Incretin-based therapies, including GLP-1 receptor agonists and dual GLP-1-GIP receptor agonists, have transformed obesity management, producing substantial weight loss and cardiometabolic benefits, with potential improvements in obesity-related complications, physical function, quality of life, and psychological wellbeing for many individuals. However, reduced appetite, rapid weight loss, gastrointestinal adverse effects, and changes in eating behaviour might create nutritional, functional, or psychological risks in some individuals. This EASO-EFAD-ECPO Consensus Statement outlines pragmatic nutritional, functional, and psychological considerations during incretin-based therapy treatment. We synthesise evidence on medical nutrition therapy, including protein targets during weight loss, dietary quality, and mitigation of gastrointestinal adverse events. We discuss pragmatic approaches that could help support preservation of fat-free mass and physical function during weight loss, including adequate protein intake and progressive resistance exercise. We emphasise the psychological and identity-related challenges during incretin-based therapy, including shifts in food reward, coping, and social connection, and recommend psychological screening, with integrated support where needed. We propose pragmatic monitoring during weight loss, including diet quality, micronutrient risk, and functional measures, with body-composition assessment where indicated. We suggest approaches to address disparities in access and adherence to ensure equity. We discuss the importance of shared decision making with the patient in decisions to start, up-titrate, delay, pause, down-titrate, or discontinue incretin-based therapies, considering the physical and psychological risks of treating versus not treating. Finally, we identify future research priorities, including longitudinal research on micronutrient status, macronutrient requirements, changes in dietary patterns and food choices, musculoskeletal outcomes, unique dosing schedules, and post-cessation maintenance to optimise safety, efficacy, and the patient experience.
