Introduction
Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) have emerged as a breakthrough therapy for obesity, overweight, and other associated health conditions, delivering unprecedented weight loss in clinical trials. For example, the STEP 1 trial of once-weekly semaglutide (2.4 mg) in people without diabetes achieved a ~15% average body weight reduction over 68 weeks (source), with a mean baseline BMI of ~38 (source). Such results, along with evidence of cardiovascular benefits (e.g. the 2023 SELECT trial), have fueled surging global demand. However, impressive outcomes in clinical trials can fail to translate into sustained real-world success. We now know that patients frequently discontinue GLP-1 therapy within months, negating long-term benefits, and also struggle to meet the requirements of lifestyle changes that are prescribed alongside the medication. The disconnect stems from how GLP-1 medications are traditionally prescribed and supported. This post examines two key shortcomings of standard GLP-1 protocols and explains how Noom Med’s GLP-1Rx Program with SmartDose may be prescribed to address these gaps to provide a personalized, behaviorally integrated approach for patients who need it.
Pitfalls of Standard GLP-1 Treatment Protocols
1. Trial Efficacy vs. Real-World Adherence Collapse
Clinical trials set a high bar for GLP-1 effectiveness, but they do so in highly controlled conditions with selective populations. Participants in trials like STEP 1 tend to have extreme obesity (average BMI 38) and receive extensive support (including regular lifestyle counseling (source)). Adherence in trials is artificially high – for instance, 92.8% of patients in a 2-year semaglutide trial completed the study (source). By contrast, real-world persistence drops off a cliff fairly early on. An analysis of insurance claims for GLP-1 weight-loss therapy (in patients without diabetes) found only 29% were still on the medication at 1 year, and a mere 15% at 2 years (source). In other words, barely 1 in 7 patients remains on GLP-1 therapy after two years, despite obesity being a chronic condition requiring long-term treatment. This huge adherence gap means that real-world effectiveness falls far short of trial efficacy.
Why does this matter? Because stopping GLP-1 therapy can minimize the long-term health gains. Without changes to lifestyle, weight that took months to shed is rapidly regained once the medication is discontinued, reversing the improvements to metabolic health. Not only does this treatment failure burden the healthcare system with excess costs, it can also be devastating for patients who end up right back where they started. In one study, patients regained about two-thirds of the weight they had lost just one year after stopping semaglutide treatment, and their cardiometabolic risk markers (blood sugar, cholesterol, etc.) reverted toward baseline (source). The FDA has acknowledged this reality on the label itself: weight care requires ongoing therapy, and GLP-1 drugs are approved for chronic weight management only as an adjunct to diet and exercise – they are not magic bullets that cure obesity after a few doses. Yet, in standard practice, patients often receive the drug with little else, and many discontinue early. The result is weight regain leading to the recurrence of pre-diabetes, hypertension, dyslipidemia, and other risks, and essentially wasted effort, cost, and time. Without sustained adherence, the “wonder drug” benefits of GLP-1s often cannot be fully realized.
2. Lack of Lifestyle Support & Side Effects Driving Dropout
Poor long-term adherence is not the patient’s “fault” – it’s a predictable outcome when medications are prescribed in isolation. There are two major drivers of GLP-1 discontinuation in typical care: tolerability issues and insufficient behavioral support.
Side effects are a major hurdle. GLP-1 RAs commonly cause gastrointestinal symptoms, and those symptoms increase at higher doses. In the STEP 1 trial, about 74% of participants on semaglutide experienced GI side effects (nausea, vomiting, diarrhea, or constipation) (source). Over a longer 2-year trial, the rate of GI adverse events climbed to 82% on semaglutide (source). These effects are usually mild to moderate, but they can still meaningfully impact daily comfort and medication adherence. In real-world practice, side effects loom even larger – patients may not have close monitoring or reassurance, and frequently “self-discontinue” when persistent nausea or other issues make them feel worse before they feel better. Dose-related GI symptoms during the rapid titration phase are a well-documented cause of patients quitting GLP-1 therapy (source). Noom’s own internal data also shows that the likelihood of experiencing side effects increases significantly as dosages increase. This is troubling, since those who discontinue early miss out on the long-term weight loss and health improvements that typically accrue after 3+ months of therapy.
