When adhered to, glucagon-like peptide 1 receptor agonist (GLP-1) prescriptions are a highly effective treatment for obesity. Clinical trials show GLP-1 treatment inducing weight loss of 10%-25% over a 1-2-year period. However, GLP-1s don’t cure obesity but treat it much like blood pressure medication attenuates hypertension. Remove the medication and the disease returns.
Weight recidivism, or regain, is common after weight loss, and stopping treatment with GLP-1 brings about a similar undesirable endpoint. In other words, a lifetime of GLP-1 prescription is to be expected for long-term effectiveness.
But patient adherence to GLP-1 regimens is low, with more than 50% of patients stopping treatment within the first 3 months and only 33% still adhering to their prescription at 1 year. Side effects, cost, food addiction, and simply missing the joy of eating are among the reasons for lack of adherence. Hence, the common belief that GLP-1 medications are a miracle cure for obesity may be greatly exaggerated.
Additionally, when approving GLP-1s for obesity treatment, the Food and Drug Administration specified these medications were to be used in addition to a reduced caloric diet and increased physical activity. However, in practice, patients are generally not supported to adopt a healthy lifestyle or to engage in lifestyle medicine when GLP-1s are prescribed.
One promising way to promote drug adherence and lifestyle change is to provide health well-being coaching (HWC) alongside GLP-1 prescriptions. This is the focus of an article I co-authored, “Health and Well-being Coaching Adjuvant to GLP-1 Induced Weight Loss,” published online November 19, 2024, in the American Journal of Lifestyle Medicine (AJLM).
“Changing lifestyle behaviors is difficult, and physicians’ advice on diet and exercise often goes unheeded, with poor adherence to best laid plans,” notes AJLM article co-author Neil F. Gordon, MD, PhD, MPH, and CEO of the population management company INTERVENT International. Patients need far more than brief advice or a brochure from their physician to successfully change their behavior, he adds. HWC, by contrast, is an evidence-based strategy to promote health via lifestyle that can be used in combination with GLP-1 prescriptions, Gordon says.
Margaret Moore, MBA, another co-author of the AJLM article, describes HWC as “a partnership between a patient and coach eliciting self-motivation and confidence through a creative change process that leads to sustainably better health outcomes.” Moore is a pioneer in the HWC field, founding Wellcoaches Corporation in 2000, co-founding the Institute of Coaching in 2009, and the HWC certifying agency, the National Board of Health and Wellness Coaches, in 2010.
“HWC competences translate into positive-action evidence-based theories, such as self-determination theory, social cognitive theory, transtheoretical model, positive psychology, mindfulness, motivational interviewing, and goal setting,” Moore says. “The coaching process is empowering patients to find a personal formula of lifestyle medicine they can enjoy and sustain.”
Michael Scholtz, MA, a board-certified health and wellness coach in practice for 23 years, says that HWC can be “an essential ingredient” to losing weight and preventing weight regain.
“Patients I work with tend to stick with their medication prescriptions better than the average patient because I'm careful to support their autonomy in choosing to take and adhere to their medications,” he says. “My c lients who are focused on losing weight show a remarkable resilience in sustaining diet and exercise habits.”
There are many patients with whom Scholtz has stayed in touch for several years who have maintained both their healthy habits and their lower weight, he says. These patients tell him that “their coaching relationship and related support are important to their weight loss success," he adds.
Research supports Scholtz’s view that medication adherence is a benefit of HWC. A study examining pharmaceutical claims found that patients engaging in HWC increased their medication possession ratio over a 6-month trial. This effect persisted in the 6 months following the coaching sessions.
The study’s first author, Ruth Q. Wolever, PhD, professor of physical medicine and rehabilitation at Vanderbilt School of Medicine, Nashville, TN, notes that HWC is not only effective for treating obesity, but is also an effective strategy for helping patients with diabetes. Medication persistence is a key component of HWC, but not the sole reason for the positive effects, she adds.
“HWC is about effectively empowering patients to make and maintain healthy lifestyle changes aligned with their best selves,” Wolever says.
Research showing that HWC can result in long-term weight loss pre-dates the surge in GLP-1 prescriptions. The body of evidence includes two studies with randomized and controlled design that clearly demonstrate the effectiveness of HWC for obesity treatment with clinically significant and sustained weight loss. Neither study involved medication prescription for weight loss.
A definitive comparative effectiveness study of patients using GLP-1 medications with HWC is yet to be undertaken. However, Moore, notes: “It makes good sense to combine the best of both – GLP-1 medications for reducing weight and HWC for helping people sustain weight loss while improving health through lifestyle medicine.”
Moore is co-leading the path to establishing permanent current procedural terminology (CPT) codes for the reimbursement of HWC services. The Centers for Medicare and Medicaid Services added HWC CPT codes to the Medicare Telehealth list on a provisional basis in 2024. The US Department of Veteran’s Services now offers HWC services at 118 sites.
A recent paper describes the advocacy efforts for permanent CPT codes. This article also explains how to bring HWC services to patients struggling with obesity and other lifestyle-related chronic diseases.
Neil F. Gordon, MD, is CEO of INTERVENT. Margaret Moore, MA, is CEO of Wellcoaches Corporation. Ruth Q. Wolever, PhD, consults for WONDR Health. Michael Scholtz, MA, is owner and operator of Vista Life Coaching. Gary A. Sforzo, PhD, is research advisor for Wellcoaches.
