyHealth, sees these information as validation of his strategy: “The majority of common chronic conditions — hypertension, [congestive heart failure] CHF, hyperlipidemia, diabetes, depression, and obesity — are fundamentally lifestyle issues. Therefore, a lifestyle-first approach to care makes perfect sense because it addresses root cause.”

Clinical Philosophy Rooted in Sustainability

For physicians dedicated to lifestyle-first care, the strategy stems from noticed affected person outcomes fairly than theoretical preferences. Kenji Kaye, MD, a board-certified internist and concierge doctor with South Denver Concierge in Denver, explains: “Without foundational lifestyle changes, medications and surgery are destined to fail. We have seen many patients not lose weight or even gain weight despite max dosages of these pharmaceuticals.”

This perspective is knowledgeable by understanding weight problems as a multifactorial situation requiring complete intervention. As Kaye notes: “Lifestyle habits, genetics, hormonal state, activity level, and other comorbid conditions all contribute to obesity. I like to focus on addressing the variables that will have the biggest impact while evaluating for underlying contributing medical conditions.”

The sustainability argument extends past weight reduction to broader well being outcomes. Shurney emphasizes the systemic advantages of way of life interventions: “Lifestyle medicine has a much broader clinical application than a single medication or surgical intervention, which are typically designed to treat one condition at a time and come with multiple side effects. Lifestyle interventions work well to effectively avoid the polypharmacy issues that many patients often face.”

He cites dramatic outcomes achievable with intensive way of life packages: “When starting a patient on a rigorous lifestyle medicine program for type 2 diabetes, it is often necessary to reduce their insulin dose by half within days to avoid hypoglycemia. I have routinely seen average drops in cholesterol of 20%-50% within 7-8 weeks.”

Strategic Medication Use Within Lifestyle Framework

Even amongst physicians who lead with lifestyle-based care, some incorporate GLP-1 receptor agonists as a part of a broader therapy plan that features habits change. Elizabeth Slauter, MD, a board-certified household medication and weight problems medication doctor who practices at a direct major care clinic in Boerne, Texas, explains her strategy: “Studies consistently show that the best outcomes with obesity medications occur when they are combined with lifestyle changes. So, it makes sense to start with lifestyle interventions as a foundational approach.”

The determination so as to add medicines typically hinges on sensible concerns. Cost stays a big barrier, with many sufferers unable to afford long-term therapy. Slauter often encounters this problem: “Many people cannot afford the cost of medications, especially long term — and research shows that these medications are often needed long-term to maintain results,” she stated.

Insurance protection inconsistencies and prior authorization necessities create extra boundaries. The Cleveland Clinic research recognized price and insurance coverage protection as major causes for therapy discontinuation, alongside unwanted side effects and drugs shortages.

For these physicians, medicines function instruments inside a complete framework fairly than standalone options. Kaye describes his typical course of: “My usual practice is to discuss these medications as an option but only after a careful review of their food choices, activity level, health history, and current medications.”

Navigating Patient Expectations and Media Influence

The widespread media protection of GLP-1 receptor agonists has created new medical challenges. Patients more and more current with particular remedy requests, typically based mostly on social media testimonials or celeb endorsements fairly than medical assessments.

Kaye addresses this instantly: “Medications like GLP-1s are mentioned almost everywhere including the media, pharmaceutical ads, and celebrity gossip. When a patient presents asking for a prescription, it is a perfect opportunity to really delve into the details of what these medications can offer and also the risks involved.”

Setting reasonable expectations turns into essential, Slauter stated. “One issue I run into frequently is that patients expect to be on weight-loss medication for a short term, and this is not always reasonable,” she stated. This expectation administration is especially essential given the Cleveland Clinic information displaying that discontinuation results in diminished effectiveness.

The instructional strategy permits physicians to deal with misconceptions whereas sustaining therapeutic relationships, Kaye stated. “Most of the time patients welcome an open discourse about options and strategies to achieve their goals,” he stated.

Systemic Pressures and Professional Conviction

Healthcare methods more and more favor interventions that produce fast, measurable outcomes, creating strain to prescribe medicines over time-intensive way of life counseling. Reimbursement buildings typically inadequately compensate for the prolonged counseling classes required for efficient way of life interventions.

Shurney identifies this as a elementary barrier: “The lack of reimbursement parity for lifestyle interventions is a disincentive to practice this way,” he stated. “It’s much easier to prescribe a medication and receive the ‘quality prize’ for checking the drug adherence box than to prescribe lifestyle and not receive a similar financial reward.”

Some physicians have modified their apply fashions to keep up their medical philosophy. “I joined a direct primary care specifically to have the time to counsel my patients on this,” Slauter stated. “A traditional insurance-based practice did not offer the time needed for this.”

Long-Term Perspective Drives Clinical Decisions

What finally sustains these physicians’ dedication to lifestyle-first care is their long-term perspective on affected person outcomes, Kaye stated. “After seeing many patients start down the pathway of pharmaceuticals and ultimately not reaching their goals reaffirmed my commitment to a more holistic approach,” he stated. “In my experience, without a strong foundation of lifestyle changes, the long-term success rate is low even with antiobesity medications.”

This perspective is bolstered by issues about healthcare sustainability. Shurney warns: “What we risk are ever-higher healthcare costs, since these medications are very expensive and need to be taken for years, if not forever, to sustain the weight loss. Additionally, we still do not know the long-term effects of these medications.”