Night Shift

The Big Shift in Lifestyle Programs for Obesity

It’s long been overdue. For as long as we can remember, one presumption has been dominant. The real cure for obesity is (supposed to be) a change in lifestyle. It is the “foundation of obesity treatment” says just about everyone, even today. But the sand underneath that foundation is shifting. So the time has come for a big shift in lifestyle programs for obesity.

If you have doubts, we suggest a careful reading of the new review on this subject from Thomas Wadden – perhaps the foremost expert in obesity on lifestyle therapy.

Or you might take a careful look at the strategic decisions that WeightWatchers has made to adapt to the new reality of coping with obesity. This company has come to terms with a whole new world.

Much to Learn, So Change Is Likely

Wadden and a whole collection of distinguished experts in obesity research and clinical care offer an impressive review of what is known and unknown about lifestyle therapy in the context of obesity treatment with advanced obesity medicines. They sum up the likely change quite well:

“When used with the new AOMs, the focus of lifestyle modification is likely to change from inducing weight loss (through calorie restriction) to facilitating patients’ adoption of dietary and activity patterns that will promote optimal changes in body composition and overall health.”

While the direction of change is clear enough, they caution that:

“Little, however, is known about whether patients who lose weight with these anti-obesity medicines adopt healthy diet and activity patterns needed to optimize body composition, cardiometabolic health, and quality of life.”

There is much to learn and new clinical guidance will take time to emerge.

From Weight Watching to Weight Health

Meanwhile WeightWatchers is dealing with the here and now. In the minds of consumers concerned about their weight, this has been the dominant brand for more than half a century. But in one way or another, it has always been about support for weight loss and a healthy lifestyle. Not about a medical condition. Certainly not about obesity.

While obesity is still not a word you will see Weight Watchers tie to its brand, it is certainly adapting to the new reality of advanced medicines for this medical condition that burdens a person with too much weight. The company now identifies itself as “The trusted authority in evidence-based Weight Health and community support.” In our view, the shift to weight health is important.

Weight loss is not banished from the conversation by any means. Community support is all about helping people find healthy patterns for living and eating. But following the acquisition of a telehealth program for GLP‑1 medicines, WeightWatchers is rolling out the WeightWatchers Clinic and integrating it with support programs designed specifically to work with the use of these new medicines.

Moving Fast Comes with Bumps

The value of WeightWatchers stock tanked after the approval of semaglutide for obesity treatment in 2021. This year, after the company acquired their telehealth program for GLP-1 medicines, it has more than doubled.

The landscape will surely continue to shift for lifestyle programs that support people pursuing weight health or obesity care. So there will be bumps. But the changes are fascinating to watch.

Click here for the review by Wadden et al, here, here, and here for more on the evolution at WeightWatchers.

Night Shift, painting by Marianne von Werefkin / WikiArt

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December 15, 2023

3 Responses to “The Big Shift in Lifestyle Programs for Obesity”

  1. December 15, 2023 at 11:23 am, Richard Atkinson said:

    Hallelujah. The shift away from considering diet, exercise, and behavior modification as the “primary treatment of obesity” seems to be picking up steam and finally obesity can be considered as a disease, just as many other human conditions. When I first began preaching that D, E, and BM were not the answer for obesity, I did a literature search in PubMed with the terms: “diet, physical activity, obesity, and treatment.” There were about 6000 hits in those days. I just repeated that search and there are now 15,366 hits, none of which show a long term, acceptable success rate in a majority of patients (or even in a decent minority). As the column above points out, we still have a lot to learn about treatment of obesity with the various GLP1 and other gut hormone agonists, but we finally have a pharmacological treatment that works, at least for an extended period. The theory that if we could just figure out how intestinal bypass and gastric bypass worked, we could develop a pharmacological treatment turned out not to be so crazy after all.

  2. December 22, 2023 at 6:29 pm, Owen Kelly said:

    Diet and lifestyle (D&L) do work, poor compliance is the issue. There are many reasons for this, including cost of good food and exercise facilities, One must remember, the trials using GLP-1 agonists were in conjunction with D&L changes – this fact is conveniently ignored. Furthermore, the drugmakers recommend the same. D&L will not have any potential for nasty side effects. The greatest issue has been the clinical outcomes chosen in D&L trials. Weight loss is associated with many issues, but in clinical trials the assumption is it is cause-effect, with primary variables not connected in a viable mechanism of action (MoA). Drug trials have a very clear MoA, companies wouldn’t do them if they didn’t..

    • December 23, 2023 at 4:00 am, Ted said:

      “Poor compliance” is a gentle way to say the patient is not behaving as instructed. But outcomes count and blame does not provide a pathway to better outcomes.