Nutritional and lifestyle strategies play a role in addressing key challenges around GLP-1 treatment of obesity, and focusing on this comprehensive care will help clinicians to be more effective in advancing the health of their patients, according to a joint advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and the Obesity Society, published May 30 in the American Journal of Clinical Nutrition.

GLP-1s are shifting the treatment of obesity, but real-world challenges and limited knowledge can limit the benefits of this treatment. "This is an important and timely topic that prompted a response from four major organizations to assure that there are evidence-based recommendations for nutrition support to complement the prescription of GLP-1 receptor agonists," says Eugenia Gianos, MD, FACC, chair of ACC's Prevention of Cardiovascular Disease Member Section. "In the era of highly effective weight loss medications such as GLP-1 receptor agonists, we must assure that we are providing optimal nutritional guidance and support to improve success rates with treatment and maintenance of cardiovascular health."

Dariush Mozaffarian, MD, FACC, et al., appraised the scientific literature regarding GLP-1 treatment of obesity to identify nutritional and lifestyle priorities for clinicians.

The authors note several challenges patients face, including 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. Although recommended by numerous practice guidelines, evidence-based nutritional and behavioral therapy for adults with obesity is not widely used along with GLP-1 treatment.

The authors discuss strategies for these priorities to support patients being treated with GLP-1 drugs:

1. Patient-centered initiation of GLP-1s, including goals for weight reduction and health
2. Baseline screening, including usual dietary habits, emotional triggers, disordered eating and relevant medical conditions
3. Comprehensive exam including muscle strength, function and body composition assessment
4. Social determinants of health screening
5. 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" the authors write.

By developing care plans that implement nutritional and lifestyle interventions before during and after GLP-1 treatment of obesity, treatment benefits will go beyond body weight and improve patients' overall health.