• A new advisory details the top priorities for supporting patients on GLP-1 drugs for obesity.
• These guidelines address eight key nutritional and lifestyle components.
• Following these recommendations can help patients avoid many of the common pitfalls.

A joint advisory from leading U.S. clinical and research societies—including the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society—highlights eight critical nutritional and lifestyle priorities to support the use of glucagon-like peptide 1 receptor agonists (GLP-1) drugs in obesity treatment. 

Published online in The American Journal of Clinical Nutrition, this guidance addresses the real-world challenges and maximizes the efficacy of GLP-1 therapy through comprehensive, evidence-based nutritional interventions, aiming to improve long-term patient outcomes and healthcare cost-effectiveness in clinical practice across the United States and potentially globally, including underserved communities who often face barriers to obesity treatment and preventive care.

GLP-1 receptor agonists, such as semaglutide, liraglutide, and tirzepatide, represent a transformative advancement in obesity management, demonstrating significant weight loss of 5% to 18% in clinical trials. 

Despite this, challenges like gastrointestinal side effects, nutrient deficiencies due to calorie reduction, loss of muscle and bone mass, high discontinuation rates, and financial barriers limit their long-term effectiveness in real-world settings.

This advisory synthesizes expert knowledge and scientific evidence to provide pragmatic nutritional and lifestyle priorities to optimize GLP-1 therapy. 

Key recommendations include:

• Patient-Centered Initiation: Tailoring GLP-1 therapy based on individual health goals, preferences, and comorbidities, alongside screening for social determinants of health that may affect adherence and access.
• Comprehensive Baseline Assessment: Conducting thorough medical, nutritional, and lifestyle evaluations—including diet history, muscle strength and body composition, mental health, and substance use—to identify potential risks and personalize interventions.
• Management of Side Effects: Employing gradual dose escalation and nutritional strategies to mitigate gastrointestinal adverse effects, which are common and impact medication adherence.
• Prevention of Nutrient Deficiencies: Emphasizing nutrient-dense, minimally processed foods.
• Preservation of Muscle/Bone Mass:  Recommending regular resistance training combined with aerobic exercise to maintain lean body mass and bone density during weight loss.
• Integration of Multicomponent Lifestyle Interventions: Encouraging intensive behavioral therapy, ideally delivered by registered dietitian nutritionists (RDNs), through modalities such as group medical visits, telehealth platforms, and Food is Medicine programs to enhance adherence and equitable access to care.
• Addressing Equity and Access: Recognizing the significant disparities in GLP-1 access and supportive care due to socioeconomic factors, race/ethnicity, and food insecurity, and advocating for policy and healthcare system reforms to improve equity.
• Future Directions: Identifying research gaps on dietary modulation of endogenous GLP-1 secretion, long-term adherence strategies, nutritional priorities post-therapy cessation, and the potential benefits of combination or staged lifestyle and pharmacologic interventions.

Dr. Raj Dasgupta, Chief Medical Advisor for Garage Gym Reviews, summed up the overall intent of the guidelines, saying, “The advisory underscores that GLP-1 therapy should not be viewed in isolation but rather as an adjunct to comprehensive, evidence-based nutritional and lifestyle management.”

Dasgupta was not involved in drafting the guidance.

He said that, in his opinion, this sort of integrative care can mitigate adverse effects, enhance weight loss maintenance, and improve cardiometabolic health beyond that achieved through weight reduction alone.

“This guidance provides a timely, practical framework for clinicians to optimize obesity treatment with GLP-1s, addressing key clinical challenges and promoting sustainable, equitable health outcomes in patients with obesity,” said Dasgupta.

Dr. Gretchen San Miguel, Chief Medical Officer and Board-Certified Obesity Medicine Specialist at Medi Weightloss, said, “As healthcare professionals, we have a critical opportunity to reinforce these eight priorities throughout every stage of patient care.”

San Miguel added that in her clinic, what this looks like is a full nutritional assessment, a tailored nutrient-dense diet plan, monitoring for nutrient deficiencies, the encouragement of adequate protein intake and resistance training, and help for patients in dealing with GI side effects, alongside promoting positive lifestyle habits like better sleep, reduced stress, and social support.

By taking these steps, doctors can help patients avoid common pitfalls of GLP-1 use, such as nutrient deficiencies, muscle loss, intolerable side effects, and failure to adopt sustainable lifestyle changes.

“These priorities aren’t just complementary, they are essential to maximizing both the safety and the efficacy of GLP-1 therapy,” she said. “Long-term success requires more than pharmacology. It requires partnership, personalization, and a commitment to treating the whole patient.”

San Miguel also emphasized the importance of a patient-centered approach to initiating therapy—one that includes setting personalized goals, discussing expectations, and assessing readiness for behavioral change.

“Engaged, informed patients are more likely to adhere to treatment and make sustainable lifestyle changes,” she said.

“By embracing these evidence-based priorities, healthcare professionals can provide more holistic, effective, and compassionate care, transforming GLP-1 therapy from a medication-only approach into a comprehensive lifestyle intervention,” San Miguel concluded.