The case for medical weight loss programs and intensive lifestyle change

Even in a world where GLP-1 weight loss drugs seem like a miraculous weight loss solution, diet, exercise, and other healthy lifestyle changes are still needed to help people lose weight and keep those pounds off. If youve struggled to make behavioral tweaks in the past, it may be time to consider a doctor-led weight loss program, sometimes known as an intensive lifestyle intervention (ILI), that offers continued expert guidance and psychological support.

Many people think of lifestyle changes [related to weight loss] as obsolete, but they really arent, says Amy Rothberg, MD, the director of the University of Michigan Weight Management Program in Ann Arbor. We need to be thinking of weight loss medications as adjuncts to lifestyle changes.

ILIs are highly structured diet and exercise programs prescribed by your doctor that help you make targeted and lasting changes. Whether you use a GLP-1 drug or not, these types of regimens can help you achieve your weight loss goals and optimize your health.

What Is an Intensive Lifestyle Intervention?

Its a prescribed program with a clear end point, says Jonathan Bonnet, MD, MPH, a clinical associate professor of medicine at Stanford University School of Medicine and a member of the American Board of Lifestyle Medicine. The meetings are more frequent, and theres more being asked of patients and what theyre changing.

These programs are offered by a variety of different organizations, including government initiatives, academic hospitals and weight loss clinics, private health networks and telemedicine businesses, and some larger health insurance providers.

ILIs can be an especially smart choice for those who are trying to manage or reverse a condition related to obesity like diabetes, high cholesterol, or high blood pressure.

ILIs are probably more appealing to someone who has chronic conditions and who is frustrated with the results theyve been able to achieve on their own, says Dr. Bonnet. They may want to choose a more lifestyle-centric approach thats still rooted in science, but still want some autonomy and control over how they lose weight.

What ILIs Offer

These programs may call to mind boot camps or Biggest Loserstyle weight loss, but they dont involve extreme diets or punishing exercising plans.

We tend to focus on the overarching health goals that you want to achieve and finding the lifestyle-based strategies we can use to support that, saysRyan Kane, MD, MPH, an assistant professor of nutrition at Tufts University in Boston.

• Education, including how to make healthy food choices, combat feelings of deprivation, and fit exercise into your regular schedule.
• Progress tracking, including private weigh-ins.
• Troubleshooting, where youll talk to experts about topics such as managing challenges, staying motivated, or eating healthy while traveling or at social events.
• Peer-to-peer-support, such as support groups where you meet with others who are in a similar situation.

That said, motivation matters. ILIs can give you a plan to lose weight in order to improve your health, and your team will guide you along the way. But youll still need to do the work to reach your goals.

You get out of it what you put into it, says Dr. Kane. For folks who arent ready to engage, it might not be the right time to try one."

Do ILI Programs Help People Lose Weight?

They give people a sense of community so theyre not doing it all by themselves, says Dr. Rothberg.

Far before the discovery of these drugs, people were losing weight and maintaining their reduced weight, Rothenberg says. It all comes down to having a plan and a solid support system in place.

Combining GLP-1s and Lifestyle Changes

Doctor-led weight loss programs that focus on lifestyle are not at all incompatible with GLP-1 use; by the same token, taking weight loss drugs doesnt mean you get to ignore healthy eating and exercise. When both medications and informed lifestyle changes are part of a weight loss approach, they can be very synergistic, says Kane.

Weight loss medications dont give you health and vitality completely, says Bonnet. Theyre just part of the puzzle. You still have to engage in physical activity, be thoughtful about the foods youre eating, find ways to deal with stress, and get enough sleep.

Pairing a GLP-1 with an ILI also makes it easier to maintain your weight loss, should you one day decide to go off your med. Without locking down healthy lifestyle changes, theres no hope of keeping the weight off because you havent developed the habits to not to be on the medication, Bonnet says.

Intensive Programs and Weight Loss Maintenance

Obesity is a chronic disease that needs lifelong care. Thats why many of these programs consist of two parts: A core phase that focuses on weight loss and other health goals, followed by a maintenance phase thats a little more relaxed.

You might go from meeting with your team weekly to monthly or quarterly for another year, says Bonnet.

How to Find the Right Program

Start by asking your doctor or a registered dietitian to refer you to a program, but you can also search for programs yourself in your area.

If you live close to an academic center or major hospital, reach out to see what they might offer, Rothberg recommends.

Private weight loss clinics offer intensive interventions as well, including Blue Zones Health, Pivios Complete Health Improvement Program, and Wellvolution. Look for providers who have training in lifestyle medicine or weight management, like a certification from the American Board of Lifestyle Medicine, the American College of Lifestyle Medicine, or the American Board of Obesity Medicine. They should also offer frequent check-ins, customized diet and exercise plans, access to nutrition and mental health experts, peer support, and a plan for weight loss maintenance.

If youre not sure whether a program is the right fit for you, run it by your primary care provider before signing up.

Can You Do an Intensive Lifestyle Intervention by Yourself?

Its not impossible, but most people find it significantly tougher to go solo. But theres no shortage of good resources to steer you in the right direction, including those from the American College of Lifestyle Medicine. Plus, theres an array of apps and trackers that can help you target your sleep, stress, and social connectivity goals.

Weight loss can come with risks for those with diabetes, older adults, and those who are on medications, so its good for those groups to have medical supervision when making major lifestyle changes.

If you had someone on insulin switch to a ketogenic diet overnight, for instance, they could end up having hypoglycemia, Bonnet says.

But if youre generally healthy, theres no harm in trying it. Just make sure to discuss your plans with your healthcare provider first.

The Takeaway

• Intensive lifestyle interventions (ILIs) are structured programs that combine reduced-calorie eating, regular exercise, and behavioral changes like better sleep and stress management.
• Even if you take GLP-1 weight loss medications, lifestyle changes are essential for weight management.
• Research shows ILI programs may lead to greater and more sustainable weight loss than going it alone, often producing significant body-weight reductions and improvements in conditions like diabetes, high blood pressure, and metabolic syndrome.
• Many organizations and businesses offer medical weight loss programs, but you and your primary doctor should vet programs to be sure they provide the kind of multidisciplinary expertise and holistic support that can set you up for long-term success.