Mixed

An intensive weight loss intervention combining total diet replacements (TDR), behavioral support, and weight loss medications (WLM) as needed achieves and maintains ≥20% weight loss in adults with obesity class I or II, significantly outperforming usual care.

To achieve significant weight loss (≥20%), you need a structured, long-term (2-year) program that combines strict initial calorie restriction (via meal replacements), regular coaching, and physical activity. If you don't lose enough weight in the first month, the program adds medication support. This is more intensive than typical 'eat less, move more' advice, which usually results in minimal weight loss.