New obesity therapies have made adherence the constraint rather than access. What that looks like in practice, and what it takes to hold someone on a therapy for a year.
Obesity is now recognized as a chronic, relapsing disease, and the arrival of GLP-1 therapies has changed what the constraint is. Access and prescription were the problem. Increasingly, staying on the therapy is.
Patients typically start with high motivation. Without structured follow-up, behavioral support and realistic expectation management, that declines over months. The early warning signals — side effects, discouragement, goals that were never achievable — are the ones missed most often, because they appear between appointments.
Care is also fragmented. A patient may move between a general practitioner, a dietitian, a psychologist, a physiotherapist and a specialist center, with medication started somewhere in that sequence. Each touchpoint is competent and the journey still does not feel continuous.
Three things, consistently.
A behavior-change model rather than reminders. Reminders address forgetting. They do not address discouragement, and discouragement is what ends most therapy journeys. Programs that hold people are built on a model of how behavior actually changes — building motivation first, then converting it into specific, achievable actions.
Support matched to the person. Some patients need a coach checking in weekly. Others need a medication diary and nothing more. Giving everyone the same intensity is expensive for the people who do not need it and thin for the people who do.
Structured assessment at entry. A guideline-aligned assessment gives the GP a clear patient profile and decision support on treatment intensity and referral, and gives the specialist a patient who arrives already characterized. It creates one clinical language across primary care and specialist care.
Obesity is an unusually clear case because the behavioral component is so visible. The pattern is not specific to it. Any therapy where the outcome depends on what the patient does between appointments — specialty immunology, respiratory maintenance therapy, lipid management — has the same shape, and the same three requirements.
The corollary for a sponsor is that an adherence program is not a marketing add-on to a launch. It is part of whether the therapy performs in the real world the way it performed in the trial.
Our own obesity program in Belgium is SHIFT — a digital lifestyle program following the guidelines of the Belgian Association for the Study of Obesity, built on the HAPA behavior-change model, with a coach alongside the app. Full details of the program, including how to join, are at shiftcoach.be.
Tell us what you are working on and we will help you get it moving.
