The weight loss injections Ozempic and Wegovy are being heralded as a breakthrough in the medical treatment of obesity. These medications add to a growing set of pharmacological approaches – including antihypertensives and statins – to reducing the risk of heart diseases. Yet the emergence of these treatments has raised the question of whether behaviour change is still relevant.
Prof. Dr. Nikkil Sudharsanan, head of the Rudolf Mößbauer Assistant Professorship of Behavioral Science for Disease Prevention and Health Care, together with Mohammed K. Ali, professor of global health and epidemiology at Emory University in Atlanta/USA, and Harsha Thirumurthy, professor at the Department of Medical Ethics and Health Policy at the University of Pennsylvania in Philadelphia/USA, have argued in an article that behavioural changes should not be neglected despite the novel biomedical solutions. The commentary was now published under the title "Behaviour change in the era of biomedical advances" in the journal "Nature Human Behaviour". The journal has an impact factor of 24.252.
In the commentary, the researchers discuss the latest biomedical solutions for disease management, such as weight-loss drugs, and whether this makes measures and strategies for possible behaviour change obsolete.
Eating a healthy diet, being physically active, avoiding tobacco and alcohol abuse, getting enough sleep and taking appropriate medication if necessary have long been the main recommendations for preventing and treating cardiometabolic diseases. However, despite a large number of studies, there has been limited success in encouraging individuals to practice and maintain healthy behaviours. The number of people affected by obesity, diabetes and hypertension has more than tripled worldwide over the last four decades.
Furthermore, behavioural strategies, such as structured counselling programs used to promote the adoption of lifestyle measures, have little or short-term impact. Therefore, the question arises whether behavioural interventions and strategies should continue to be used to prevent and manage cardiometabolic disease.
The researchers argue that neglecting strategies to promote healthy behaviours carries many risks. This may slow down the reduction of the burden of cardiometabolic diseases, cancer and other chronic diseases.
Therefore, the paper discusses five reasons why behaviour change remains essential despite expanded biomedical options:
- The effectiveness of biomedical drugs also depends on human behaviour as these interventions only work if individuals take them consistently. Therefore, acceptance and adherence to treatment remain crucial.
- Since biomedical drugs have to be used continuously, their use on a large scale is expensive. Not everyone can afford them in the long run.
- Even though drugs are effective for common diseases such as obesity, changes in lifestyle and obesity-promoting dietary habits would be important for the success of treatment.
- The effectiveness of biomedical drugs may be limited by the fact that not everyone is eligible or interested in using them. Many populations are suspicious of them and prefer non-pharmacological interventions.
- It is currently unclear whether biomedical interventions are “one-size-fits-all” solutions. There is a growing body of data showing that the risk factors for (or causes of) obesity and type 2 diabetes are each more complex.
For the above reasons, large-scale provision of biomedical solutions may not be practical. Moreover, recommending their sustained use may be challenging.
“The new drugs are currently receiving a lot of attention, especially in the media,” explains Prof. Sudharsanan. “However, patients have to take them regularly and consistently. They also have side effects that cannot be ignored and not everyone will want to or be able to take them. Therefore, we should not lose sight of the importance of lifestyle changes! Ideally, the best effect is achieved through a combination of biomedical and behavioural measures that are individually adapted."
To the commentary “Behaviour change in the era of biomedical advances” in the journal “Nature Human Behaviour”
Prof. Dr. Nikkil Sudharsanan
Rudolf Mößbauer Assistant Professorship of Behavioral Science for Disease Prevention and Health Care
phone: 089 289 24990
Text: Romy Schwaiger
Photos: “Nature Human Behaviour”/private