Impact of Added Structured Exercise and Nutrition at a Tertiary Pediatric Obesity Center

Objectives: The purpose of this study was to evaluate the efficacy of a commercial medical weight management program that combines obesity telemedicine with a virtual behavioral program specifically tailored to those taking a glucagon-like peptide 1 receptor agonists (GLP1s) on: 1) diet quality, 2) strength training behavior, and 3) healthy habits.Methods: WeightWatchers Clinic patients who were treated with a GLP-1 (35% semaglutide; 65% tirzepatide) combined with a virtual GLP-1 specific behavioral program were recruited for a 6month single arm clinical trial (n180).Participants (M age44.1 (SD10.41);91% female; 81% White; M weight102.6 kg (SD20.9);M BMI37.1 kg/m 2 (SD6.7))experienced a 6-month weight loss of 12.3% (SD 6.9%).Participants were assessed at baseline and 6-months for changes in diet quality (measured via Healthy Eating Index (HEI)-2020 scores), strength training days per week, and habit strength of healthier and less healthy habits (measured by Self-Reported Behavioral Automaticity Index (SRBAI)).Wilcoxon rank-sum tests were conducted to evaluate differences in outcomes: baseline vs. 6 months.P values were adjusted using a False Discovery Rate approach.Results: Participants significantly improved their HEI-2020 scores by 34.7% (55.0 at baseline to 65.1 at 6 months)(p<0.001).Participants increased the number of days per week they performed strength training by 53.2% (2.0 days per week to 2.5 days)(p<0.001).The following healthier habits were significantly strengthened over 6 months: Considering portion sizes; tracking food; considering protein content; eating vegetables; self-weighing; being physically active; talking kindly to oneself after a setback; arranging the kitchen so healthy foods are easy to access and planning meals for the day (all p<0.001).The following less healthy habits became less strong over 6 months: eating fried foods; eating sweets; and drinking sugar-sweetened beverages (all p<0.001).Conclusions: An obesity telemedicine program that combines GLP-1s with a GLP-1-specific behavioral program showed significant improvements in diet quality, resistance training, and key behaviors associated with long-term weight management.