Lifestyle Interventions for Obesity in the Era of GLP-1 Receptor Agonists

A central goal of obesity treatment is sustaining weight loss of at least 5%, with at least 10% weight loss conferring greater cardiometabolic health benefits. As new pharmacological antiobesity therapies emerge, including incretin-based treatments that produce a mean of 15% to 21% weight loss, the utility of lower-intensity, lifestyle-based interventions could be questioned. In this issue of JAMA, Hoddinott et al and Spring et al present results from 2 remotely delivered behavioral weight loss interventions. Hoddinott et al compared 2 weight loss interventions to a wait-list control group in middle-aged men with obesity in the United Kingdom. The first intervention delivered approximately 1 behaviorally focused text message per day along with a financial incentive and the second intervention delivered 1 behaviorally focused text message per day without the financial incentive. At 12-month follow-up, text messaging combined with financial incentives reduced weight by a mean (SD) of 4.8% (6.1%), which was a mean difference of −3.2% (97.5% CI, −4.6% to −1.9%; P < .001) compared with the wait-list control group. Text messaging without the financial incentive reduced weight by 1.4% (97.5% CI, −2.9% to 0.0%; P = .05) compared with the wait-list control group.