Dose Lifestyle Like Another Drug During GLP-1 Therapy, says Lifestyle and Obesity Medicine Specialist

Lifestyle medicine is emerging as an indispensable component of any approach to prevent, mitigate, or even reverse chronic disease, according to obesity medicine specialist Jonathan Bonnet, MD, MPH. In the arena of obesity management, for example, he emphasized that neglecting to assess lifestyle attributes and incorporate focused changes into a weight loss regimen using GLP-1 receptor agonists (GLP-1s), is likely to sabotage long-term success and also lead to unintended health risks.

Bonnet is an active member of the American College of Lifestyle Medicine (ACLM) and coauthor of the recent guidance titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity: A joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society.”

The advisory's recommendations for successful and healthy use of GLP-1s are rooted in the well established 6 pillars of lifestyle medicine. In the short video above, Bonnet highlights the 6 pillars and discusses why they are central to optimal treatment with GLP-1s and to the most durable weight-loss outcomes.

The following transcript has been lightly edited for style and flow.

Patient Care: Would you talk about the primary tenants of lifestyle medicine and why they're so important right now in terms of disease prevention and management?

Jonathan Bonnet, MD, MPH: I’ve been very involved with the American College of Lifestyle Medicine, which has developed and built out 6 pillars of a healthy lifestyle. The quick, easy mnemonic is: what you do with your feet, your fork, and your fingers, and then how you manage your stress, how you sleep, and the state of your loving, meaningful relationships. In more straightforward terms, that’s your nutrition or diet, your physical activity, minimal use of toxic substances, restorative sleep, effective stress management, and meaningful connection with others, yourself, or a higher power, if you choose.

There’s a lot of data showing how powerful these lifestyle behaviors are for disease prevention. When they are dosed, or applied, consistently or more intensively, they can also be used to treat disease and, in some cases, even reverse disease. These are tried-and-true behaviors and recommendations that don’t cost much, are available to just about anyone, and can make significantly improve quality of life. They can reduce the risk of or treat disease without the expense or side effects of some medications.

The "big idea" is to focus on lifestyle first because it’s effective, affordable, and widely available. That’s not to say it replaces medication. Medications are valuable tools, but they work best when used appropriately and as an adjunct to lifestyle changes. The long-term objective isn’t just short-term weight loss over 3 or 6 months, only to regain it later—it’s to help people lose weight, maintain a healthy lifestyle, and keep the weight off for the long run.

Jonathan Bonnet, MD, MPH, is the program director of medical weight loss at the Clinical Resource Hub Weight Management Center at Palo Alto Veteran's Affairs in Palo Alto, California. He is also an associate professor (affiliate) at Stanford University School of Medicine, and serves on the board of the American Board of Lifestyle Medicine. Bonnet is board-certified in family, sports, obesity, and lifestyle medicine.

For more from our conversation with Bonnet, see:

• Are the GLP-1 Agonists "Forever Drugs?" It's an Open Question, According to Jonathan Bonnet, MD, MPH
• GLP-1 Medications Need a Permanent Place in Primary Care, Says Obesity Medicine Specialist
• Ready to Prescribe a GLP-1 Medication? Please Dive Deep Into the Patient's History First, Advises John Bonnet, MD,
• Beyond Nutritional Deficiencies: Managing GLP-1 Side Effects With Lifestyle Interventions
• Why 4 Medical Societies Issued a Joint Advisory on Nutrition and GLP-1 Therapy for Obesity