COMMENTARY
Coaching Boosts GLP-1 Effectiveness in Managing Weight Loss
DISCLOSURES
| March 27, 2025When adhered to, glucagon-like peptide 1 receptor agonist (GLP-1) prescriptions are a highly effective treatment for obesity. Clinical trials show GLP-1 treatment inducing weight loss of 10%-25% over a 1-2-year period. However, GLP-1s don’t cure obesity but treat it much like blood pressure medication attenuates hypertension. Remove the medication and the disease returns.
Weight recidivism, or regain, is common after weight loss, and stopping treatment with GLP-1 brings about a similar undesirable endpoint. In other words, a lifetime of GLP-1 prescription is to be expected for long-term effectiveness.
But patient adherence to GLP-1 regimens is low, with more than 50% of patients stopping treatment within the first 3 months and only 33% still adhering to their prescription at 1 year. Side effects, cost, food addiction, and simply missing the joy of eating are among the reasons for lack of adherence. Hence, the common belief that GLP-1 medications are a miracle cure for obesity may be greatly exaggerated.
Additionally, when approving GLP-1s for obesity treatment, the Food and Drug Administration specified these medications were to be used in addition to a reduced caloric diet and increased physical activity. However, in practice, patients are generally not supported to adopt a healthy lifestyle or to engage in lifestyle medicine when GLP-1s are prescribed.
One promising way to promote drug adherence and lifestyle change is to provide health well-being coaching (HWC) alongside GLP-1 prescriptions. This is the focus of an article I co-authored, “Health and Well-being Coaching Adjuvant to GLP-1 Induced Weight Loss,” published online November 19, 2024, in the American Journal of Lifestyle Medicine (AJLM).
“Changing lifestyle behaviors is difficult, and physicians’ advice on diet and exercise often goes unheeded, with poor adherence to best laid plans,” notes AJLM article co-author Neil F. Gordon, MD, PhD, MPH, and CEO of the population management company INTERVENT International. Patients need far more than brief advice or a brochure from their physician to successfully change their behavior, he adds. HWC, by contrast, is an evidence-based strategy to promote health via lifestyle that can be used in combination with GLP-1 prescriptions, Gordon says.
Margaret Moore, MBA, another co-author of the AJLM article, describes HWC as “a partnership between a patient and coach eliciting self-motivation and confidence through a creative change process that leads to sustainably better health outcomes.” Moore is a pioneer in the HWC field, founding Wellcoaches Corporation in 2000, co-founding the Institute of Coaching in 2009, and the HWC certifying agency, the National Board of Health and Wellness Coaches, in 2010.
“HWC competences translate into positive-action evidence-based theories, such as self-determination theory, social cognitive theory, transtheoretical model, positive psychology, mindfulness, motivational interviewing, and goal setting,” Moore says. “The coaching process is empowering patients to find a personal formula of lifestyle medicine they can enjoy and sustain.”
Michael Scholtz, MA, a board-certified health and wellness coach in practice for 23 years, says that HWC can be “an essential ingredient” to losing weight and preventing weight regain.
“Patients I work with tend to stick with their medication prescriptions better than the average patient because I'm careful to support their autonomy in choosing to take and adhere to their medications,” he says. “My c lients who are focused on losing weight show a remarkable resilience in sustaining diet and exercise habits.”
There are many patients with whom Scholtz has stayed in touch for several years who have maintained both their healthy habits and their lower weight, he says. These patients tell him that “their coaching relationship and related support are important to their weight loss success," he adds.
Research supports Scholtz’s view that medication adherence is a benefit of HWC. A study examining pharmaceutical claims found that patients engaging in HWC increased their medication possession ratio over a 6-month trial. This effect persisted in the 6 months following the coaching sessions.
The study’s first author, Ruth Q. Wolever, PhD, professor of physical medicine and rehabilitation at Vanderbilt School of Medicine, Nashville, TN, notes that HWC is not only effective for treating obesity, but is also an effective strategy for helping patients with diabetes. Medication persistence is a key component of HWC, but not the sole reason for the positive effects, she adds.
“HWC is about effectively empowering patients to make and maintain healthy lifestyle changes aligned with their best selves,” Wolever says.
Research showing that HWC can result in long-term weight loss pre-dates the surge in GLP-1 prescriptions. The body of evidence includes two studies with randomized and controlled design that clearly demonstrate the effectiveness of HWC for obesity treatment with clinically significant and sustained weight loss. Neither study involved medication prescription for weight loss.
A definitive comparative effectiveness study of patients using GLP-1 medications with HWC is yet to be undertaken. However, Moore, notes: “It makes good sense to combine the best of both – GLP-1 medications for reducing weight and HWC for helping people sustain weight loss while improving health through lifestyle medicine.”
Moore is co-leading the path to establishing permanent current procedural terminology (CPT) codes for the reimbursement of HWC services. The Centers for Medicare and Medicaid Services added HWC CPT codes to the Medicare Telehealth list on a provisional basis in 2024. The US Department of Veteran’s Services now offers HWC services at 118 sites.
A recent paper describes the advocacy efforts for permanent CPT codes. This article also explains how to bring HWC services to patients struggling with obesity and other lifestyle-related chronic diseases.
Neil F. Gordon, MD, is CEO of INTERVENT. Margaret Moore, MA, is CEO of Wellcoaches Corporation. Ruth Q. Wolever, PhD, consults for WONDR Health. Michael Scholtz, MA, is owner and operator of Vista Life Coaching. Gary A. Sforzo, PhD, is research advisor for Wellcoaches.
Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
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