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A recent study published in Nature Medicine indicates that earlier intervention with weight-loss medication, specifically GLP-1s, could significantly enhance weight loss outcomes compared to prolonged behavioral modifications alone. This research challenges the current U.S. Preventive Services Task Force (USPSTF) guidelines, which recommend six months of behavioral interventions before considering medication.
The study found that patients who underwent only one month of behavioral modifications, including a calorie-restrictive diet and increased physical activity, followed by the addition of a weight-loss medication, experienced double the weight loss compared to those who adhered to six months of behavioral changes.
“We showed more success when we added medication early on,” stated lead study author Jena Shaw Tronieri, PhD, from the University of Pennsylvania. The study suggests that many individuals struggle to achieve significant weight loss through lifestyle changes alone, even with counseling.
Co-study author Thomas A. Wadden, PhD, emphasized that a significant percentage of patients, estimated between 35% and 40%, do not achieve meaningful weight loss within six months of behavioral interventions. “Our study showed that you can tell within a month who is going to be successful with behavior modifications and who is not,” he said.
The researchers also noted that the study used an older weight-loss medication, Phentermine, which typically results in 5% to 7% weight loss. GLP-1 medications, on the other hand, are known to produce 10% to 15% weight loss. “You can imagine that if a GLP-1 were used for the study, it would have been even more effective than this weight loss medication,” said Dr. Ziyad Al-Aly of Washington University.
The study suggests earlier intervention with GLP-1s could be particularly beneficial for patients at risk of comorbidities like diabetes and heart disease, where rapid weight loss can be crucial.
However, the effectiveness of behavioral modifications is influenced by environmental factors such as food culture and social habits, making it a “David and Goliath struggle” for many, according to Dr. Al-Aly.
Insurance coverage also plays a role in the timing of GLP-1 prescriptions. Supriya Rao, MD, from Tufts University School of Medicine, noted that some insurers require patients to adhere to behavioral modifications for extended periods before covering the medication.
Despite the potential benefits of earlier GLP-1 intervention, the study emphasizes the importance of combining medication with ongoing behavioral modifications. Research published in the International Journal of Obesity indicates that GLP-1s can alter food preferences, promoting healthier eating habits. Furthermore, weight loss can motivate patients to increase physical activity, creating a positive feedback loop.
“When you have some success, that begets more success,” said Wadden.
Disclaimer: This news article is based on the provided information and should not be considered medical advice. Consult with a healthcare professional before making any decisions related to your health or treatment.1 The results of this study may not be applicable to all individuals, and further research is needed to confirm these findings and update clinical guidelines.(https://www.medscape.com/viewarticle/when-prescribe-glp-1s-earlier-might-be-better-2025a100081h)
