Psychosocial Outcomes in Telemedicine and Long-Acting Incretin-Specific Behavioral Intervention.
This single-arm pragmatic trial examined psychosocial outcomes in 180 adults with obesity (mean age 44.1 years; 91% female; 81% white; mean weight 102.6 kg) enrolled in a telemedicine program (WeightWatchers Clinic) who received semaglutide or tirzepatide alongside an adjunctive virtual behavioral intervention tailored for patients on long-acting incretin therapy. Psychosocial measures—including depression (PHQ-8), perceived stress (Perceived Stress Scale), well-being (WHO-5), weight bias internalization (WBIS-2F), and weight-related quality of life (IWQOL-Lite)—were collected at baseline, 12 weeks, and 24 weeks. Wilcoxon signed-rank tests with False Discovery Rate correction were used; an intent-to-treat analysis using last observation carried forward (LOCF) was also performed. The study found statistically significant improvements from baseline to 24 weeks across all five psychosocial outcomes. Key limitations include the absence of a control group, a predominantly white and female sample limiting generalizability, and the inability to separate medication effects from behavioral intervention effects. The findings suggest an association between the combined telehealth and behavioral approach and improved psychosocial outcomes, but causality cannot be established.
Why this grade: Single-arm trial with no control group (n=180) prevents attribution of outcomes to either medication or behavioral intervention, and the sample lacks demographic diversity, limiting generalizability.
Background Newer generation anti-obesity medications such as semaglutide and tirzepatide are highly efficacious, resulting in a proliferation of telehealth prescribers. Few, however, augment medication with a behavioral intervention, and little research has examined the impact of these medications on psychosocial variables. Objective This study evaluated the efficacy of a telehealth provision of semaglutide/tirzepatide with a virtual behavioral program on psychosocial outcomes at 12 and 24 weeks. Methods In this single-arm pragmatic trial, 180 participants (M age = 44.1; 91% female; 81% white; M weight = 102.6 kgs) were recruited from a telemedicine obesity program (WeightWatchers Clinic) and offered an adjunctive virtual behavioral program tailored for patients on long-acting incretin therapy. Participants completed the PHQ-8 measuring depression, Perceived Stress Scale, Self-Compassion Scale, WHO-5 measuring well-being, Weight Bias Internalization Scale-2F and Impact of Weight on Quality of Life-Lite at baseline, 12 and 24 weeks. Wilcoxon signed-rank tests were conducted to evaluate outcome differences. p values were adjusted using a False Discovery Rate approach. Intent-to-treat analysis was performed using last observation carried forward (LOCF). Results There were significant improvements from median baseline to 24 weeks in measures of depression (-2), perceived stress (-3), well-being (3), weight bias internalization (-0.6), and impact of weight on quality of life (-18). All p 's Conclusions Virtually delivered obesity treatment combining telemedicine and a long-acting incretin-specific behavioral program demonstrated clinically significant improvements in psychosocial outcomes over 24 weeks.
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