Obesity is a significant chronic disease whose prevalence is worsening despite continued interventions and funding. Obesity is also a precursor to many other health conditions, including diabetes, cardiovascular disease, sleep apnea, cancer, neurodegenerative diseases and orthopedic problems.
GLP-1 medications represent a hope in the fight against obesity; however, misinformation about and misuse of these medications abound. For optimal results in managing obesity, it is important to combine GLP-1 medications' intake with lifestyle changes.
This was a major theme in a discussion about obesity at Becker's Payer Issues Roundtable, led by Linda Anegawa, MD, chief medical officer at Noom.
Four key takeaways were:
1. GLP-1 drugs have multiple benefits. GLP-1 medications are effective due to their dual mechanism of action: stimulates insulin release from the pancreas in response to dietary glucose/carbohydrates and then delays gastric emptying and reduces food intake by direct action on receptors in the hypothalamus (hunger center of the brain). "Beyond the impact in the gut . . . the beneficial effects go way beyond. We're only at the tip of the iceberg of learning about these beneficial effects," Dr. Anegawa said.
2. GLP-1 medications can be effective in weight loss, but they should be combined with behavior change interventions. Proper nutrition and physical activity are crucial to realizing the promise of GLP-1 medications sustainably. In 2018, Noom offered a support program to 65,000 early-stage GLP-1 users, whereby Noom offered personalized programs introducing nutrition and exercise habits to those taking GLP-1s. The program was very successful. At six months, users using Noom + GLP-1 experienced 3x more weight loss; at 12 months, that same group experienced 6x more weight loss. "Changing behavior is essential to maximizing outcomes," Dr. Anegawa highlighted. "If you use Noom and you take a GLP-1 medication, you're going to lose the most weight of any group."
3. Personalized care plans and support tools are crucial for successful weight loss and maintenance. Noom's psychology-based offering includes a detailed questionnaire and evaluation of each user's metabolic needs in order to develop a customized care plan, which is then followed by periodic adjustments, based on user response.
"It [Noom] personalizes the offering, it builds commitment and momentum — and we found that by tweaking things, we were able to improve retention and user engagement," Dr. Anegawa said. Noom's offering also includes a food lookup tool, mini-courses and conversations, and a non-judgmental weight feedback tool.
4. Access to GLP-1 medications should be based on individual needs, not solely BMI. There are many factors beyond an individual's body mass index that affect their weight; that's why prescribing GLP-1 medications based on weight alone is inappropriate, Dr. Anegawa said. "Treating by BMI alone and having BMI be the sole or main qualifying criteria is absolutely wrong."