Maverick MD on Privilege, Continued

As we learned from the previous post, Dr. Yoni Freedhoff proposes that the idea of holding patients entirely responsible for managing their own weight loss — even with the help of professionals — is unrealistic, to say the least. The privilege he refers to is the amount of free time, energy, money, and enthusiasm that some people have for projects like cooking their own totally clean meals from scratch and enrolling in ambitious exercise regimens.

\Also, not many dangerously obese folks have the means or the time for the intense therapy it would take to get to the bottom of their eating issues. Dr. Freedhoff writes,

There’s a tremendous amount of privilege involved in intentional behavior change in the name of improving health, regardless of what that issue might be. …[W]e all have the same number of hours in the day, but our hours are not all the same.

I would argue that it is a very, very small sliver of the population who truly possesses the privilege to be able to prioritize this as a very important thing in perpetuity. Because this is a chronic condition. If you stop treatment for a chronic condition, the condition comes back.

As a compassionate professional who hears a lot of stories other than his own, Dr. Freedhoff is hyper-aware that many people are already handling as much as they can, and simply do not possess the physical, mental or emotional energy to change their lives in any major or significant way. This is because modern society is just not set up for that to work. He suggests that many aspects of life, even in formerly remote areas of the globe, are rigged to ensure that people continue to eat too much of the wrong stuff, in the wrong ways, at the wrong times, and for the wrong reasons.

Captives and victims of the zeitgeist

Particularly in the USA and other Westernized countries, the spirit/mood/trend of the times is to indulge to our hearts’ content. At the same time, we suffer from enough cognitive dissonance to believe that controlling the damage is entirely up to us. It isn’t. Gigantic corporations with bloated advertising budgets and huge sales staffs are determined to sell us as many worthless and harmful products as they can possibly manage, and we are no match for them.

Especially in America, we love the idea of freedom, even when it is used by greedy corporate interests to turn us into a nation of overweight, unhealthy, fat-shamed people who can’t figure out what’s best for us, and who believe we can do anything we set our minds to, including single-handedly defend ourselves against the corporate juggernaut. If only!

Dr. Freedhoff writes,

It’s true that weight is responsive to lifestyle changes… It’s also true that you can buy low and sell high in the stock market and become a multimillionaire. It’s true that if you just cheered up, you have less depression. So these aren’t useful truths.

Let free enterprise not reign!

As much as we dislike the idea of the government controlling our lives, Dr. Freedhoff believes that something like a tax on sugar-sweetened beverages could help the situation a lot. Despite our deep resentment toward official interference, it’s quite possible that we could all benefit from stricter rules about advertising, especially when children are the targets. Maybe we need a stern government bureau to keep a watchful eye on the claims the food industry makes on their packaging, especially since the industry doesn’t seem to be so good at self-policing.

Perhaps it would be advantageous to keep a closer eye on what children are fed at school. As contrary as this is to the free-enterprise spirit, maybe we could all benefit from restrictions about how many fast-food outlets are built, and in what areas. Speaking of areas, there are still many places, both urban and rural, where people have a really hard time accessing things like fresh vegetables.

We have pretty much managed to get used to the concept of traffic lights and speed limits to save lives. Maybe we could be a bit more accepting of rules in this area, too.

Your responses and feedback are welcome!

Source: “ Obesity (with Dr. Yoni Freedhoff),” TabooScience.show, 12/03/20
Image by Wall Boat/Public Domain

Maverick MD on Privilege

Dr. Yoni Freedhoff, who occupies the roles of Associate Professor of Family Medicine at the University of Ottawa and Medical Director of Ottawa’s Bariatric Medical Institute, has for years been pushing back at what seem to be common assumptions about obesity. Mainly this has to do with personal responsibility, a phrase which often functions as a euphemism for blame.

According to that worldview, whether the issue is treatment with the new weight-loss drugs, or taking part in any other weight-loss regimen, if a person does not sign up for one or the other, their fat body is their own darn fault. His tenets include these:

If any amount of desire, guilt or shame were sufficient to drive sustained change, we’d have been rid of the so-called lifestyle diseases decades ago.

