GLP-1 Therapy for Obesity Requires Substantial Nutritional Framework, Multidisciplinary Support, Joint Advisory Warns
GLP-1 medications are transforming obesity medicine but strong evidence points to a need for integrating nutrition and lifestyle support for lasting weight loss and health benefits.
"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."1
As the use of glucagon-like peptide-1 receptor agonists (GLP-1s) continues to grow for management of overweight and obesity, an increasingly bright light is revealing that pharmacotherapy alone is not sufficient to achieve long-term weight loss success. Although the medications, which include semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have shown weight loss ranging from 5% to 18% in clinical trials, the real-world impact is often more modest, with high rates of discontinuation,2 nutritional deficiencies, and weight regain.3 A new joint advisory from 4 leading professional organizations underscores the urgent need for comprehensive, patient-centered care that integrates nutrition, behavioral support, and lifestyle medicine to optimize the therapeutic potential of GLP-1s.1
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The advisory, titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity,” was published in the American Journal of Clinical Nutrition and coauthored by representatives from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. It calls on clinicians to go beyond prescription-writing and actively engage patients in structured, evidence-based programs that support healthful eating, physical activity, and psychosocial well-being.1
The Role of Comprehensive Support
GLP-1s are effective in promoting weight loss and offer additional benefits for conditions such as cardiovascular disease,4 heart failure,5 obstructive sleep apnea,6 chronic kidney disease,7 and in more recent studies, substance use disorders. However, therapy often comes with gastrointestinal side effects, including nausea, vomiting, and diarrhea, that can reduce appetite and compromise nutrient intake, the guideline authors stressed. As a result, patients may experience fatigue, hair loss, skin issues, poor wound healing, or muscle and bone loss, largely due to inadequate consumption of protein, vitamins, and minerals.1
These physiological risks are compounded by behavioral and socioeconomic factors. Disordered eating patterns, low health literacy, food insecurity, and limited access to high-quality foods all interfere with adherence to nutritional guidelines. Furthermore, many clinicians have little time during routine visits to offer meaningful lifestyle counseling, and reimbursement mechanisms for health coaching and nutrition therapy remain limited.1
“All these challenges may be partially mitigated by an evidence-based, structured lifestyle program, particularly around food, when prescribing GLP-1s for obesity,” advisory authors said. “However, practical guidance for clinicians to implement such an approach is limited.”
The financial barriers8 to overall success of GLP-1 therapy cannot be overlooked, the authors emphasize. Annual costs for GLP-1s can exceed $16,000, even with rebates or compounded formulations, and recent studies suggest they are not yet cost-effective relative to their impact on long-term health outcomes.1
Patient-Centered Framework
To guide clinicians, the advisory proposes a structured approach built on the 5As framework: assess, advise, agree, assist, and arrange. This model supports ongoing dialogue, goal setting, and care coordination throughout the treatment journey. Eight key nutritional priorities are outlined to support patients using GLP-1s:
- Initiation with a Patient-Centered Plan
Treatment should begin with shared decision-making, realistic goal setting, and alignment with patients’ values and health priorities. - Baseline Nutritional Assessment and Screening
A comprehensive evaluation of eating behaviors, psychosocial factors, body composition, and food security provides critical context for individualized care. - Management of Gastrointestinal Side Effects
Strategies include modified dose titration, dietary modification, and education on symptom management to maintain adequate nutrient intake, especially protein. - Navigation of Dietary Preferences and Intake
Shifts in taste or food tolerance reported with GLP-1 therapy require adaptive counseling to support the continued consumption of nutrient-dense, minimally processed foods. - Prevention and Mitigation of Nutrient Deficiencies
Monitoring and supplementation of key nutrients—particularly iron, B vitamins, calcium, and vitamin D—are essential, especially when intake is reduced. - Preservation of Muscle and Bone Mass
Incorporating resistance training and focusing on sufficient protein intake help mitigate the loss of lean body mass during weight reduction. - Maximizing Weight Loss Efficacy
Behavioral support, physical activity, and personalized nutrition increase adherence and enhance pharmacologic effects. - Promotion of Other Lifestyle Measures
Sleep quality, stress management, social support, and substance use cessation all contribute to better outcomes.
Team-Based Care, Emerging Tools
Given the time constraints in most primary care settings, successful implementation of this framework will depend in part on multidisciplinary collaboration, the advisory said. Referrals to community professionals, including registered dietitians and nutritionists, behavioral therapists, case managers, and social workers can help enhance behavior continuity and reinforce lifestyle strategies. Other strategies the advisory outlines include group medical visits, digital platforms, and telehealth services, which can all augment patient engagement and accountability.
Equity is a critical consideration. The advisory calls for systemic changes to improve access to medical nutrition therapy and behavioral health services, especially for marginalized communities. The expansion of "Food as Medicine" programs and culinary literacy initiatives may also bridge gaps in care.
Research Needs and The Future
The advisory authors are clear that additional research in the field of obesity medicine is essential. The field still lacks standardized language and diagnostic criteria for clinical and preclinical obesity, as well as data on the long-term impact of nutritional interventions in patients using GLP-1s, they wrote. Among other important investigations, future research should explore how dietary patterns influence endogenous GLP-1 activity, how best to maintain weight loss after medication discontinuation, and how to scale effective behavioral interventions across diverse populations.
GLP-1s represent a powerful tool in the treatment of obesity, but their potential is best realized when embedded in a robust, personalized plan that prioritizes nutrition, movement, and behavioral health, the group concluded. Clinicians prescribing these agents should ensure that every patient receives tailored guidance before, during, and after treatment that is supported by a multidisciplinary team. Integrating lifestyle medicine not only mitigates side effects and nutrient deficits, but also helps sustain functional health and weight loss long-term.