Internal Noom data shows that Noom GLP-1Rx Program members self-report higher rates of side effects at higher dosages. We analyzed the weekly incidence of side effects during the first two weeks that a participant recorded a given dose amount, using a Bayesian logistic mixed-effects model.
Exacerbating the problem, most patients get little to no help with the required lifestyle changes. Obesity treatment guidelines emphasize that GLP-1 medication should be combined with a reduced-calorie diet and increased physical activity (source). In clinical trials, participants indeed received counseling to improve diet and exercise (STEP 1 provided monthly individualized lifestyle counseling to all arms (source)). But outside of trials, this guidance often falls through the cracks. Primary care providers, who write the bulk of GLP-1 prescriptions, seldom have the resources or time to deliver effective weight management support (source). As a result, many patients are prescribed a GLP-1 and told to “eat healthier and move more,” but without more specific guidance, structured coaching, or follow-up. Human nature being what it is, even motivated patients struggle to make and sustain lifestyle changes on their own – especially while dealing with medication side effects. The human bias toward immediate comfort over distant benefit often prevails; for instance, it’s easier to skip the gym or eat the familiar comfort food (and now one might justify it by “I’m on a weight-loss shot anyway”). Without ongoing behavioral intervention, old habits remain in place, undermining the potential added benefits of the drug. In short, the standard “prescribe and refer back in 3 months” approach leaves a support vacuum. This lack of lifestyle integration not only blunts weight loss (since diet/exercise contribute significantly), but also magnifies attrition – patients who aren’t seeing lifestyle progress or feel unsupported are more likely to give up on the medication when challenges arise.
The outcome of these two gaps – side effect management and lifestyle support – is low real-world persistence. People stop the medication, regain weight, and slide backwards medically. These are the gaps that Noom’s GLP-1Rx Program is designed to address.
Noom Med’s GLP-1Rx Program: A Personalized, Integrated Solution
Noom’s approach to individualized treatment was designed in consultation with obesity clinicians from the ground up to solve the adherence puzzle and deliver on the full promise of GLP-1 therapy, when a patient is identified to be at higher risk of discontinuation. It addresses the pitfalls above through two core strategies: 1) a highly personalized “low and slow” titration protocol aimed at maximizing tolerability and finding the right dose for each individual, in combination with 2) deep lifestyle integration using behavioral science focused on ensuring patients build healthy habits alongside the medication.
Noom Med’s GLP-1Rx Program has been designed in collaboration with our clinical leadership and clinical partners to include compounded medication as an option that providers may prescribe to meet the needs of individual patients whose needs cannot otherwise be met through commercially available FDA-approved medication. Not every patient needs this treatment approach – Noom-affiliated prescribers, at their discretion on a patient’s need, can also prescribe branded GLP-1 medications like Zepbound, oral medications like metformin, and alternate GLP-1 medications like liraglutide – but for those who do it could mean all the difference.
SmartDose: Personalizing Titration for Adherence and Sustainable Results
Traditional GLP-1 prescribing follows a one-size-fits-all titration schedule dictated by the drug label. For example, the standard semaglutide (Wegovy) protocol exponentially escalates the dose every 4 weeks – 0.25 mg for 4 weeks, then 0.5 mg, 1.0 mg, 1.7 mg, and finally 2.4 mg/week by about week 16 (source). This pace is fixed, regardless of how the patient is tolerating each increase. In reality, individual tolerance varies widely – some people breeze through titration, but according to a Blue Health Intelligence report “almost all new users of GLP-1 drugs suffer from some gastrointestinal side effects” (source).