[T]hough everyone possesses the theoretical ability to focus on healthy habits and lives, many people’s realities make lifestyle reform a nearly impossible luxury.

[T]he folks who both read about healthy living and have lives that are appropriately and realistically conducive to change are an incredibly privileged and small subset of the population.

[P]ersonal responsibility-based healthy living efforts require privileges that the vast majority of people don’t possess.

Dr. Freedhoff argues that most people simply do not have the time, the means, or the incentive to do the things they would need to do in order to lose a meaningful amount of body fat. And that’s just ordinary, basically healthy people with families and jobs; who possess “the privilege of life being settled enough to even consider personal responsibility-based healthy lifestyle change.”

Of the people who do not have that privilege, a very large subset are those who live with chronic pain and/or severe fatigue, who “may find purposeful behavior change to be literally too difficult or figuratively too low a priority, given their day-to-day pain and challenges.” To be in that situation without a supportive family and/or a job, is an avalanche of misfortune that few humans have the wherewithal to dig themselves out of.

In Dr. Freedhoff’s view, the society we live in is what needs to change, and in major, consequential ways:

Right now, we’re facing a torrential current of calories, ultra-processed foods and a culture of convenience that considers the use of junk food to reward, pacify and entertain our kids and ourselves at every turn as entirely normal.

We need policies that will help make healthier lifestyles occur by default, or that make purposeful changes easier or more valuable. Whether those changes are sugar-sweetened beverage taxes, front-of-package health claim reforms, banning advertising that targets children, improved school food policies and programs, zoning laws affected where fast food and convenience stores are located and more…

Among other cogent points he makes, one of them is this: The science of weight management is known to involve at least 5,000 genes and 37 hormones whose existence the human body has been fostering and fine-tuning for millions of years, during which time most people on earth have had a hard time getting enough food to sustain life.

We all have ancient genes and we are living in a very non ancient and fairly toxic food environment. When it comes to the availability of calories, they are now everywhere.

Today, almost every aspect of the culture, in almost every corner of the world, tells us to eat eat eat. And, like it or not, there are just some people whose weight will remain stable, or sadly, may increase, even on the most ambitious diet.

Your responses and feedback are welcome!

Source: “Check Your Privilege Before Talking About Obesity and Personal Responsibility,” USNews.com, 09/27/16
Source: “Obesity (with Dr. Yoni Freedhoff),” TabooScience.show, 12/03/20
Image by wp paarz/CC BY-SA 2.0 DEED

New Drugs — Does Lifestyle Intervention Still Count? Part 7

A multi-author paper discussed mHealth, or the use of mobile phones and other wireless technology to deliver medical care. It is more thoroughly defined as…

[…] the delivery of preventive, monitoring, or clinical procedures and protocols through the mobile communication devices, such as mobile phones, tablets, personal computers, personal digital assistants, biosensors, and other up-to-date technological devices.

But why? Well, when it comes to obesity, traditional chronic care management apparently has had some thin spots. Typically, distance has been a problem. Patients are unable, or simply not inclined, to make repeated journeys back and forth to a clinic or medical center. But everything has changed since the introduction of distance-vanquishing interventions.

The concept of mHealth is also described as “the integration of Internet-based technologies into psychological and multidisciplinary protocols according to a stepped-care approach.” Now we need another definition.

Stepped care is about right-sizing, about landing on the level of support that neither under-treats nor over-treats the patient. The idea is to start with the most effective treatment that uses up the least resources, and then “step it up” or “step it down” until the fit is right for the level of client need. The important thing to know is, “[T]he mHealth applications have achieved positive results in adult obesity and in childhood obesity too.”

The ingredients

Whether close-up or from a distance, treatment may be required to address any or all of these factors, as listed by the Mayo Clinic:

Symptoms of mental illness
Relapse of those symptoms
Medications aren’t a good option
Stressful life situations
Ways to manage emotions
Relationship conflicts
Better ways to communicate
Grief or loss
Emotional trauma related to abuse or violence
Medical illness
Chronic physical symptoms

In the area of weight loss for health, two things are clear: Long-term sustainability is the prevention of relapse, and relapse avoidance is long-term viability. What kinds of counseling have been associated with weight loss up until now? One is Cognitive Behavioral Therapy, which seems flexible enough to meet quite a few needs. Childhood Obesity News talked about some of its sub-varieties.

