Combined GLP-1 medication and virtual coaching leads to sustained weight loss
Presenter: Donna Ryan MD, Pennington Biomedical Research Center, Baton Rouge, LA
Boyd K, Medeiros KL, Kramer D, et al. Metabolic health and weight loss outcomes from a combined GLP-1 medication and ILI program at scale. Presentation at Obesity Week, October 14–17, 2023, Abstract Oral 0-69.
Combining glucagon-like peptide 1 (GLP-1) receptor agonist medications with intensive lifestyle interventions can lead to sustained weight loss, according to data from a real-world virtual obesity treatment program presented by Donna Ryan, MD, of Pennington Biomedical Research Center in Baton Rouge, LA, at the 2023 Obesity Week annual meeting.1
Earlier research showed that, in combination with one-on-one video coaching and small lifestyle changes, GLP-1 receptor agonists are a safe, effective long-term option for weight loss.2 However, fewer than 2% of qualifying adults receive obesity pharmacotherapy, and even fewer receive these medications paired with intensive lifestyle intervention to support behavior change to sustain weight loss.3,4 Possible explanations include physicians’ lack of training in obesity management and use of antiobesity medications, limited time during clinical visits, the high cost of many antiobesity medications with limited insurance coverage, and hesitancy stemming from a history of failure of antiobesity medications after regulatory approval.5,6
In the current study, outcomes of a program combining GLP-1 medication and a comprehensive intensive lifestyle intervention “demonstrate excellent engagement and retention over 12 months with more than two-thirds enrolling for year 2,” said Dr. Ryan.
The Calibrate telehealth program includes video visits plus asynchronous check-ins and messaging, and uses GLP-1 medications and intensive lifestyle interventions, with one-on-one coaching and digital tracking and medical treatment provided by board-certified physicians. The program has enrolled more than 30,000 people in all 50 states and Washington, D.C.
Program criteria includes a body mass index (BMI) greater than 30 kg/m2 or greater than 27 kg/m2 with a weight-related comorbidity, no contraindication to treatment with GLP-1 receptor agonists or an intensive lifestyle intervention, and insurance that covers the medications. Participants must commit to at least 1 year with the program. They receive treatment with semaglutide, liraglutide, dulaglutide, or tirzepatide, depending on physician judgment, insurance coverage, and medication availability.
The comprehensive, evidence-based, intensive lifestyle intervention encourages incremental changes to diet, sleep, physical activity, and emotional health. This is paired with biweekly meetings with coaches over the first year. Members regularly track their weight using cellular-connected digital scales and electronically submit their weight and track habits. They complete company questionnaires at baseline and at 6 and 12 months for changes in diet, sleep, exercise, and emotional health.
In the study, 2,643 patients, mean age 47 years, were eligible after 12 months of observation; 92.6% were female, 3.9% had type 2 diabetes, and 22.8% had prediabetes. At baseline, the mean BMI was 37.1 kg/m2. At 12 months, 2,397 patients (90.7%) had logged weights. Of those, 1,507 (67.2%) re-enrolled for year 2.
The average weight loss at 12 months was 15.6%, and the mean BMI was 31.3 kg/m2. Weight loss was 15.9% at 15 months among 1,319 patients, 15.8% at 18 months among 569 patients, and 16.8% at 24 months among 38 patients.
For the 706 patients with diabetes or prediabetes, at 12 months, 73.2% had hemoglobin A1c levels lower than 5.7%, and 81% showed improvement in disease. Mean change in waist circumference at 12 months was –5.95 inches among 1,507 patients, with improvements seen in lipids, hemoglobin A1c, liver function tests, insulin, and high-sensitivity C-reactive protein levels.
The medications were well tolerated, with only 1.9% of patients dropping out due to adverse effects of medications, said Dr. Ryan.
Dr. Ryan concluded: “Weight loss was robust at year 1 (more than 15%) and sustained at 15 and 18 months, and was accompanied by expected improvements in cardiometabolic risk. No safety issues were observed.”
As the program expands, developing a more precise understanding of those who benefit most from these medications and the contribution of the intensive lifestyle interventions to sustain post-medication weight loss will become increasingly important, said Dr. Ryan.
References
- Boyd K, Medeiros KL, Kramer D, et al. Metabolic health and weight loss outcomes from a combined GLP-1 medication and ILI program at scale. Presentation at Obesity Week, October 14–17, 2023, Abstract Oral 0-69.
- Pi-Sunyer X, Astrup A, Fujioka K, et al. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med 2015; 373(1):11–22. doi: 10.1056/NEJMoa1411892
- Saxon DR, Iwamoto SJ, Mettenbrink CJ, et al. Antiobesity medication use in 2.2 million adults across eight large health care organizations: 2009–2015. Obesity 2019; 27(12):1975–1981. doi:10.1002/oby.22581
- Claridy MD, Czepiel KS, Bajaj SS, Stanford FC. Treatment of obesity: pharmacotherapy trends of office-based visits in the United States from 2011 to 2016. Mayo Clin Proc 2021; 96(12):2991–3000. doi:10.1016/j.mayocp.2021.07.021
- Enright C, Thomas E, Saxon DR. An updated approach to antiobesity pharmacotherapy: moving beyond the 5% weight loss goal. J Endocr Soc 2023; 7(3):bvac195. doi:10.1210/jendso/bvac195
- Connolly HM, Crary JL, McGoon MD, et al. Valvular heart disease associated with fenfluramine-phentermine. N Engl J Med 1997; 337(9):581–588. doi:10.1056/NEJM199708283370901
Disclosures
Donna Ryan is an advisor for Calibrate, Wonder Health, Real Appeal, Novo Nordisk, Lilly, Amgen, Altimmune, Biohaven, Carmot Therapeutics, CinRx Pharma, Epitomee, Gila Therapeutics, Scientific Intake, Structure Therapeutics, Xeno Bioscience, and Zealand Pharma. She holds stock options with Calibrate, Epitomee, Scientific Intake, and Xeno Bioscience; is a speaker for Novo Nordisk and Lilly; serves on a data monitoring committee for Lilly; and has a research administration relationship with Novo Nordisk.