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

Dariush Mozaffarian, Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.
Monica Agarwal, Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Monica Aggarwal, Division of Cardiology, University of Florida, Gainesville, Florida, USA.
Lydia Alexander, Enara Health, San Mateo, California, USA.
Caroline M. Apovian, Center for Weight Management and Wellness, Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
Shagun Bindlish, Department of Medicine, Touro University and One Medical, Dublin, California, USA.
Jonathan Bonnet, Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, California, USA.
W Scott Butsch, Department of Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, Ohio, USA.
Sandra Christensen, Integrative Medical Weight Management, Seattle, Washington, USA.
Eugenia Gianos, Northwell Cardiovascular Institute, Lenox Hill Hospital, New Hyde Park, New York, USA.
Mahima Gulati, Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Connecticut Health, Farmington, Connecticut, USA.
Alka Gupta, Division of General Internal Medicine, Weill Cornell Medicine, New York, New York, USA.
Debbie Horn, Center for Obesity Medicine and Metabolic Performance, University of Texas at Austin, Austin, Texas, USA.
Ryan M. Kane, Division of General Internal Medicine, Department of Medicine, Duke University, Durham, North Carolina, USA.
Jasdeep Saluja, Aroga Lifestyle Medicine, Victoria, British Columbia, Canada.
Deepa Sannidhi, Department of Family Medicine, University of California San Diego, San Diego, California, USA.
Fatima Cody Stanford, Department of Medicine-Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, MGH Weight Center, Boston, Massachusetts, USA.
Emily A. Callahan, Food is Medicine Institute, Friedman School of Nutrition Science and Policy, Tufts University, Boston, Massachusetts, USA.

Document Type

Journal Article

Publication Date

5-30-2025

Journal

Obesity (Silver Spring, Md.)

DOI

10.1002/oby.24336

Abstract

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.

Department

Medicine

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