The whole point is to break negative behavior cycles and create new patterns. Any program that is going to last, has to address all areas of life — the family, the peer network at school or job, the community at large; and presumably must also harmonize with a person’s moral and spiritual beliefs and practices.

That is a tall order. Obviously no drug, regardless of how revolutionary or seemingly miraculous, can handle all this. But with the help of a mHealth application, it might.

Your responses and feedback are welcome!

Source: “Cognitive behavioral therapy to aid weight loss in obese patients,” NIH.gov, 06/06/17
Source: “Cognitive Behavioral therapy,” MayoClinic.org, undated
Image by bluesbby/CC BY 2.0 DEED

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,” Nature.com, 10/15/23
Image by Maggie Jones/Public Domain

New Drugs — Does Lifestyle Intervention Still Count? Part 5

As mentioned in a recent post, drug trial literature mentions the term “lifestyle intervention” with astonishing frequency, and the phrase is even often prefaced by the adjective “extensive.”

To put it bluntly, their products don’t work unless the patient is also involved in some aspect of what they define as intervention. To be either a test subject or a regular patient, someone must reportedly partake in lifestyle interventions either before starting their GLP-1 medication, and/or during the course of it.

It appears that to be effective, these meds must be continued basically forever, with the strong implication that the patients are also meant to have intervention forever. Frequently mentioned are nutritional counseling, creating a reduced-calorie diet, and physical activity, typically 150 minutes per week. An example follows.

This article is about tirzepatide, but mentions a similar trial of liraglutide which provided “17 lifestyle counseling sessions during the medication phase of the study compared with only quarterly visits in the present trial.” Why was this brought up? Because the author wants to acknowledge the importance of counseling — which is apparent, because the placebo group of participants regained more weight than comparable placebo patients in other studies, who had partaken in more counseling.

In other words, lifestyle intervention makes a measurable and significant difference. Now back to the main subject of the piece:

Tirzepatide substantially increased the magnitude of weight loss when administered following an initial 12-week intensive lifestyle intervention that reduced baseline body weight by an average of 6.9% in successful program completers.

In other words, during the preparation stage, before starting on the drug, 12 weeks of lifestyle intervention helped the subjects lose nearly 7% of their baseline weight, which is a pretty darn good outcome for only three months of going at it. It might suggest to more conservative minds that anyone who can lose that much with only non-medicated intervention, would probably, overall, be best served by continuing on the same path.

The alternative is to start taking an expensive drug that might involve undesirable side effects, and that apparently needs to be continued forever. Why not just continue the lifestyle intervention aspect of the treatment forever, instead? Which they are supposed to do anyway because, according to reports, even the medicated person will need to stick with physical activity, calorie reduction, and probably counseling, forever, anyway.

(F)indings indicate that individuals with overweight or obesity who have lost approximately 5-10% of their body weight with supervised lifestyle intervention — or potentially through their own self-directed diet and exercise efforts — could expect to achieve further clinically meaningful weight loss with the addition of tirzepatide.

Those same findings could also be interpreted, by a skeptical type of person, as suggesting that the patient could probably achieve additional “meaningful weight loss” by simply continuing with the other interventions, and staying away from weight-loss drugs altogether.

And then, imagine how much additional pound-shedding might be achieved with the help of a powerful tool like BrainWeighve.

Your responses and feedback are welcome!

Source: “Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial,” Nature.com, 10/15/23
Image by Tim Green/CC BY 2.0 DEED

Displacement and the Crucial Switch

The scientific-minded person tends to disparage “anecdotal evidence” and to say, “Show me the scientific evidence.” But fundamentally, they are one and the same.

In an ancient tribal society, one injured person might eat part of a plant and find that it decreases the pain. Then another person might have the same experience, and then another. If one particularly alert member of the tribe listened to these people and drew the obvious conclusion, he or she might collect that plant and then counsel other members who were in pain to eat some of it. After a while, that person who listened to anecdotal evidence and transformed it into advice would be known and respected as the group’s Healer.

