New Drugs — Does Lifestyle Intervention Still Count? Part 6

A typical article (from Nature) about versions of the GLP-1 drugs states that people who receive “traditional lifestyle intervention” tend to helplessly regain weight when their program is over. But that discouraging news comes with a mitigating factor:

Regain can be decreased to 10-15% at 1 year with participation in a weight loss maintenance program, offered in person or by phone, which provides continued lifestyle counseling on a monthly or more frequent basis.

Still, after around two and a half years, even that tends to wear off. The author interprets this as revealing that…

These findings reveal the potential benefits of tirzepatide, relative to traditional weight loss maintenance counseling, in not only sustaining weight reduction achieved with intensive lifestyle intervention but in adding to it.

They also say that intensive lifestyle intervention, followed by tirzepatide, has about the same effect as the first year following a sleeve gastrectomy. In addition, these results are said to emphasize the “additional benefits that patients may receive from treatment with tirzepatide after first losing weight with intensive lifestyle intervention, or potentially with their own self-directed diet and activity programs.”

The Nature article also discusses the intensity (defined there as frequency) and scope of lifestyle intervention in conjunction with anti-obesity medications:

Weekly lifestyle visits and daily monitoring of food and energy intake historically have been required to help patients achieve and maintain the 500-750 kcal per day deficit needed to induce clinically meaningful weight loss.

The purveyors of semaglutide and tirzepatide believe that their products help to “physiologically drive this reduction in energy intake,” making a trait such as willpower less essential, which signifies to them that their products are better than conventional lifestyle counseling. Taking the meds to lose some weight is also credited with encouraging exercise — simply because it is easier to move around, which can lead to further weight loss.

They also say,

Trials of the response to antiobesity medications in persons who are unsuccessful with intensive lifestyle intervention are needed, because lack of success with lifestyle interventions has been a common prerequisite for initiation of pharmacotherapy or bariatric surgery.

Still, much of the literature seems to imply that the main component of “intensive lifestyle intervention” is calorie restriction, which would be unfortunate because…

[…] caloric restriction alone does not address the underlying physiology regulating body weight or fat mass, and antiobesity medication has the same overall ultimate effect regardless of whether or not caloric restriction preceded the medication.

It seems to imply that reducing diets are pointless. Maybe various kinds of counseling are pointless too. Except for the one that engages the mind and several personality components; encourages people to figure out what’s going on in their own heads; and offers pathways to that. As Socrates said, “Know thyself,” and this is a good place to mention that BrainWeighve is a tool for doing exactly that.

Your responses and feedback are welcome!

Source: “Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial,”, 10/15/23
Image by Maggie Jones/Public Domain

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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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