Overview
Research Article Title: Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
Authors: Dariush Mozaffarian et al.
Published in: The American Journal of Clinical Nutrition
Date of Publication: 17 April 2025
Link to Article →
Summary
Increased usage of GLP-1 medications is shifting the treatment landscape for obesity. However, there are clear challenges in both nutritional and lifestyle interventions to help provide a patient-centered approach for weight management. Approaches to address and support the ability of individuals to achieve long-term success with their weight management program is a critical area of research.
All clinicians when prescribing GLP-1s for obesity management should establish a thoughtful plan of care that includes thorough nutritional and lifestyle counseling before, during, and after the weight reduction period.
Nutritional Priorities:
- Patient-centered initiation of GLP-1s including goals for weight loss and health
- Baseline screening including dietary habits, emotional triggers, disordered eating, and relevant medical conditions
- Comprehensive exam including muscle strength, function, and body composition assessment
- Social determinants of health
- Lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections
Methodology
An expert group of multiple clinical and research disciplines appraised the current body of scientific literature and utilizing expert knowledge and clinical experience, identified relevant topics, priorities, and emerging directions for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity. The general focus is on the U.S. but the recommendations have implications for use globally.
Why It Matters
All individuals who would benefit from obesity treatment, including those prescribed GLP-1’s, should be offered or referred to an intensive, multi-component behavioral intervention for both weight loss and weight maintenance. This type of program should be centered on the individual’s values and goals, stage of change, and access to therapies. The goal is to maximize benefits, minimize potential risk, and increase efficiency of GLP-1 therapy for weight loss.
Aside from weight loss, there are many clinical benefits of GLP-1’s which include: improved cardiometabolic risks, fewer major adverse cardiovascular events, decreased mortality in heart failure, improvements in obstructive sleep apnea, prediabetes, chronic kidney disease, knee osteoarthritis, substance use disorders, and metabolic-associated steatotic liver disease.
Nutritional Priorities to Support GLP-1 Therapy:
- Initiation of GLP-1 use with a patient-centered approach: individualized care that focuses on physical, mental, and psychological health vs. solely body weight.
- Completion of baseline nutritional assessment and screening: a nutrition and medical assessment and screening should include a comprehensive medical history, assess current dietary habits, screened for signs of eating disorders or disordered eating patterns, screened and monitored for mood disorders or suicidal thoughts, and risk of sarcopenia and osteopenia including baseline physical activity levels.
- Management of GI side effects: these side effects tend to be temporary so employing both proactive prevention and effective support are vital. Clinicians should advise individuals to contact them early to help mitigate prolonged side effects.
- Navigation of dietary preferences and intakes: GLP-1’s have a meaningful impact on total energy intake with changes in food preferences such as limited interest in food, reduced hunger, and increased fullness. This can cause individuals to go prolonged periods of time without eating, inadequate nutrient intake, and potential loss of quality of life from reduced pleasure from food.
- Prevention and mitigation of nutrient deficiencies: Clinicians should emphasize a diverse diet rich in fruits, vegetables, whole grains, legumes, lean proteins, nuts, and seeds. Small, frequent meals may be effective when hunger and food interest is low. Ongoing monitoring and follow-ups should include dietary assessment and continuously adjusted based on weight reduction, nutrient status, individual tolerance, and treatment response.
- Preservation of muscle and bone mass: lack of physical activity and adequate protein intake can have a negative impact on muscle and bone mass with weight loss. Assessing protein intake is an important part of the nutrition intervention but increased protein alone is not enough to support muscle mass. GLP-1’s should be prescribed together with a structured exercise program aiming for strength training at least 3 times weekly plus at least 150 minutes of moderate-intensity aerobic exercise to preserve muscle and bone mass. If available, monitor muscle mass and strength over time.
- Maximization of weight reduction: a structured, comprehensive nutrition and lifestyle program could help add to the efficacy of GLP-1’s. The SURMONT 3 trial provided 12 weeks of intensive lifestyle interventions followed by tirzepatide dosage afterwards (10 or 15 mg/wk) which produced a 25% body weight loss - the largest reduction seen in a GLP-1 trial to date (Wadden et al., 2023).
- Other supportive lifestyle interventions: other lifestyle interventions include improving sleep quality, managing mental stress, minimizing substance use, and nurturing positive social connections to be part of the multicomponent lifestyle program.
Future Implementation:
- Telehealth and digital platforms: a way to not only provide individual and group-based visits, there is hope that this improves accessibility and engagement with better tracking of progress, broader reach to underserved areas, and improved cost-effectiveness compared to in-person platforms.
- Food is Medicine: this is a growing area of interest as it can help overcome multiple barriers to healthful eating including cost, time, access, and knowledge.
Limitations
When looking at the nutritional priorities to support GLP-1 therapy for obesity, there are many limitations identified from access to medications, to food security, to the need for more research to standardize care protocols. In the clinical trials, there is frequent and structured use of Registered Dietitians and this could demonstrate larger weight reductions vs. real-world utilization of GLP-1 where it remains limited due to the limited insurance coverage for medical nutrition therapy. Registered Dietitians play a key role in delivering comprehensive obesity care as they have the formal medical training in nutrition and obesity to provide evidence-based nutrition counseling.
Some other limitations include:
- GLP-1 Access: potential barriers to GLP-1 access include being uninsured, lacking a regular provider, having low income, or lacking higher education. Race/ethnic disparities in weight bias and stigma have also been documented in healthcare settings and may impact GLP-1 access.
- Food and Nutrition Insecurity: the inability to consistently access sufficient and nutritious food impacts the ability to adhere to an obesity treatment plan especially given the importance of dietary modification to optimize the benefits of GLP-1 use.
- Future Research: There is a need for controlled trials to look at the effect of more robust, structured nutrition and lifestyle therapy to mitigate weight gain after GLP-1 cessation and to standardize how “intensive” these lifestyle interventions are defined and implemented.
Final Thoughts
As both clinical and public interest in GLP-1’s accelerates, the pace of peer-reviewed evidence has not kept up to provide answers to all relevant topics and standardize the appropriate approach to a comprehensive approach for nutrition and lifestyle management to support weight loss. Comprehensive care will make clinicians more effective stewards of these medications and positive contributors to their patients’ health.
Our hope here at Mend is to not only provide you more insight about this growing area to provide great patient-centered care but also to advocate the use of your resources to provide a multi-disciplinary approach to support healthy and meaningful weight loss. Our team of Registered Dietitians are here to help support you along the way!
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