That was the first scientist. Even today, even in highly structured scientific trials, the foundation is the same. Statistics are nothing but one person’s anecdotal testimony added to another person’s anecdotal testimony, and so on down the line, until a pile of them accumulates, and voilà! What do we have? Statistics!

This is how an official Study comes into being. An alert person notices that something seems to be going on, and designs a format through which the suspicion can be verified by a preponderance of Evidence. If all goes well, that pioneer is no longer just an eccentric with a feeling that “something seems to be going on.” Pursuing that feeling, by putting it through a formulaic procedure, transforms her or him into an Expert.

Examples of this phenomenon are found in Dr. Pretlow’s paper (Pretlow et al. 2020):

Anecdotally, a 20-year-old obese female was surprised that she was no longer tempted to turn into a McDonald’s drive-through once she had created plans for her difficult life situations before driving home from work.

Dr. Pretlow is working to develop “an intervention based on the displacement mechanism, adaptable for any addiction.” The aim is to help people replace harmful, dysfunctional displacements with constructive and healthy ones. In the light of all this, the writer of this page offers a personal anecdote:

I knew a man (we will call him David) in his early thirties who was intelligent and mild-mannered, and certainly nice enough, but usually rather remote and detached in social situations. One day, in the company of a few friends, David started to talk about kayaking, the activity that was obviously the passion of his life.

This was news to the rest of us, and I think the others were as stunned as I was at the transformation that took place before our eyes — because David turned into another person. He sounded different and even looked different. Describing his experiences on the water, he was incandescent with enthusiasm and pure love for the activity.

The rest of us talked it over later, and all came to the same conclusion. If someone had asked, “Would you rather have a free carton of cigarettes, or go kayaking?” David would have regarded the questioner as insane. We were convinced that “Would you rather have a case of champagne? Would you prefer a hit of the finest heroin?” or any other similar example, would have elicited the same reaction.

There was no doubt in anyone’s mind that for David, kayaking came first, last, and always. As long as he had that, there would be no danger of him ever turning into any species of addict whatsoever.

Dr. Pretlow writes,

It may be possible to consolidate the causes of different addictions and explain all addictions using a single theory. Perhaps, a universal treatment for addiction may be feasible. The displacement mechanism might be the basis for such a unified theory of addiction…

Your responses and feedback are welcome!

Source: “A Unified Theory of Addiction” by Dr. Pretlow
Image by Yves Ouellette/CC BY-ND 2.0 DEED

New Drugs — Does Lifestyle Intervention Still Count? Part 4

Sometimes, a headline seemingly tells the whole story. For example,

Lilly’s tirzepatide shows additional 21.1% weight loss after 12 weeks of intensive lifestyle intervention, for a total mean weight loss of 26.6% from study entry over 84 weeks.

At other times, light is focused on a subject from another angle. Case in point: A different article published on the same day, “Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial.” That piece mentions the word “lifestyle” a total of 67 times, and we will get back to the ramifications of that rather surprising frequency.

In the weight loss field, some treatments work by penetrating, facilitating, or disrupting various body systems. They work on organs, chemical production, etc. BrainWeighve, on the other hand, works with — you guessed it — the brain. Or more accurately, the app assists a person in sorting out a bunch of conscious and unconscious stuff, in order to accomplish something; in this case, weight loss that lasts. Now, there’s a lifestyle intervention to write home about!

What does it mean?

Readers will recall the question asked in an earlier post:

Do the new, remarkably effective GLP-1 obesity medications eliminate the need for obesity interventions such as BrainWeighve?

The question encourages relevant and useful consideration. Any one of the app’s suggestions and exercises can lead to an epiphany, and potentially to the reduction of what some programs call “stinkin’ thinkin.” For instance, a lot of us have allowed ourselves to fall into the self-delusional trap of thinking of food as a reward. Because we are excellent humans, we carry out our duties in the world.

