Nonpharmacologic Weight Loss Strategies Materials

FOUNDATIONS FOR SUCCESS: EMPOWERING PATIENTS WITH NONPHARMACOLOGIC WEIGHT LOSS STRATEGIES

Faculty:

L. Austin Fredrickson, MD, FACP

L. Austin Fredrickson, MD, FACP, is an Associate Professor of Internal Medicine at Northeast Ohio Medical University, where he serves as core faculty and teaches diagnostics, therapeutics, clinical skills, and health humanities. He is board-certified in general internal medicine and practices rural primary care.

Susan Bowlin, DNP, FNP-BC, ACNP-BC, CBN

Dr. Susan Bowlin, DNP, FNP-BC, ACNP-BC, CBN, is a double-board certified nurse practitioner with over 25 years of experience in family practice, acute care, and obesity medicine. She is the founder of Priority One Weight Loss, where she specializes in evidence-based obesity care, empowering patients to achieve sustainable health and vitality. Dr. Bowlin holds a Certificate of Advanced Education in Obesity Medicine. She is a national speaker and educator on cardiometabolic disease and a founding member and treasurer of the Dallas Obesity Society. An active leader in her field, Dr. Bowlin is dedicated to transforming lives through compassionate care, patient-centered solutions, and innovative treatment modalities.

Liz Fredrickson, PharmD, BCPS

Liz Fredrickson is an Associate Professor of Pharmacy Practice and Pharmaceutical Sciences at the Northeast Ohio Medical University (NEOMED) College of Pharmacy.

Pamela Sardo, PharmD, BS

Pamela Sardo is a freelance medical writer, pharmacist licensed in 2 states, and the founder/principal at Sardo Solutions. She received her BS from the University of Connecticut and a PharmD from the University of Rhode Island. Pam’s career spans many years in retail, clinics, hospitals, long-term care, Veterans Affairs, pharmaceutical manufacturing, and managed healthcare across broad therapeutic classes and disease states.

Topic Overview:

Nonpharmacologic strategies are essential to a holistic and multimodal approach to obesity management. These strategies include personalized dietary interventions, tailored physical activity prescriptions, and evidence- based behavioral counseling designed to enhance adherence and long-term success. For patients seeking additional options, surgical interventions may also be explored as part of an individualized treatment plan. This course identifies effective dietary and behavioral strategies to support sustainable weight loss and describes physical activity interventions that can be tailored

to individual needs. Additionally, it explores motivational interviewing as a powerful tool to engage patients and promote healthy, long-term weight-loss behaviors. Emphasis will be placed on leveraging the unique competencies of team members to create patient-centered and sustainable weight-loss plans.

Accreditation Statement

RxCe.com LLC is accredited by the Accreditation Council for Pharmacy Education (ACPE) as a provider of continuing pharmacy education.

Universal Activity Number (UAN): The ACPE Universal Activity Number assigned to this activity is 

Pharmacist  0669-0000-25-042-H01-P

Pharmacy Technician  0669-0000-25-043-H01-T

Credits: 2 contact hour(s) (0.2 CEU(s)) of continuing education credit

Type of Activity: Knowledge

Media: Internet/Home study Fee Information: $6.99

Estimated time to complete activity: 2 contact hour(s) (0.2 CEU(s)), including Course Test and course evaluation

Release Date: April 7, 2025 Expiration Date: April 7, 2028

Target Audience: This educational activity is for pharmacists and pharmacy technicians.

Secondary Audiences: This educational activity is also for other healthcare professionals, such as nurses, physicians, or others who may be part of a healthcare team and may be interested in this educational topic. A healthcare team approach to patient care may be discussed in this activity, as applicable. No state board or professional organization has evaluated this activity to determine whether it meets the continuing education requirements of nurses, physicians, or other professions not listed under the “Target Audience” described above. Always verify with individual employers or supervisors whether they will accept this educational activity upon completion.

How to Earn Credit: From April 7, 2025, through April 7, 2025, participants must:

Read the “learning objectives” and “author and planning team disclosures;”

Study the section entitled “Educational Activity;” and

Complete the Course Test and Evaluation form. The Course Test will be graded automatically. Following successful completion of the Course Test with a score of 70% or higher, a statement of participation will be made available immediately. (No partial credit will be given.)

