October 28, 2020
2 min read
Aronne LJ. Behavioral-based therapies for the management of obesity. Presented at: Cardiometabolic Health Congress; Oct. 21-24, 2020 (virtual meeting).
Aronne reports he is a consultant, speaker, adviser, or receives research support from Allurion, Boehringer, Eli Lilly, Janssen, Jazz, Novo Nordisk and Pfizer; has an ownership interest in Allurion, Intellihealth, ERX, Gelesis, Myos Corp., and Zafgen Inc., and serves on the board of directors for Intellihealth, Jamieson Wellness and Myos Corp.
Intensive behavioral therapy can provide additive weight-loss benefits for adults with obesity when combined with medication and diet, and online therapy could improve access to therapy at a lower cost, according to a speaker.
Louis J. Aronne
“Obesity can be treated using well-established behavioral treatments either in person or online,” Louis J. Aronne, MD, FACP, FTOS, DABOM, Sanford I. Weill Professor of Metabolic Research at Weill Cornell Medical College, told Healio. “The use of anti-obesity medication plus diet and behavior produces enough weight loss to significantly reduce metabolic disease risk, like type 2 diabetes, in the majority of patients.”
Aronne discussed intensive behavioral therapy for individuals with obesity at the virtual Cardiometabolic Health Congress.
Intensive behavioral therapy has become a key part of obesity treatment, according to Aronne. Guidelines published in Obesity in 2014 suggest that adults with overweight or obesity participate in a comprehensive lifestyle program for at least 6 months to lose 5% to 10% of initial weight. Participants should take part in 14 or more on-site, high-intensity weight-loss intervention sessions provided in an individual or group setting.
Shared decision-making between the provider and patient is crucial to developing the best diet, exercise and medical interventions, according to Aronne. Providers should set realistic goals, monitor food intake, activity and weight, and practice cognitive restructuring with participants.
Maintenance visits should also continue for individuals who lose weight at 6 months. Maintenance visits take place in an office or over the phone for at least 1 year with a trained interventionist. High levels of physical activity and a reduced-calorie diet appropriate for a lower body weight should be developed.
A randomized controlled trial published in Obesity in 2019 showed behavioral therapy combined with liraglutide (Saxenda, Novo Nordisk) and diet results in the greatest weight loss. Participants who had only intensive behavioral therapy had a 5% mean weight loss, whereas those who had behavioral therapy and liraglutide had a 9.5% mean weight loss. Participants who had intensive behavioral therapy, liraglutide and a meal replacement had a 14% mean weight loss.
Additionally, therapy can be provided by registered dietitians, health counselors and medical assistants. The trial showed there was little difference in weight loss for participants treated by a physician vs. a registered dietitian. There was also no difference for participants who went to a novice interventionist and those who had an experienced interventionist.
Intensive behavioral therapy is beginning to transition to more online care. Aronne said online visits could reach a larger number of people at potentially lower costs. Online services can also connect devices such as activity monitors and digital scales to allow providers to receive live data. Aronne said optimal intervention therapy would combine live visits, video visits and remote monitoring of weight, diet and other variables.
“We have developed a platform, Intellihealth Evolve, that allows providers to deliver this kind of care remotely or in the office setting,” Aronne told Healio. “It has education about obesity treatment, treatment recommendations and all the behavioral tools needed for this type of care. We are beginning to implement it as part of our electronic medical record system at Weill Cornell. A large-scale trial is coming out on Nov. 3 in JAMA, which documents the effectiveness of our program delivered remotely.”