Creating a bridge between weight loss drugs and long-term behaviour change

GLP-1s have been shown to provide game-changing opportunities for patients who are overweight or obese to improve their health, and are also showing positive results in cardiovascular disease, renal conditions, stroke, kidney disease and sleep problems.

In a sector projected to reach an annual value of $150bn by 2035, the race is on to launch GLP-1 weight loss pills to help give patients better ease of use than the currently available GLP-1 weight loss injections.

However, while scientific advances have enabled the creation of weight loss medicines that work by suppressing patients’ appetites, it is vital that their use is combined with a deep understanding of the complex psychological and societal triggers that underpin obesity and defy behaviour change.

This need is becoming clearer as, despite the medication’s ability to help people lose weight rapidly and safely, many people revert to ingrained habits and behaviours when they stop using the medication, resulting in weight gain.

For strained healthcare systems, these medications are providing what could be viewed as only a temporary respite from the cost of caring for the one billion people worldwide who are living with obesity.

The dilemma has magnetised research and a slew of new product launches is expected to reach the market over the next five years. Importantly, however, the defining market differentiator may not be in the compound, but in a companion behaviour change programme.

The imperative to address physical, psychological and social-environmental factors as a first-line consideration is crucial to the success of shifting behaviour patterns, observes Alice Sibelli, of Personia Health, an agency that specialises in transforming deep scientific behavioural research into practical, scalable solutions that improve lives.

“All these factors interact with each other to affect our health and the way we cope with diseases. It is complex and multifactorial, but behavioural science allows us to understand why people behave the way they do and then how we can measure, predict and influence behaviour by supporting people’s decision-making,” says Alice, who has 15 years’ experience in health psychology and developing digital-based solutions to improve health.

“To develop successful behavioural change programmes, we need a strong foundation based on theoretical frameworks, scientific evidence gathered through literature reviews and research studies, but it is also critically important to evaluate any programme when it reaches the real world – this is what we call implementation science – and implement changes to account for any gaps and barriers.

“You have to be flexible and be prepared to make changes without altering the core components of the interventions that contribute to positive change.”

Healthcare systems around the world are under extreme pressure, so the positive role played by behaviour change is a critical component to sustaining them. The World Health Organization has long advocated the application of behavioural change to create more efficient and equitable health systems and it established a Behavioural and Cultural Insights Unit to generate and share understandings. It is a work in constant progress.

The key barriers are how patients perceive their need to take a medication, their concerns about the downsides of taking it (eg, side effects and long-term effects) and trust in the system, along with practical considerations about access and using the medication, adds Alice, who helped devise and run a successful digital intervention that addressed adherence for people living with inflammatory bowel disease (IBD).

“Digital therapies can be a good route to reduce some of the gaps and empower people to feel they have an active role in finding the best solution that works for them,” she says.  “While information is important, the answer is not a matter of supplying more of it, but providing information that is relevant to them and tailored for them – it cannot be generic. Digital solutions with the right content along with the right behavioural change strategy tools can empower people and nurture that intrinsic motivation that is essential for sustained and meaningful change, but is often elusive.

“Many companies are working hard to find the sweet spot of engagement with digital solutions that leads to improvements in clinical outcomes and, with a lot of progress in the digital therapeutic space, there is optimism that more digital programmes that are user-friendly, personalised and engaging will be developed.”

She highlights the success of Personia’s Persignia system, a digital coaching tool developed from 25 years research, validated by the UK’s National Institute for Health and Care Excellence. Persignia delivers personalised support that addresses their concerns and doubts about treatment and helps them overcome the practical difficulties of managing medicines.

“When we achieve that, their motivation to change moves from extrinsic (doing it because the doctor said so) to intrinsic – (doing it for their own health), which is a much stronger predictor of long-term success,” adds Alice. “The tools and techniques we deploy at Personia move beyond informing to motivating and enabling the change.”

Successful programmes take account of the perceptions affecting motivation (‘Do I want to do this?’) as well as the practicalities influencing ability (‘Can I do this?’) to create a toolkit that helps them navigate relapses and addresses their ‘doubts, concerns and practical difficulties’, which can change over time.

She concludes: “This category of weight loss medications gives us an unprecedented opportunity to improve public health and individual health and well-being. But to realise that potential, we need to introduce effective behaviour change support at the same time as the medication. Motivating and enabling more healthy lifestyle changes while the medication is working to reduce weight is necessary to help prevent a reversal of the beneficial effects once the medication is stopped.”

We need to recognise that the right formula has two two core parts, not just one – the medication plus the sustained behaviour change programme.

Danny Buckland is a freelance journalist specialising in the pharmaceutical industry