Credit for this course will be uploaded to CPE Monitor®.

Learning Objectives: Upon completion of this educational activity, participants should be able to:

Identify effective dietary and behavioral strategies for sustainable weight loss

Describe physical activity interventions for weight loss

Compare and Contrast surgical options for weight loss

Describe motivational interviewing as a tool to promote healthy weight loss

Disclosures

The following individuals were involved in developing this activity: L. Austin Fredrickson, MD, FACP, Liz Fredrickson, PharmD, BCPS, Susan Bowlin, DNP, FNP-BC, ACNP-BC, CBN, and Pamela Sardo, PharmD, BS. Austin Frederickson, Liz Frederickson, and Pamela Sardo have no conflict of interest or financial relationship or commercial or financial support relevant to this activity to report or disclose in the development of this activity.

Disclosure: Susan Bowlin is a member of the Speaker’s Bureau for Eli Lilly and Novo Nordisk.

© RxCe.com LLC 2025: All rights reserved. No reproduction of all or part of any content herein is allowed without the prior, written permission of RxCe.com LLC.

Educational Activity

Foundations for Success: Empowering Patients with Nonpharmacologic Weight Loss Strategies

Introduction

Nonpharmacologic strategies are essential to a holistic and multimodal approach to obesity management. These strategies include personalized dietary interventions, tailored physical activity prescriptions, and evidence- based behavioral counseling designed to enhance adherence and long-term success. For patients seeking additional options, surgical interventions may also be explored as part of an individualized treatment plan. Within this continuing education activity, learners will identify effective dietary and behavioral strategies to support sustainable weight loss and describe physical activity interventions tailored to individual needs. Additionally, participants will explore the use of motivational interviewing as a powerful tool to engage patients and promote healthy, long-term weight-loss behaviors. Emphasis will be placed on leveraging the unique competencies of team members to create patient-centered and sustainable weight-loss plans.

Screening and Assessment

Nonpharmacologic strategies play a crucial role in optimizing weight loss and improving the health of patients with obesity, with recommendations informed by established screening and diagnostic guidelines. ACC/AHA/TOS and AACE/ACE recommend annual screening for overweight and obesity in adults using body mass index (BMI) as a key metric.1-3 Patients with a minimum BMI of 25 kg/m² require further evaluation; this is lowered to 23 kg/m² for patients of South Asian, Southeast Asian, and East Asian descent, who face higher health risks at lower BMIs.1-3 Patients with a BMI of 25–35 kg/m² should also have waist circumference measured.1 Measurements exceeding 102 cm (40 in.) in men and 88 cm (35 in.) in women indicate abdominal obesity, which increases the risk of adiposity-related diseases.1 Other important factors to consider include patient age, sex, muscle

composition, and conditions like sarcopenia or edema.1 It is essential for care teams to use these metrics together to make informed decisions rather than focusing strictly on BMI.4

In addition to obtaining these metrics, a comprehensive assessment of weight-related complications is vital for tailoring treatment plans. Patients with obesity should be screened for prediabetes, type 2 diabetes mellitus (T2DM), dyslipidemia, hypertension, cardiovascular disease, nonalcoholic fatty liver disease, osteoarthritis, and obstructive sleep apnea.1 Thorough evaluations help clinicians identify complications that could influence both prevention and treatment goals. Table 1 summarizes AACE/ACE recommendations for the diagnosis and medical management of patients with obesity.1,2

Table 1

Diagnosis and Management of Patients with Obesity1,2

Guideline-Based Approaches to Obesity Management

Numerous organizations have published guidelines for the management of obesity.1-7 Two publications—the 2014 American College of Cardiology (ACC)/American Heart Association (AHA)/The Obesity Society (TOS) and 2016 American Association of Clinical Endocrinologists (AACE)/American College of Endocrinology (ACE)—are considered the standard of care in this area.1 However, notable advancements have been made since these publications, and research pertaining to the management of obesity remains ongoing, as evidenced by the Lancet Diabetes & Endocrinology Commission’s 2025 publication.4

