New Drugs — Does Lifestyle Intervention Still Count? Part 2

The previous post discussed the STEP trials, which are multi-staged and spread out over many institutions. We mentioned Timothy Garvey, M.D., who wrote that the weight loss achieved by many of the trial participants “is beginning to close the gap with bariatric surgery,” and…

It is important to use this medication in conjunction with lifestyle intervention. What this medicine does is help patients adhere to a reduced-calorie diet. With obesity, you always need lifestyle changes plus the medicine.

A New England Journal of Medicine article mentioned that while semaglutide is being used to treat adult obesity, information on its effect on adolescents is scarce. It is known that…

[…] once-weekly treatment with a 2.4-mg dose of semaglutide plus lifestyle intervention resulted in a greater reduction in BMI than lifestyle intervention alone.

Like adults, teens begin with a 12-week lifestyle intervention “run-in phase” before being assigned to randomized groups for the actual testing of the drug (or placebo). This three-month preparation period…

[…] reflects clinical practice recommendations to implement lifestyle modifications for weight loss before initiating pharmacotherapy in adolescents. The inclusion of parents or guardians in the lifestyle intervention provided throughout the trial may also have contributed to the high completion rates, since the inclusion of parents or guardians in lifestyle counseling is known to improve weight-loss outcomes among young people.

This makes sense of course, because usually it is the parents who provide most of the food consumed by teenagers, and because dependent minors might need an eye kept on them for other possible reasons as well. Another article about semaglutide notes,

Lifestyle intervention, consisting of diet and exercise, remains the cornerstone of weight management.

That was way back in early 2021, but spoiler alert: lifestyle intervention is still vital. Just the headline and subtitle of a very recent piece from tell the story:

Weight Loss Drug Trial Shows 21% Additional Loss After Lifestyle Intervention
A phase 3 clinical trial showed an additional 21.1% weight loss after intensive lifestyle intervention.

Now, they are mainly talking about certain types of intervention, which we will get into. But remember the original question posed in a recent post: Do the new, remarkably effective GLP-1 obesity medications eliminate the need for obesity interventions such as BrainWeighve? These drug trial research teams have a lot on their plates, and they can’t do everything. What they mean by lifestyle intervention, and what others may mean by that same term, are not necessarily synonymous.

Your responses and feedback are welcome!

Source: “Who will benefit from new ‘game-changing’ weight-loss drug semaglutide?,”, 04/09/22
Source: “Once-Weekly Semaglutide in Adolescents with Obesity,”, 12/15/22
Source: “Trial Finds Semaglutide With Lifestyle Intervention Reduces Body Weight by Nearly 15%,”, 02/10/21
Source: “Weight Loss Drug Trial Shows 21% Additional Loss After Lifestyle Intervention,”, 10/18/23
Image by Bill Smith/CC BY 2.0 DEED

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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