Noom’s individualized program, leveraging SmartDose, breaks free of the rigid schedule. It employs a highly personalized “low and slow” titration that we call SmartDose, effectively doubling the number of dose steps and checking in more frequently than the standard protocol. Frequent touchpoints assist each patient in understanding side effects and progress, and then tailor the next dose adjustment (or hold) accordingly. The guiding principle is to find the lowest effective dose that comfortably sustains continued outcomes for the long term, rather than rushing everyone to the maximum dose in the minimum time.
An illustrative personalized protocol with the Noom Med GLP-1Rx Program increases dosages to the lowest effective dose for each individual, compared to a nearly exponential increase in dosages from standard approaches.
This personalized titration strategy is well-aligned with emerging expert recommendations. A multidisciplinary panel of endocrinologists recently advised clinicians to extend the dose-escalation phase or pause dose increases if patients are experiencing GI adverse effects (source). In practice, many obesity specialists have found themselves deviating from the label – slowing down titration, adding intermediate doses, maintaining lower doses longer, or skipping weeks – to help patients stay on therapy. What you can’t do with standard medication forms is change the preset dosage. Noom’s program formalizes and scales this patient-centric approach. By identifying and titrating at the patient’s pace, we can improve tolerability. The moment a patient hits a dose that causes troublesome nausea or loss of appetite beyond what’s manageable, Noom’s clinician-designed protocol holds at that dose longer, or even dials back to the prior dose until symptoms subside. Importantly, this does not mean patients lose efficacy; in fact, allowing the body to acclimate can prevent treatment interruptions, so patients actually receive more cumulative exposure to the medication over time.
Equally, Noom’s clinician-designed protocol recognizes that a higher dose isn’t always better for every patient. While 2.4 mg is the FDA-approved maintenance dose for semaglutide, not everyone needs the absolute max to achieve substantial weight loss. Clinical experience has shown many patients can get excellent weight loss on lower doses – pushing them to the maximum dose risks additional side effects for marginal gains. Our clinicians, coaches, and care team monitor each member’s weight trajectory and side effect profile closely. If a patient is consistently losing a healthy amount of weight and feels well, the patient’s clinician may elect to establish the current dose as meeting the patient’s needs rather than force an increase for protocol’s sake. This adaptive dosing program establishes the “lowest effective dose” for each individual, minimizing unnecessary drug exposure and side effects. By keeping patients more comfortable, long-term adherence improves. In short, Noom’s individualized approach to titration can optimize the risk–benefit tradeoff, which can be especially important for patients at higher risk of discontinuation. For these patients, the goal of personalization is to prescribe just enough medication to achieve targeted results but not so much that the cure feels worse than the disease.
Behavioral Integration: Habit Change to Complement the Medication
Medication is only one piece of the weight-loss puzzle. Noom’s philosophy is that sustainable results come from coupling pharmacotherapy with behavior change, in accordance with FDA guidance. Noom Med’s GLP-1Rx Program fully integrates and expands Noom’s groundbreaking digital coaching platform – the same behavior science that has helped millions develop healthier lifestyles. This goes far beyond a generic “diet and exercise” handout. Instead, we use a curriculum of psychological principles to help members build sustainable habits, one small step at a time.
Noom leverages psychology to help people deeply understand their own habits and behaviors by uncovering the underlying triggers, patterns, and psychological barriers that drive daily choices. By blending cognitive behavioral techniques with habit-forming principles, Noom empowers individuals to develop personalized, actionable strategies that directly address their unique challenges.