We do not expect medals, or induction into anybody’s Hall of Fame. On the other hand, “I do deserve a piece of pie, or a couple of pieces. Maybe even the whole pie. Besides, it has been a rough week…” and on and on.

The benefits spread out

Many of us tend to be quite tolerant of our own willingness to tell ourselves fairy tales about how much we eat and why. We can be very self-forgiving, and even righteous, about the importance of living life to the fullest. After all, we do have a responsibility to enjoy the good things that life offers — like pie, for instance.

We might build a defensive wall, and keep it in place, by telling ourselves a lot of jive that sounds good at first, but turns out to be baloney. Telling ourselves enough stories to justify our harmful habits (and our stinkin’ thinkin’) is a full-time job. What if we took all that energy and devoted it, instead, to getting out of the trap and chipping away at the wall?

This is what BrainWeighve can assist a person to do. There seems to be something in it for everybody; ways to use it that appeal to different personality types and that work in various circumstances. Every key to solving a problem relating to weight loss is transferrable to other areas of life.

And this vital assistance is widely available, and available for a long time — even a lifetime. It helps to develop skills that are useful every day of a person’s existence, no matter how many years on earth they are granted.

Your responses and feedback are welcome!

Source: “Lilly’s tirzepatide shows additional 21.1% weight loss after 12 weeks of intensive lifestyle intervention, for a total mean weight loss of 26.6% from study entry over 84 weeks,” Lilly.com, 10/15/23
Source: “Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial,” Nature.com, 10/15/23
Image by Hey Paul/CC BY 2.0 DEED

New Drugs — Does Lifestyle Intervention Still Count? Part 3

Moving on to tirzepatide, it is semaglutide mixed with another GLP-1 agonist. Under the brand name Mounjaro, it is currently approved only for type 2 diabetes, but is widely used “off-label” to achieve weight loss.

The SURMOUNT-1 trial included 2,539 adults without diabetes, but with at least one weight-related complication. After two weeks of screening, subjects were randomized into four sectors: the placebo group, of course, with the others receiving three different doses of tirzepatide. The substances were…

[…] administered subcutaneously once weekly for 72 weeks as an adjunct to lifestyle intervention. Lifestyle intervention included regular lifestyle counseling sessions, delivered by a dietitian or a qualified health care professional, to help the participants adhere to healthful, balanced meals, with a deficit of 500 calories per day, and at least 150 minutes of physical activity per week.

This is typical of such experimental explorations. The number and nature of counseling sessions may differ, or the amount of physical exertion asked for or performed may vary, but that seems to be about the extent of the lifestyle intervention. The effectiveness varies. One thing the researchers mention is…

[…] evidence that diet and exercise prompt physiological counterregulatory mechanisms that limit weight reduction and impede weight maintenance.

In other words, in many cases, even though patients work out and receive counseling, and astonishing new meds, of course, the body has its ways of fighting back in a stubborn effort to maintain its weight. The astute reader may guess that we will be making a point about all this: work on the head is also needed, and that is the ingredient that BrainWeighve provides.

Another news article concerns participants in two trials, SURMOUNt-3 and SURMOUNT-4, preceded by

[…] a 12-week intensive lifestyle intervention lead-in period that included exercise, low cal diet, and weekly counseling sessions during which candidates had to lose at least 5% of body weight.

So apparently, that is the definition of intensive. Still, no mention of self-management skills and other benefits available from a program like BrainWeighve.

In mid-October of this present year, the Lilly pharmaceutical firm prudently issued its
Cautionary Statement Regarding Forward-Looking Statements” aimed, it seems, at over-excited investors who tend to hear what they want to hear:

[A]s with any pharmaceutical product, there are substantial risks and uncertainties in the process of drug research, development, and commercialization. Among other things, there can be no guarantee that planned or ongoing studies will be completed as planned, that future study results will be consistent with the results to date, that tirzepatide will receive additional regulatory approvals, or that tirzepatide will be commercially successful.

Your responses and feedback are welcome!

