Digitally delivered behavior-change prompts plus short videos boosted GLP-1 users’ expectations to adopt healthy lifestyle behaviors in a new, early-stage randomized clinical trial.

“What surprised us was that a single, short exposure [to the intervention] produced measurable effects across all eight behavioral expectation outcomes immediately after the intervention and 2 weeks later,” said Maya Adam, MD, PhD, director of Health Media Innovation and associate director of the Center for Digital Health at Stanford School of Medicine, Palo Alto, California.

“It was also exciting for me that the storytelling booster video generally performed slightly better than the didactic video across most domains,” she told Medscape Medical News. “This suggests that a narrative health communication format may add value even with very short digital interventions.” 

The study was published online in JAMA Network Open.

Adjuncts to Pharmacotherapy

Researchers conducted a three-arm, online, randomized controlled trial from June 19 to July 1, 2025, to evaluate whether a low-cost digital intervention could increase expectations to adopt health behaviors among adults taking GLP-1s.

The trial involved 5054 participants (mean age, 39; 66% women); all were English-speaking adults using GLP-1s. Most were from the US and the UK (68%), and the rest were from other countries (32%). They received a single exposure to one of three conditions: written microsteps plus a short (approximately 2-minute) storytelling video (arm A); written microsteps plus a short didactic video (arm B); or a do-nothing control condition (arm C).

The eight behavioral nudges focused on small dietary improvements, physical activity, stress management strategies, and sleep hygiene. For example, for better sleep, the nudge was: “Avoid caffeine after 2 PM. Caffeine can stay in your system for hours, making it harder to fall asleep.” For more movement: “Schedule time on your calendar for movement. You wouldn’t miss an important meeting or doctor’s appointment, so blocking out movement time on your calendar in the same way can help you shift your mindset to prioritize your physical well-being.”

The primary outcome was behavioral expectation to adopt health nudges, immediately after exposure and 2 weeks later. Secondary outcomes were post-exposure hope and happiness, as well as changes (over 2 weeks) in three key self-reported beh aviors: frequency of sugar-sweetened beverage intake; dietary protein intake; and physical activity. The behaviors were measured using a 4-point Likert scale, ranging from 1 (rarely or never) to 4 (daily).

Immediately after exposure to the interventions, compared with control, standardized effects (in SD units) across the eight microsteps expectation outcomes ranged from 0.30 to 0.72 in arm A and from 0.26 to 0.77 in arm B, with smaller effects 2 weeks later.

The storytelling video was more effective across seven of the eight microsteps: “breathe when stressed” (arm A, 0.57 vs arm B, 0.50) and “go outside for 5 minutes” (arm A, 0.53 vs arm B, 0.48). 

Immediate increases were observed in hope (arm A, 0.31; arm B, 0.25) and happiness (arm A, 0.26; arm B, 0.22), but those gains dissipated by 2 weeks.

At follow-up, the storytelling video group also reported reduced sugar-sweetened beverage consumption compared with the control group. There were no significant effects on protein intake or physical activity.

“These findings suggest a potential role for the written microsteps intervention plus short video boosters as adjuncts to pharmacotherapy,” the authors wrote. “Longer trials are warranted to determine whether the behavioral expectations stimulated by such interventions may lead to sustained behavior change.”

“My take-home message is that lifestyle support doesn’t always have to be intensive to be meaningful,” Adam added. “For clinicians, that suggests there may be value in pairing pharmacotherapy with simple, scalable, behaviorally informed supports rather than treating medication and lifestyle counseling as separate worlds.”

Increased Readiness, Not Actual Behavior Change

“The intervention is highly feasible,” Robyn Pashby, PhD, research assistant professor of psychology at F. Edward Hébert School of Medicine at Uniformed Services University, Bethesda, Maryland, told Medscape Medical News. “It was brief, digital, low-cost, and easy to scale.”

“That said, this study measured shifting expectations about behavioral activation and readiness, not actual ‘behavior change,’ which is often more complex,” said Pashby, who is also a member of the National Board of Directors at Obesity Action Coalition, and was not involved in the study.

“The intervention seems capable of making lifestyle change feel approachable and doable,” she noted. “For many patients on GLP-1s (and those not), that is a meaningful first step.”

Nevertheless, this early-phase study is still “one step removed from what most clinicians ultimately care about: people doing the things they intend to do,” she said. “Many people live thinking ‘I know what to do, I just don’t do it’ when it comes to their health behaviors. Helping people engage in the behaviors they want to and intend to perform is often more complex than a daily reminder.”

The reminders may be a useful adjunct strategy, she said, “because they make behavior change feel smaller, more concrete, and more achievable. Those are often key components that help people get unstuck.”

“At the same time, it is important not to overstate their role,” she said. “Lifestyle engagement in obesity care is rarely limited to a lack of ideas or motivation. A very brief digital intervention appeared to increase people’s readiness to adopt small health behaviors while taking GLP-1s, which is clinically relevant. However, readiness is not the same as sustained behavior change.”

The study was supported by internal funding from the Stanford Center for Digital Health. Adam and Pashby reported no conflicts of interest.

Marilynn Larkin, MA, is an award-winning medical writer and editor whose work has appeared in numerous publications, including Medscape Medical News and its sister publication MDedge, The Lancet (where she was a contributing editor), and Reuters Health.