Awareness is powerful, but a core challenge in lifestyle change is the human tendency to prioritize immediate comfort over future health – what behavioral economists call present bias. One study found that over half of young adults exhibit present-biased decision-making, preferring smaller instant rewards over larger delayed rewards. Noom’s program is deliberately designed to counteract present bias by providing immediate, positive reinforcement for healthy actions. We incorporate “micro-incentives” and gamified tracking throughout the user experience. For example, members get daily tasks like logging their meals or taking a 10-minute walk, and the app gives instant feedback – visual progress charts, streak counts, virtual “high-fives” from coaches, and more. These small rewards may seem trivial, but they effectively turn habit formation into a game. By making each healthy choice a little more fun and rewarding in the moment, Noom helps members overcome the motivational valley between short-term effort and long-term payoff.
Noom’s digital app experience is designed to build and sustain healthier behaviors in the areas of nutrition and physical activity – supporting improved muscle mass and enduring long-term health benefits.
Crucially, Noom’s behavioral program targets diet quality and physical activity, fulfilling the often-neglected “lifestyle” component of medical obesity treatment. Members learn to implement evidence-based nutrition strategies (like volumetric eating with high-fiber foods and prioritizing protein intake for muscle preservation) in addition to finding enjoyable ways to move more. These changes synergize with the GLP-1’s effects – for instance, as the medication curbs appetite, coaches help patients to leverage that effect by establishing a more balanced meal pattern, so they can nourish their bodies adequately while still maintaining a calorie deficit. Moreover, these habit changes lay a foundation for long-term health. Should a member ever need to pause the medication (e.g. during a pregnancy), the healthy habits they’ve built with Noom can help safeguard against rapid weight rebound. Moreover, Noom has shown these habits can drive health outcomes both on their own and alongside medication.
The Noom app experience awards a “NoomCoin” each day that a member completes a set of recommended actions, so we use the number of NoomCoins earned as a measure for a member’s investment in behavior change. Our data shows that Noom GLP-1Rx Program members who use the Noom app regularly (defined as earning 10 or more NoomCoins) have more than double the likelihood of reaching 10% weight loss at 4 months. Powerful habit change combined with personalized pharmacology creates transformational results.
By deeply integrating medication with behavior change, Noom’s GLP-1Rx Program tackles obesity on both physiological and psychological fronts. Every member’s care plan involves Medication, Mindset, and Lifestyle. This comprehensive approach is what the FDA and medical guidelines call for, but rarely operationalize. Noom makes it a reality by delivering behavioral support at scale through its app-based coaching, educational curriculum, gamified habit formation, and community features. The end result is that members don’t feel like they are “on their own” with an injection that produces difficult side effects – they feel supported, informed, and empowered to change their lives, with the medication as an aid rather than a crutch.
Conclusion
Noom Med’s personalized GLP-1Rx Program with SmartDose represents a model for improving real-world outcomes with anti-obesity medications for patients at higher risk of discontinuation. By addressing the two major failure points of standard GLP-1 treatment – rapid, inflexible titration and lack of lifestyle intervention – Noom aims to maximize long-term adherence and health benefits. The “low and slow” SmartDose dosing protocol acknowledges individual variability and prioritizes patient comfort, preventing unnecessary dropout while using the minimal effective medication dose. In parallel, Noom’s intensive behavioral platform ensures that patients actually follow through on the diet and exercise recommendations that are meant to accompany the drug, thereby amplifying weight loss and fostering habit change that can last a lifetime.
This approach is grounded in scientific evidence from multiple fields, including clinical trials and real-world data on adherence, the behavioral psychology of habit formation, present bias, and outcomes research on comprehensive obesity care. Noom Med’s personalized GLP-1Rx program provides the missing layer of support and individualized treatment that many patients need. By marrying pharmacology with behavior change, we can resolve the adherence dilemma that has plagued real-world use of these drugs. Patients can be treated not as passive recipients of a magic shot, but as active participants in their health journey – with coaching, tools, and a tailored treatment plan that meets them where they are. Obesity is a chronic, complex condition; it demands a long-term, comprehensive and personalized treatment strategy that we are committed to and proud to make available through the Noom Med GLP-1Rx Program with SmartDose.