Intervention for clinical and preclinical obesity may include nonpharmacologic responses. This decision should be based on the risk- benefit assessment of the patient, the severity of excess or abnormal adiposity, and the presence or absence of other risk factors, obesity-related diseases, or disorders. When other risk factors, obesity-related diseases, or disorders are present, the healthcare professional must consider the impact a specific treatment may have on them.4

Healthcare teams can reference the guidelines presented in Table 2 for recommendations related to nonpharmacologic weight loss strategies.1-3,5,6

Table 2

Guidelines Recommendations for Nonpharmacologic Weight Loss Strategies1-3,5,6

Nonpharmacologic Prevention and Treatment Strategies

Prevention and treatment plans should be customized to each patient’s specific circumstances, needs, and goals, including the patient’s readiness for lifestyle changes.1 For individuals with a BMI of 18.5–24.9 kg/m², maintaining a healthy weight through balanced nutrition and regular physical activity is essential.1 High-risk individuals, including those with a family history of obesity or specific biomarkers, should receive counseling to prevent weight gain.1 For patients with a BMI of 25 kg/m² or higher, treatment targets will depend on the extent of weight-related complications.1 Those without complications are encouraged to prevent further weight gain or achieve

moderate weight loss, while individuals with complications should aim for at least 5%–10% weight loss within six months.1 The AACE/ACE guidelines recommend early weight-loss targets of 2.5% within the first month to predict long-term success.1,2 Patients with severe complications may require a more aggressive goal of at least 10% weight loss in 6 months.1

Dietary Changes

The AACE/ACE guidelines note that reducing total caloric intake as the primary driver of weight loss, with macronutrient composition (carbohydrate, protein, and fat), is less critical than overall adherence to dietary interventions.2 However, there may be cases in which modifying macronutrient distributions can lead to improved adherence, metabolic outcomes, or comorbidity management.2

There are numerous “diet plans” with which patients may be familiar or wish to try. Some diets, such as the DASH diet and Mediterranean diet, have demonstrated efficacy in weight loss and cardiometabolic risk reduction.2 The DASH diet is rich in fruits, vegetables, and low-fat dairy and limits saturated fats and sodium. It has shown significant improvements in blood pressure and weight loss when patients are calorie-restricted.2 Similarly, the Mediterranean diet, which emphasizes olive oil, plant-based foods, and moderate protein, has proven effective in preventing cardiovascular events, type 2 diabetes, and metabolic syndrome.2 High-protein, high-fiber diets have also been shown to enhance satiety, and reduced-fat or low-carbohydrate diets may lower energy density and overall caloric intake.2

Short-term strategies like high-protein, low-carbohydrate diets or fasting may provide initial benefits but require caution due to potential adverse effects.7 Sustainable health outcomes depend on long-term adherence to nutritionally balanced eating patterns.7 Overall, the guidelines emphasize that successful weight loss depends more on caloric restriction and behavioral adherence than on specific macronutrient composition.2 Because adherence to dietary plans is crucial, tailoring eating patterns to personal and cultural preferences may improve long-term compliance.2 To assist clinicians,

popular diet types are detailed in Table 3, and Table 4 describes their associated risks and benefits.7 Table 5 describes adherence challenges and outcomes.7 For example, low carbohydrate and keto diets are difficult to maintain long term.

Table 3

Descriptions of Popular Types of Diets7

Table 4

Risks and Benefits of Types of Diets7

Table 5

Adherence Challenges and Outcomes for Diet Types7

Increased Physical Activity

The AACE/ACE guidelines highlight the importance of physical activity as a critical component of lifestyle interventions for weight management in patients with overweight BMIs or obesity.2 Key recommendations include aerobic exercise for at least 150 minutes per week, spread across 3 to 5

sessions, with a gradual progression in intensity and duration.2 Resistance training is also recommended 2 to 3 times weekly to promote fat loss while preserving muscle mass.2 Additionally, increasing non-exercise activity, such as active leisure or reducing sedentary behavior, is strongly encouraged for patients.2 The guidelines suggest clinicians create individualized exercise prescriptions that align with patients' preferences, capabilities, and physical limitations.2 Structured walking programs and modified activity regimens are effective alternatives for patients unable to meet standard exercise recommendations.2 For patients with physical or health-related constraints, even minimal increases in activity levels are beneficial, and efforts should focus on achieving sustainable long-term engagement in physical activity. Table 6 summarizes recommendations for collaborative care teams to assist their patients in meeting physical activity goals.

