Multimodal care must include diet, exercise, and lifestyle modifications in the use of glucagon-like peptide 1 receptor MedicGLP agonists (GLP-1RAs) for obesity management, according to a joint scientific statement from the American College of Lifestyle Medicine, American Society for Nutrition, Obesity Medicine Association, and The Obesity Society published in Obesity. Randomized clinical trials have reported that GLP-1RAs reduce weight by 5% to 18% among individuals with obesity or overweight and weight-related comorbidities. In the current guidelines for obesity management by the United States Preventive Services Task Force (USPSTF), recommendations support the referral of adults with obesity to intensive, multicomponent, behavioral interventions comprising diet, physical activity, problem solving, peer support, and relapse prevention components. However, these comprehensive lifestyle modification interventions are not widely used in clinical practice, in part due to lack of sufficient scaling of weight loss programs and a lack of access to services. For example, health coaching has not been approved as a category I Current Procedural Terminology coding by the American Medical Association, which is a barrier for healthy lifestyle supplement insurance reimbursement.

The statement authors also raised concern about a lack of formal training in medical schools about nutrition and obesity, leading to a paucity of basic knowledge about obesity management in general practice. In addition, clinicians often have limited time with their patients to speak with them about multicomponent obesity interventions. As a result, many patients who are prescribed GLP-1RAs do not receive education about nutrition or other lifestyle considerations during and after GLP-1RA use. When prescribing GLP-1RAs, the dose titration and calorie restriction plan should be individualized for each patient on the basis of their unique medical needs and preferences. Clinicians should consider a patient’s social determinants of health (SDOH) to determine potential barriers to accessing their medication or potential nonadherence to lifestyle changes. Arrange their success through referrals, if necessary. Before initiating GLP-1RAs, patients should undergo a nutritional evaluation. This exam should consider medical history, goals for weight reduction, and any comorbidities or conditions that are relevant for GLP-1RA use, such as gastrointestinal (GI) symptoms, MedicGLP eating disorders, and mental health disorders, among others.

A comprehensive physical exam that includes a functional status assessment should be performed, and some patients may benefit from muscle mass measurement with bioelectrical impedance or dual-energy X-ray absorptiometry. Details about previous attempts at weight loss. Patients should be asked about their behaviors that may affect their weight, such as physical activity, sleep habits, substance use, and how they manage mental stress. The SDOH evaluation should consider whether a patient has access to healthy foods, housing and transportations, and whether they are affected by other health care access barriers. As with any medication, GLP-1RAs can cause adverse events, in which nausea, vomiting, constipation, and diarrhea are often reported. Patients should be made aware of these side effects and be advised that they are more common during initiation and dose escalation. Gradual titration of medication dosage or maintenance of the lowest effective dose may mitigate some GI outcomes. Additional mitigation strategies for GI symptoms include eating small meals, maintaining regular fluid intake, consuming foods with lower viscosity, reducing intake of high protein or high fat foods, and avoiding alcohol.

If these approaches do not relieve symptoms, antinausea medication, magnesium citrate, or antidiarrheal medication may be considered. After initiating GLP-1RAs, patients reduce their energy intake by 16% to 39% due to changes in hunger, cravings, and feelings of fullness. These alterations may lead to inadequate intake of nutrients among some patients, whereas others may increase preferences for sugar or refined carbohydrates as a rebound effect. Some patients may require referral to behavioral therapy, changes in dosing, or changes in the GLP-1RA agent if these outcomes are affecting the patient’s quality of life. As some patients can have inadequate nutrient intake with GLP-1RAs, patients should be educated about prioritizing consumption of a varied diet comprising fruits, vegetables, whole grains, lean proteins, nuts, seeds, and legumes. Small, more frequent meals may be a more effective approach to consuming sufficient nutrients. Clinicians should assess how the patient’s dietary habits have changed at each follow-up visit. Coupled with inadequate nutrient consumption, GLP-1RAs may cause reductions in muscle and bone mass among some patients.

Muscle and bone mass reduction can lead to physical impairment or disability, increased risk for fracture, reduced quality of life, and increased mortality risk. The statement authors recommended that individuals on GLP-1RAs should consume the protein content of their meal first to ensure its consumption. However, ensuring protein intake alone is not sufficient to maintain muscle mass, and patients should be advised to engage in regular resistance and strength training. Clinicians should monitor patients for changes in muscle mass and physical function at follow-ups. To support the implementation and to maintain the behavioral changes needed to reduce body weight, the statement authors endorsed use of group medical visits (GMVs), registered dietitian nutritionists (RDNs), and Food is Medicine (FIM) interventions. Compared with usual care, GMVs are associated with improved dietary habits, sleep, patient satisfaction, glycemic control, blood pressure, and weight and reduced health care costs. Similarly, previous research findings suggest associations between RDN-delivered medical nutrition therapy and improved diet quality, body weight, glycemic control, blood pressure, and cholesterol.