Source: “Tirzepatide Once Weekly for the Treatment of Obesity,” NEJM.org, 07/21/22
Source: “Eli Lilly’s tirzepatide aces 2 more late-stage obesity trials as FDA decision nears,”
FiercePharma.com, 07/27/23
Source: “Lilly’s tirzepatide shows additional 21.1% weight loss after 12 weeks of intensive lifestyle intervention…,” Lilly.com, 10/15/23
Image by Jordan Schwartz/CC BY 2.0 DEED

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 TechnologyNetworks.com 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?,” UAB.edu, 04/09/22
Source: “Once-Weekly Semaglutide in Adolescents with Obesity,” NEJM.org, 12/15/22
Source: “Trial Finds Semaglutide With Lifestyle Intervention Reduces Body Weight by Nearly 15%,” AJMC.com, 02/10/21
Source: “Weight Loss Drug Trial Shows 21% Additional Loss After Lifestyle Intervention,” TechnologyNetworks.com, 10/18/23
Image by Bill Smith/CC BY 2.0 DEED

New Drugs — Does Lifestyle Intervention Still Count? Part 1

Today’s question is: Do the new, remarkably effective GLP-1 obesity medications eliminate the need for obesity interventions such as BrainWeighve? At this moment, it looks like the answer to that question is a resounding “No!”

First, a definition:

Lifestyle interventions can be defined as changes that patients can make to their lifestyles that improve these diseases in lieu of, or in addition to, clinical and pharmaceutical interventions, and often are prescribed as a first line of defense for patients showing diabetes and other symptoms of the metabolic syndrome.

An important reason why lifestyle intervention is vital is contained in a batch of recent news about those very drugs. One is the generic liraglutide (sold under the trade names of Saxenda and Victoza) that requires daily injections. It has been approved as an obesity treatment:

Liraglutide, used in conjunction with lifestyle changes, can help induce and maintain weight loss and improve insulin sensitivity. Liraglutide may be an especially attractive alternative in patients with severe obesity when lifestyle modification is unsuccessful or only partially effective…

At the very least, lifestyle intervention in the form of exercise has been shown to alleviate some of the side effects of liraglutide’s therapeutic use:

[The] combination of liraglutide and exercise can also bring benefits in weight loss. Furthermore, the combination of liraglutide and physical exercise can prevent adverse effects observed in the administration of liraglutide.

Apparently, exercise is especially useful in reducing adverse effects of the gastrointestinal kind, and also improves the patient’s resting heart rate.

Another generic

Next up is semaglutide, a weekly injection that might soon be available as an oral medication. It is sold under the proprietary names of Ozempic and Wegovy, which are both legitimately prescribed to fight obesity in the absence of diabetes.

Semaglutide has been described as “a new weight-loss drug that produced jaw-dropping clinical trial results in early 2021.” It was used in the highly publicized STEP trials conducted at many medical centers.

The results, released in February, were important enough to warrant prominent placement in the New England Journal of Medicine for the STEP 1 trial results and Journal of the American Medical Association for STEP 3 trial results, and a major feature in the New York Times.

Participants lost an average of 37 pounds through the combination of semaglutide and behavioral intervention in the STEP 3 trial.

There it is again, a reference to behavioral intervention, which means some exercise. Not much detail about the corporeal side of the intervention is to be found, except a mention of 150 minutes of physical activity per week, or two and a half hours, which is not a lot, but probably more than some of the participants were accustomed to.

(To be continued…)

Your responses and feedback are welcome!

Source: “Lifestyle Intervention,” ScienceDirect.com, undated
Source: “Liraglutide with Lifestyle Intervention in Adolescents with Overweight/Obesity, Nonalcoholic Fatty Liver Disease, and Type II Diabetes Mellitus,” NIH.gov, 11/08/21
Source: “Liraglutide and Exercise: A Possible Treatment for Obesity?,” MDPI.com, 08/17/22
Source: “Who will benefit from new ‘game-changing’ weight-loss drug semaglutide?,” UAB.edu, 04/09/22
Image by bluesbby/CC BY 2.0 DEED

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Profiles: Kids Struggling with Weight

Profiles: Kids Struggling with Obesity top bottom

The Book

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:

Presentations

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.

Food & Health Resources