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First, healthy-user bias is a major concern: individuals prescribed newer, more expensive agents such as semaglutide may systematically differ from comparator groups in terms of health behaviors, dietary patterns, physical activity, adherence to medical care, and access to healthcare resources

Failure of Lifestyle Monotherapy Lifestyle modification (LSM) is foundational but often insufficient for long-term weight maintenance in Class II or III obesity: Timing: Patients with a history of weight cycling (yo-yo dieting) are unlikely to achieve sustained success through behavioral interventions alone

Biomed Res Int , 2014, 2014: 151479

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