International Experts Issue Practical Nutrition and Lifestyle Guidance for GLP-1 Weight-Loss Therapy

An international panel has published the first consensus framework on how to pair GLP-1–based obesity medications (liraglutide, semaglutide, tirzepatide) with nutrition and lifestyle support to improve outcomes and tolerability.

Using a modified Delphi process, 15 experts from multiple countries reviewed recent literature and developed 52 statements, organized into seven practical modules: nutrition, physical activity, care before starting therapy, management during active weight loss, weight-maintenance strategies, management of gastrointestinal side effects, and approaches if therapy is discontinued.

Across modules, the core message is that GLP-1 drugs must be embedded in structured, individualized care rather than used in isolation.

Key themes include:

• Personalized nutrition: Diet and lifestyle plans should be tailored to patient preferences, culture, and goals, emphasizing guideline-endorsed patterns, adequate protein, micronutrient sufficiency, hydration, and minimization of alcohol. Many patients may benefit from dietitian involvement and, in some cases, supplements or high-protein oral nutrition products.
• Protecting lean mass: The panel stresses resistance training plus sufficient protein (higher during rapid weight loss) to help preserve muscle and bone, especially in older, frail, or sarcopenic patients.
• Pre-treatment preparation: Clinicians should address weight stigma, screen for eating disorders, review weight-promoting medications, and set realistic, health-focused goals. In some cases, a structured low-calorie diet and lifestyle program before starting a GLP-1 agent may enhance results.
• During treatment: Close monitoring for excessive weight loss, dehydration, GI symptoms, and nutrient risk is recommended. Meal replacements can be used as total or partial diet replacements when appropriately supervised.
• Maintenance and discontinuation: Long-term support is essential, as biological and environmental pressures favor weight regain. If GLP-1 therapy must be stopped, intensified dietary counseling, protein-rich calorie control, structured exercise, and in some cases meal replacements are advised to blunt weight rebound.

The authors emphasize that most recommendations are extrapolated from obesity and bariatric nutrition guidelines rather than GLP-1–specific trials, highlighting an urgent need for direct evidence. Until those data are available, this consensus offers a pragmatic, primary care–friendly roadmap to integrating GLP-1 therapies into comprehensive, sustainable obesity management.