This joint advisory outlines pragmatic nutritional and lifestyle intervention priorities to address key clinical challenges—such as gastrointestinal side effects, nutrient deficiencies, and lean mass loss—associated with GLP-1 therapy for obesity.
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“GLP-1 receptor agonist (GLP1RA) therapies help patients with obesity‑related heart failure with preserved ejection fraction (HFpEF) feel and function better, but clinicians should monitor for adverse effects, especially in older adults at risk of frailty and sarcopenia. Strength training and higher protein intake can help mitigate muscle mass loss associated with GLP1RA therapy use.”
Clinicians should integrate nutrition counseling and resistance training with GLP-1 prescribing; extends multidisciplinary guidelines to preserve lean mass and minimize deficiencies.
BACKGROUND: Glucagon-like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-effectiveness. OBJECTIVES: We aimed to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity for the practicing clinician. METHODS: An expert group comprising multiple clinical and research disciplines appraised the scientific literature, informed by expert knowledge and clinical experience, to identify and summarize relevant topics, priorities, and emerging directions. RESULTS: GLP-1s reduce body weight by 5% to 18% in trials, with modestly lower effects in real-world analyses, and multiple demonstrated clinical benefits. Challenges include side effects, especially gastrointestinal; nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence with subsequent weight regain; and high costs with resulting low cost-effectiveness. Numerous practice guidelines recommend multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity, but use of such therapies with GLP-1s is not widespread. Priorities to address this include: (a) patient-centered initiation of GLP-1s, including goals for weight reduction and health; (b) baseline screening, including usual dietary habits, emotional triggers, disordered eating, and relevant medical conditions; (c) comprehensive exam including muscle strength, function, and body composition assessment; (d) social determinants of health screening; (e) and lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections. During GLP-1 use, nutritional and medical management of gastrointestinal side effects is critical, as is navigating altered dietary preferences and intakes, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training and appropriate diet, and complementary lifestyle interventions. Supportive strategies include group-based visits, registered dietitian nutritionist counseling, telehealth and digital platforms, and Food is Medicine interventions. Drug access, food and nutrition insecurity, and nutrition and culinary knowledge influence equitable obesity management with GLP-1s. Emerging areas for more study include dietary modulation of endogenous GLP-1, strategies to improve compliance, nutritional priorities for weight maintenance post-cessation, combination or staged intensive lifestyle management, and diagnostic criteria for clinical obesity. CONCLUSIONS: Evidence-based nutritional and lifestyle strategies play a pivotal role to address key challenges around GLP-1 treatment of obesity, making clinicians more effective in advancing their patients' health.
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Mozaffarian et al. (2025) conducted a review in Obesity. Nutritional and lifestyle interventions supporting GLP-1 therapy was evaluated on Body weight reduction (5% to 18% reduction). GLP-1s reduce body weight by 5% to 18% in trials, requiring evidence-based nutritional and lifestyle strategies to manage gastrointestinal side effects, nutrient deficiencies, and muscle loss.
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