Nutritional priorities to support GLP-1 therapy
- Ms. Hima Saxena
- Sep 8
- 4 min read
Updated: Sep 10
Glucagon-like peptide-1 (GLP-1) agonists are a class of medication utilized to treat obesity and type 2 diabetes. Some examples include Exenatide, Liraglutide, Dulaglutide, and Semaglutide. GLP-1 agonists act by lowering serum glucose levels and thereby manage metabolism in affected patients (1).
Glucagon-like peptide-1 (GLP-1) agonists are rapidly becoming central to evidence-based treatment of obesity. These agents not only offer substantial and sustained weight loss but also improve cardiometabolic outcomes. Recently, top medical societies including the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society have jointly issued evidence-based recommendations to transform obesity management. These new guidelines with nutritional priorities are proclaimed as a major milestone in obesity care (2).
1. Initiate GLP-1s with a Patient-Centred Approach
A successful obesity management strategy must begin with empathy, respect, and partnership. Use the 5As framework that provides a structured yet flexible model that supports shared decision-making and individualised care (2):
Set goals beyond weight loss. GLP-1 therapy should be personalized based on each individual’s health status, goals, and clinical history, with dosing and nutrition plans adjusted to support either gradual or more rapid weight loss (2).
2. Conduct baseline screening
A structured baseline assessment is essential before initiating GLP-1 therapy (2).
Clinical history and obesity profile
Gather a history of weight gain patterns, including age of onset and periods of rapid gain. Clarify patient weight loss goals and explore previous interventions (2).
Assessment of GLP-1-specific risk factors
Screen for gastrointestinal disorders, eating disorders, mood disturbances, sarcopenia, osteopenia, and renal impairment (2).
Physical status and body composition
Perform a basic clinical exam, assess strength using the sit-to-stand, stair climb or timed-up-and-go tests, and evaluate body composition through bioelectrical impedance analysis, air displacement plethysmography, and dual-energy X-ray absorptiometry (2).
Socioeconomic and environmental barriers
Evaluate social determinants that may impact treatment success. These include food and nutrition insecurity, housing instability, and limited transportation (2).
Nutritional intake and diet behaviour
Assess dietary intake patterns and meal structure using validated screeners like the Diet History Questionnaire, Mini-EAT, Plant-based dietary score or Diet Risk Score. Explore emotional triggers for eating, food allergies or intolerances, and prior use of dietary therapies or surgeries (2).
Behavioural and psychosocial factors
Evaluate physical activity using the Physical Activity as a Vital Sign questionnaire or International Physical Activity Questionnaire (IPAQ). Lifestyle Medicine Assessment and Lifestyle Medicine Health Behaviour Scale may be used to assess lifestyle related behaviour (2).
3. Manage Gastrointestinal side effects
Gastrointestinal adverse events, including nausea, constipation, vomiting, and diarrhea, are common during GLP-1 therapy, particularly during initiation or dose escalation. These symptoms may undermine adherence or lead to nutritional compromise if unaddressed (2).
· Use gradual dose titration, allowing up to eight weeks at each level to improve tolerance.
· Educate patients on expected side effects and encourage early communication.
· Recommend small, frequent meals and avoid high-fat or high-fiber foods to manage nausea. Supportive strategies include ginger tea, peppermint, acupressure bands, and, if needed, prochlorperazine.
· Prevent vomiting by avoiding large meals and promoting hydration.
· Manage constipation with fluids, fiber (e.g., fruits, prunes), and, if needed, magnesium citrate, PEG 3350, or stool softeners. Limit fat- or protein-heavy meals temporarily if symptoms persist.
· Address diarrhea with fiber supplements or anti-diarrheal medications and avoid large, fatty meals.
· Minimize alcohol use, which may worsen nausea or reflux.
A proactive, supportive approach during therapy adjustment improves tolerability and long-term treatment adherence.
4. Prevent nutritional deficiency
GLP-1 receptor agonists influence appetite and food preferences through gut-brain signaling and changes in reward-related brain regions, including the insula, amygdala, putamen, and orbitofrontal cortex. GLP-1 therapy often results in substantially reduced caloric intake, increasing the risk of nutrient inadequacy. Nutritional guidance should prioritize a high-quality, nutrient-dense dietary pattern that meets essential needs while minimizing energy excess (2).
Provide supplementation with vitamin D, calcium, B12, Iron, or a multivitamin based on individual needs. Use multivitamins for intakes <1200–1500 kcal/day. Monitoring should include dietary tracking and periodic nutrient testing, with adjustments based on clinical response (2).
5. Preserve muscle and bone mass
GLP-1-induced weight loss can reduce muscle and bone mass, particularly in older adults or individuals with low physical activity or inadequate protein intake. This may increase the risk of falls, fractures, impaired function, and reduced quality of life (2). Recommend protein intake: 1.2–1.6 g/kg/day (or 80–120 g/day).
Structured resistance training at least three times per week, along with 150 minutes of moderate-intensity aerobic activity, is essential. Combined with GLP-1 therapy, this approach helps preserve lean mass, maintain bone mineral density, and improve metabolic outcomes (2).
Encourage consumption of foods such as eggs, poultry, fish, Greek yogurt, cottage cheese, and nuts/seeds. Protein supplements may help individuals meet targets, especially when appetite is low (2).
Conclusion
GLP-1 receptor agonists offer significant promise in obesity treatment, but their effectiveness relies on a comprehensive, multidisciplinary approach. These guidelines offer a framework for HCPs to mitigate risks and maximize benefits of GLP-1 therapy. These strategies ensure not only the success of pharmacologic intervention but also its sustainability, aligning short-term outcomes with long-term health trajectories.
About the Author
Ms. Hima Saxena is a medical writer and editor with a Master’s in Pharmaceutics and a strong background in medical communications. She creates clear, evidence-based content that supports healthcare professionals and empowers patients. Hima collaborates with pharmaceutical and healthcare clients to deliver accurate, impactful content across diverse therapeutic areas, bridging scientific integrity with accessible communication.
Source
Collins L, Costello RA. Glucagon-Like Peptide-1 Receptor Agonists. [Updated 2024 Feb 29]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK551568/
Mozaffarian D, Agarwal M, Aggarwal M, et al. 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. Obesity (Silver Spring). 2025 May 30;1–29.
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