Table 6

Recommendations for Collaborative Care Teams to Assist Patients with Physical Activity

Importantly, physical activity contributes to weight loss, supports weight maintenance, improves cardiometabolic health, and reduces visceral adiposity.2 Combining aerobic and resistance training yields additional benefits in body composition and metabolic health.2 A systematic review examined the impact of physical activity on health outcomes independent of weight loss in individuals with obesity.8 Four major outcome categories were identified: cellular, metabolic and cardiovascular, systemic, and brain health.8 Metabolic and cardiovascular benefits included reduced serum triglycerides, increased fat oxidation, enhanced mitochondrial respiration, and lower HbA1C levels.8 Systemic outcomes included improved metabolic phenotype, cardiorespiratory fitness, and sustained exercise behaviors.8 Brain health outcomes included better sleep quality, reduced depressive symptoms and enhanced emotional health.8 The authors noted that current obesity management guidelines primarily focus on weight loss and fail to incorporate broader health outcomes achievable through physical activity. This narrow approach may unintentionally contribute to weight cycling and hinder sustainable behavior change.8

Behavioral Changes

The AACE/ACE guidelines emphasize the importance of incorporating behavioral interventions into lifestyle therapy for patients with overweight BMIs or obesity to improve adherence to dietary and physical activity prescriptions.2 Key strategies include self-monitoring (e.g., tracking weight, food intake, and exercise), goal setting, cognitive-behavioral therapy, motivational interviewing, and mobilizing social support.2 Behavioral interventions are most effective when delivered by a multidisciplinary team, including dietitians, educators, physical activity coaches, and psychologists, who can address psychological barriers such as depression or anxiety.2

Stepped-care approaches, where interventions are intensified for patients not responding early, have proven effective in achieving better weight-loss maintenance.2 High-intensity, in-person programs offering at least 14 sessions over six months are also effective, typically resulting in 5%– 10% weight loss.1 When in-person options are unavailable, remote programs

delivered via phone or online platforms can serve as alternatives.1 Virtual visits may also be beneficial to increase interactions and discuss progress.

One meta-analysis evaluated the effectiveness of behavioral therapy (BT) and cognitive behavioral therapy (CBT) interventions for obesity treatment in patients with overweight BMIs or obesity without psychological symptoms, comparing these approaches to various other interventions.9 The findings revealed that CBT was the most effective intervention for weight loss, followed by BT.9 Among the techniques analyzed, feedback and monitoring were the most frequently used in BT, while cognitive restructuring was the primary technique in CBT.9

Motivational Interviewing

While lifestyle modification counseling is a key recommendation for managing obesity, its success depends on a patient’s readiness to change and their available support systems.10 Combining systemic changes with personalized counseling is crucial for addressing obesity effectively.10 Motivational interviewing is a patient-centered, collaborative conversation style designed to enhance a person's intrinsic motivation and commitment to change.10 It offers care teams a helpful tool that empowers patients to manage their health effectively. The steps of this process do require practice and are provided in Table 7.10

Table 7 Motivational Interviewing10

Summary of AACE/ACE Recommendations Table 8

AACE/ACE Lifestyle Intervention Recommendations

Nonpharmacologic Approaches and Beyond

For patients who do not respond adequately to lifestyle interventions, adjunctive therapies may be necessary.1,2 Pharmacotherapy is recommended for individuals with a BMI of at least 30 kg/m² or 27 kg/m² with complications, provided the patient achieves a weight loss of at least 5% within three months of starting treatment.1,2 If this target is unmet, alternative medications or therapies should be explored.1,2 Bariatric surgery is an option for individuals with a BMI of 40 kg/m² or 35 kg/m² with significant comorbidities, in conjunction with continued lifestyle modifications and medical management.1,2 Surgical procedures will be described in more detail below.

