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Clinical Research

Expanding lifestyle intervention beyond “Diet and Exercise” in the GLP-1RA era

International Journal of Obesity volume 49, pages 1419–1420 (2025)Cite this article

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In obesity pharmacotherapy clinical trials, current protocols involve comparing treatment against lifestyle intervention, which consists of reducing caloric intake, increasing physical activity, and attending behavioral sessions [1]. While helpful for evaluating incremental benefits, we recommend redefining “lifestyle intervention” to include sleep and mental health management to align with current scientific thinking and improve the public’s understanding of health [2, 3].

First, sleep has established, independent associations with obesity and cardiometabolic health [4]. In 2022, the American Heart Association updated its Life’s Simple 7 to include sleep (thus becoming “Life’s Essential 8”), acknowledging its effect on cardiovascular health and relationship with other Simple 7 factors [2]. In an obesity context, a scoping review of international obesity management guidelines found that 34% incorporated sleep, demonstrating the growing recognition of sleep’s role [3]. Sleep can be addressed as a health behavior (e.g., sleep duration) or as a treated diagnosis (e.g., obstructive sleep apnea), and the increasing availability of accurate wearables for tracking sleep may make sleep assessments more feasible. While long-term, weight loss data on sleep interventions are lacking, the high prevalence of suboptimal sleep in the overall population and its connection to obesity through effects on nutrition, activity, and metabolism justify sleep’s inclusion [4].

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Acknowledgements

The views expressed here are those of the authors and do not necessarily reflect the official views of Teladoc Health.

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Authors and Affiliations

  1. Teladoc Health, 2 Manhattanville Rd, Purchase, NY, 10577, USA

    Robert Hsu & Tejaswi Kompala

  2. George Washington University, 1922 F St. NW, Washington, D.C., 20052, USA

    Anne-Kathrin Eiselt

  3. University of Utah Health, 615 Arapeen Dr, Salt Lake City, UT, 84108, USA

    Tejaswi Kompala

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  1. Robert Hsu
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  2. Anne-Kathrin Eiselt
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Contributions

RH, A-KE, and TK conceptualized the topic. RH wrote the original manuscript. A-KE and TK revised and edited the manuscript. All authors approved the final manuscript.

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Correspondence to Robert Hsu.

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Competing interests

At the time of submission, all authors were employees of Teladoc Health and received stock as a part of compensation. At the time of resubmission, Robert Hsu and Tejaswi Kompala were affiliated with Teladoc Health. No dedicated internal or external funding was provided. The company had no role in the article’s conceptualization, writing, or decision to submit. Robert Hsu reports stock in Novo Nordisk, Eli Lilly, Hims & Hers Health, and LifeMD. Tejaswi Kompala reports prior one-time consultation for Eli Lilly.

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Hsu, R., Eiselt, AK. & Kompala, T. Expanding lifestyle intervention beyond “Diet and Exercise” in the GLP-1RA era. Int J Obes 49, 1419–1420 (2025). https://doi.org/10.1038/s41366-025-01767-9

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