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The standard is "documented failure of at least one 3-month intensive lifestyle intervention." What counts as documented lifestyle intervention: Participation in a structured weight-loss program (Weight Watchers, Noom, hospital-based program) with attendance records Regular visits with a registered dietitian (minimum 4 visits over 3 months) with session notes Medically supervised diet program with weekly weigh-ins documented in medical records Participation in a diabetes prevention program (DPP) with completion certificate What does NOT count: "I tried eating less and exercising more on my own" Gym membership without documented weight-loss program Self-directed diet from a book or website Sporadic visits to a primary care doctor without structured intervention The intervention must be documented in medical records

Under normal conditions, the metabolic substrate is primarily fatty acid oxidation

within this subgroup, all outcomes improved significantly at M6

The info above reflects publicly available plan information as of February 2026

The Role of Diet and Exercise Finally, let's consider the impact of diet and exercise