Surgical Procedures and Devices for Weight Management

For patients with obesity, surgical procedures may be the most effective interventions for significant and sustained weight loss and improvement in weight-related complications.1 The American Society for Metabolic and

Bariatric Surgery (ASMBS) emphasizes the importance of using precise and unbiased terminology when discussing surgical interventions for obesity; this includes using the term "metabolic and bariatric surgery" over "weight-loss surgery."1,11 The ASMBS and the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) updated their guidelines in October 2022 to expand eligibility criteria for metabolic and bariatric surgery.12 The new recommendations include surgery, regardless of the presence or absence of obesity-related conditions in individuals with BMI ≥35 kg/m². Surgery should be considered in those with a BMI of 30–34.9 kg/m².12 Insurance carriers have not universally adopted this new criteria to qualify for surgery. Before recommending bariatric surgery, patients should undergo a comprehensive evaluation, considering risks, preferences, therapy goals, and procedural expertise.1,11 A multidisciplinary team can help assess and manage the patient’s modifiable risk factors to reduce the risk of perioperative complications and improve outcomes. The surgeon should primarily determine the decision for surgical readiness.12 Again, this decision should be based on the risk-benefit assessment of the patient, the severity of excess or abnormal adiposity, and the presence or absence of other risk factors, obesity-related diseases, or disorders.4 A summary of weight loss procedures is provided in Table 9.1,11

Table 9

Summary of Available Weight Loss Procedures1,11

Collaborative Care Team Approach

Collaborative healthcare teams play a vital role in helping patients achieve their weight loss goals through nonpharmacologic strategies. This includes utilizing a patient-centered approach, clear communication, and shared responsibility among team members. By prioritizing patient preferences and values, teams can design personalized interventions, such as dietary modifications, physical activity plans, and stress management techniques, while considering cultural and socioeconomic factors that may influence a patient’s ability to adopt these strategies.

Effective interprofessional communication is also essential, with regular discussions to evaluate progress, address challenges, and adapt care plans as needed. Techniques like motivational interviewing help patients overcome ambivalence and build confidence in making lifestyle changes. Feedback loops ensure continuous assessment and refinement of strategies, fostering a sense of ongoing support. Teams should also collaborate with patients in goal- setting, ensuring that objectives are realistic, measurable, and achievable. For instance, a patient with obesity and prediabetes might benefit from a Mediterranean diet, a low-impact exercise routine designed by a physical therapist, and counseling to manage emotional eating. The team would align recommendations and track progress through regular updates.

Summary

Effective obesity management requires a multifaceted approach integrating nonpharmacologic strategies with personalized care. Dietary interventions focusing on caloric reduction and adherence, rather than specific macronutrient compositions, are central to sustainable weight loss. Physical activity plays a critical role in weight loss and overall health improvement, with a combination of aerobic and resistance exercises yielding optimal outcomes. Behavioral strategies, including self-monitoring, goal setting, and motivational interviewing, support long-term adherence to healthy lifestyle changes.

Collaborative care teams are integral to addressing obesity through patient-centered strategies considering cultural, socioeconomic, and individual health factors. Motivational interviewing, in particular, empowers patients to take an active role in their health, fostering intrinsic motivation and long-term behavior change. Ultimately, sustainable obesity management requires a holistic, interdisciplinary approach that prioritizes patient preferences and leverages the expertise of the entire healthcare team.

Course Test

According to the American Association of Clinical Endocrinologists (AACE) and American College of Endocrinology (ACE) guidelines, what is the primary contributor to weight loss in dietary interventions?

Macronutrient composition

Total caloric intake reduction

High protein intake

Low-carbohydrate consumption

What is the AACE/ACE recommended early weight-loss target within the first month that can predict long-term success?

1%

2%

2.5%

5%

Which of the following diet types focuses on reducing carbohydrate intake to less than 20–50 grams per day?

Low-Carbohydrate Diet

Mediterranean Diet

DASH Diet

High-Protein Diet

How many minutes of aerobic exercise per week are recommended by the AACE/ACE guidelines for weight management?

100 minutes

200 minutes

300 minutes

150 minutes

What is the primary benefit of combining aerobic and resistance training in weight management?

Increased flexibility

Improved body composition and metabolic health

Enhanced cardiorespiratory fitness

Reduced fatigue

Which surgical procedure is associated with the highest potential for micronutrient deficiencies?

