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
May 30, 2025Obesity (Silver Spring, Md.)
Nutritional guidance to support weight loss treatment with GLP-1 therapy
GLP-1s may reduce body weight by 5% to 18% in trials.
Real-world analyses show modestly lower weight reduction effects from GLP-1s compared to clinical trials.
Challenges associated with GLP-1 treatment include gastrointestinal side effects, , muscle and bone loss, and low long-term adherence.
Multiple practice guidelines advocate for combining GLP-1s with evidence-based nutritional and behavioral therapy for obesity management.
Priorities for effective GLP-1 treatment include patient-centered initiation, comprehensive assessments, and addressing social determinants of health.
Management of gastrointestinal side effects and preservation of muscle mass through diet and resistance training are crucial during GLP-1 use.
AI simplified
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; 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.
Key numbers
5% to 18%
Weight Reduction Range
Placebo-adjusted weight reduction in trials for individuals with obesity.
33% to 50%
Discontinuation Rate
Reported adherence rates at one year for individuals prescribed GLP-1s.
$12,000 to $16,000
Cost of Therapy
Current US list price for GLP-1s for obesity treatment.
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