GLP-1s won’t mark the end of lifestyle management programs

This is the second in a series of articles exploring the intersection of GLP-1s and digital health. The first article looked at how virtual care can help patients with mental health associated with GLP-1 use. This second article explores the value of lifestyle management as a complement to GLP-1 use.  

The popularity of glucagon-like peptide-1 (GLP-1) receptor agonists is surging, with a Healthline survey showing about 1 in 8 Americans have tried a GLP-1 drug. While several GLP-1s initially received FDA approval to manage Type 2 diabetes, the agency has warned about the increased emergence of unapproved versions on the market at a time when Americans are increasingly turn to them for weight management.

The rise of GLP-1s comes at a tumultuous time for the lifestyle management market. While WeightWatchers recently declared bankruptcy, Omada Health was valued at $1.1 billion on its first day of trading. That begs the question: Will weight-loss drugs hurt these applications and services or offer them a boost?

A need for ongoing care

As with many healthcare questions, the answer is complicated. On one hand, an Epic Research study found 56% of patients maintained weight loss one year after they stopped taking GLP-1s, compared to 18% who regained weight.

As with other therapies, though, patients need to complete a course of treatment for the drugs to have their intended effect. Here, evidence is less promising. According to the Healthline survey, 6% of Americans were currently taking GLP-1s, compared to the 13% who tried them — an adherence rate of less than 50%. A more formal study in the Journal of Managed Care & Specialty Pharmacy found a one-year adherence rate of just 27%.

That has prompted groups ranging from the World Health Organization to four U.S.-based lifestyle medicine and nutrition organizations to call for lifestyle support alongside GLP-1 use. “[P]atients may require ongoing, specialized care to reap the value of these medications,” WHO said in its statement. One area of interest is virtual mental health support, as research points to a link between GLP-1 use and increased risk of anxiety and depression.

Meanwhile, the collaborative statement from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society laid out eight priorities for patients taking GLP-1s. These include personalized diets, exercise plans to preserve muscle mass, management of side effects, and social connections.

As the lead author of the advisory, Tufts University’s Dariush Mozaffarian, MD, noted in an accompanying LinkedIn post, regained weight is often fat, making counseling critical. In blunt terms, he said, “It is bad medicine — and economic insanity — to prescribe GLP-1s for obesity without a comprehensive program of nutrition and lifestyle.”

Related Content: How the appetite for GLP-1s is driving digital health tech

Digital lifestyle management can be a less costly complement

Dieticians and weight management specialists have said patients using GLP-1s benefit from lifestyle management (along with education and mental health support) as part of their course of treatment. Patients appear to agree. A 2024 PwC survey found 57% of patients on GLP-1s were dieting and exercising on their own, while 32% were enrolled in weight-loss programs and 26% were working with a personal trainer.

This suggests there’s potential for strong connections between GLP-1s and digital health for lifestyle management. Continuous glucose monitoring could help adjust GLP-1 doses for increased effectiveness, for example, while alerts and other nudges could provide medication reminders, track progress, and offer educational resources.

Many vendors got on board early. Noon, Omada Health and Lark Health all launched their virtual GLP-1 management programs in 2023, and others have followed. The market is currently small — roughly $6 billion, per Grand View Research — but poised to grow 15% annually for the rest of the decade.

Lifestyle management offers another long-term benefit: Cost. The list prices for GLP-1 options come in at more than $1,000 per month, which payers and employers have been hesitant to cover. A Health Affairs Scholar study argued transitioning patients from GLP-1s to alternative interventions would be slightly less effective — one literature review found patients who discontinue the treatment basically gain their weight back — but also less expensive. “[E]xpand[ing] access to anti-obesity medications during the active weight-loss phase without increasing total health care spending,” the study concluded.

Brian Eastwood is a Boston-based writer with more than 10 years of experience covering healthcare IT and healthcare delivery. He also writes about enterprise IT, consumer technology, and corporate leadership.