Sleeve gastrectomy

Roux-en-Y gastric bypass

Adjustable gastric banding

Biliopancreatic diversion with duodenal switch

What is a unique benefit of the sleeve gastrectomy procedure?

No anastomosis

Strong metabolic effects

Few long-term complications

Reversible

What is the purpose of the "Ask-Tell-Ask" framework in motivational interviewing?

Provide direct advice

Emphasize patient struggles

Seek permission, share advice, and check understanding

Develop action plans

Which step in motivational interviewing involves highlighting patient statements about their desire to change?

Set Agenda

Encourage Change Talk

Express Empathy

Follow-Up

What phrase best demonstrates empathy during a motivational interviewing session?

“You need to lose weight for better health.”

“You’ve faced challenges with weight loss, but it’s clear you want to be more in control.”

“If you don’t make changes, your health will worsen.”

“Let’s revisit this topic later.”

References

Cornier M. A Review of Current Guidelines for the Treatment of Obesity.

Am J Manag Care. 2022;28(suppl 15):S288-S296.

Garvey WT, Mechanick JI, Brett EM, et al; Reviewers of the AACE/ACE Obesity Clinical Practice Guidelines. American Association of Clinical Endocrinologists and American College of Endocrinology comprehensive clinical practice guidelines for medical care of patients with obesity. Endocr Pract. 2016;22(suppl 3):1-203. doi:10.4158/EP161365.GL

Jensen MD, Ryan DH, Apovian CM, et al; American College of Cardiology/American Heart Association Task Force on Practice Guidelines; Obesity Society. 2013 AHA/ACC/TOS guideline for the management of overweight and obesity in adults: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and The Obesity Society. J Am Coll Cardiol. 2014;63(25 part B):2985-3023. doi:10.1016/j.jacc.2013.11.004

Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity [published correction appears in Lancet Diabetes Endocrinol. 2025 Mar;13(3):e6. doi: 10.1016/S2213- 8587(25)00006-3.]. Lancet Diabetes Endocrinol. 2025;13(3):221-262. doi:10.1016/S2213-8587(24)00316-4

Apovian CM, Aronne LJ, Bessesen DH, et al. Pharmacological management of obesity: an endocrine Society clinical practice guideline [published correction appears in J Clin Endocrinol Metab. 2015 May;100(5):2135-6. doi: 10.1210/jc.2015-1782.]. J Clin Endocrinol Metab. 2015;100(2):342-362. doi:10.1210/jc.2014-3415

Grunvald E, Shah R, Hernaez R, et al. AGA Clinical Practice Guideline on Pharmacological Interventions for Adults With Obesity. Gastroenterology. 2022;163(5):1198-1225. doi:10.1053/j.gastro.2022.08.045

Freire R. Scientific evidence of diets for weight loss: Different macronutrient composition, intermittent fasting, and popular diets. Nutrition. 2020;69:110549. doi:10.1016/j.nut.2019.07.001

Pojednic R, D'Arpino E, Halliday I, Bantham A. The Benefits of Physical Activity for People with Obesity, Independent of Weight Loss: A Systematic Review. Int J Environ Res Public Health. 2022;19(9):4981. Published 2022 Apr 20. doi:10.3390/ijerph19094981

Cha JY, Kim SY, Lim YW, Choi KH, Shin IS. Comparative Effectiveness of Cognitive Behavioral Therapy and Behavioral Therapy in Obesity: A Systematic Review and Network Meta-Analysis. J Clin Psychol Med Settings. 2025;32(1):96-110. doi:10.1007/s10880-023-10000-6

Remis K and Ernest D. Using Motivational Interviewing to Promote Healthy Weight. Fam Pract Manag. 2016;23(5):32-38.

Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society for Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO): indications for metabolic and bariatric surgery. Surg Obes Relat Dis. 2022. Published online October 18, 2022. doi:10.1016/j.soard.2022.08.013

Eisenberg D, Shikora SA, Aarts E, et al. 2022 American Society of Metabolic and Bariatric Surgery (ASMBS) and International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Indications for Metabolic and Bariatric Surgery [published correction appears in Obes Surg. 2023 Jan;33(1):15-16. doi: 10.1007/s11695-022-06369- 2.]. Obes Surg. 2023;33(1):3-14. doi:10.1007/s11695-022-06332-1

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