Adherence
Intensive lifestyle modification (including meal replacements and frequent counseling) combined with semaglutide does not produce significantly greater long-term weight loss than semaglutide alone with brief counseling, suggesting the medication's efficacy may render intensive behavioral interventions redundant for long-term outcomes.
When taking semaglutide, intensive lifestyle programs (like meal replacements and frequent counseling) do not significantly improve long-term weight loss compared to brief counseling. The medication's effect is so strong that it largely overrides the need for intensive behavioral strategies for weight loss, though lifestyle changes remain important for health.
Extrapolating across STEP 1 and 3... the addition of intensive lifestyle modification and meal replacements (MRs) in STEP 3 appeared to increase early weight reduction with semaglutide but produced only marginally greater end-of-treatment weight loss (1.1 percentage points) than in STEP 1, in which semaglutide was delivered with less intensive counseling (17 visits and no MRs).
Why this rating
Based on comparison of two phase 3 trials (STEP 1 and STEP 3), though direct head-to-head comparison was not the primary design of STEP 3.
Source
The Role of Lifestyle Modification with Second-Generation Anti-obesity Medications: Comparisons, Questions, and Clinical Opportunities
Thomas A. Wadden et al. · Current Obesity Reports · 2023
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