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

doi:10.1177/15598276251344827

. 2025 May 30:15598276251344827.

doi: 10.1177/15598276251344827. Online ahead of print.

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

Dariush Mozaffarian¹, Monica Agarwal², Monica Aggarwal³, Lydia Alexander⁴, Caroline M Apovian⁵, Shagun Bindlish⁶, Jonathan Bonnet⁷, W Scott Butsch⁸, Sandra Christensen⁹, Eugenia Gianos¹⁰, Mahima Gulati¹¹, Alka Gupta¹², Debbie Horn¹³, Ryan M Kane^{14

15}, Jasdeep Saluja¹⁶, Deepa Sannidhi¹⁷, Stanford Fatima Cody^{18

19}, Emily A Callahan¹

Affiliations

¹ Food is Medicine Institute, Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States.
² Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA (MA).
³ Division of Cardiology, University of Florida, Gainesville, FL, USA (MA).
⁴ Enara Health, San Mateo, CA, USA (LA).
⁵ Center for Weight Management and Wellness, Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (CMA).
⁶ Department of Medicine, Touro University and One Medical, Dublin, CA, USA (SB).
⁷ Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA (JB).
⁸ Department of Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (WSB).
⁹ Integrative Medical Weight Management, Seattle, WA, USA (SC).
¹⁰ Northwell Cardiovascular Institute, Lenox Hill Hospital, New Hyde Park, NY, USA (EG).
¹¹ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Connecticut Health, Farmington, CT, USA (MG).
¹² Division of General Internal Medicine, George Washington University, Washington DC, USA; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA (AG).
¹³ Center for Obesity Medicine and Metabolic Performance, University of Texas at Austin, Austin, TX, USA (DH).
¹⁴ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA (RMK).
¹⁵ Clinical and Translational Science Institute, Duke University, Durham, NC, USA (RMK).
¹⁶ Aroga Lifestyle Medicine, Victoria, British Columbia, Canada (JS).
¹⁷ Department of Family Medicine, University of California San Diego, San Diego, CA, USA (DS).
¹⁸ Department of Medicine-Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, MGH Weight Center, Boston, MA, USA (FCS).
¹⁹ Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA (FCS).

PMID: 40452753
PMCID: PMC12125019
DOI: 10.1177/15598276251344827

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

Dariush Mozaffarian et al. Am J Lifestyle Med. 2025.

. 2025 May 30:15598276251344827.

doi: 10.1177/15598276251344827. Online ahead of print.

Authors

Affiliations

¹ Food is Medicine Institute, Friedman School of Nutrition Science and Policy at Tufts University, Boston, MA, United States.
² Division of Endocrinology, Diabetes and Metabolism, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA (MA).
³ Division of Cardiology, University of Florida, Gainesville, FL, USA (MA).
⁴ Enara Health, San Mateo, CA, USA (LA).
⁵ Center for Weight Management and Wellness, Division of Endocrinology, Diabetes and Hypertension, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA (CMA).
⁶ Department of Medicine, Touro University and One Medical, Dublin, CA, USA (SB).
⁷ Division of Primary Care and Population Health, Stanford University School of Medicine, Palo Alto, CA, USA (JB).
⁸ Department of Surgery, Bariatric and Metabolic Institute, Cleveland Clinic Lerner College of Medicine, Cleveland Clinic, Cleveland, OH, USA (WSB).
⁹ Integrative Medical Weight Management, Seattle, WA, USA (SC).
¹⁰ Northwell Cardiovascular Institute, Lenox Hill Hospital, New Hyde Park, NY, USA (EG).
¹¹ Division of Endocrinology, Diabetes, and Metabolism, Department of Medicine, University of Connecticut Health, Farmington, CT, USA (MG).
¹² Division of General Internal Medicine, George Washington University, Washington DC, USA; Division of General Internal Medicine, Weill Cornell Medicine, New York, NY, USA (AG).
¹³ Center for Obesity Medicine and Metabolic Performance, University of Texas at Austin, Austin, TX, USA (DH).
¹⁴ Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA (RMK).
¹⁵ Clinical and Translational Science Institute, Duke University, Durham, NC, USA (RMK).
¹⁶ Aroga Lifestyle Medicine, Victoria, British Columbia, Canada (JS).
¹⁷ Department of Family Medicine, University of California San Diego, San Diego, CA, USA (DS).
¹⁸ Department of Medicine-Division of Endocrinology-Neuroendocrine, Massachusetts General Hospital, MGH Weight Center, Boston, MA, USA (FCS).
¹⁹ Department of Pediatrics-Division of Endocrinology, Nutrition Obesity Research Center at Harvard (NORCH), Boston, MA, USA (FCS).

PMID: 40452753
PMCID: PMC12125019
DOI: 10.1177/15598276251344827

Abstract

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; 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. 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.

Keywords: clinical care; glucagon-like peptide 1 receptor agonists; lifestyle; nutrition; obesity.

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Conflict of interest statement

The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: Dr. Mozaffarian reports research funding from the National Institutes of Health, Kaiser Permanente Fund at the East Bay Community Foundation, National Association of Chain Drug Stores Foundation, Google Health, and The Rockefeller Foundation; scientific Advisory board, Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc., WndrHLTH; scientific consulting, Amazon Health; equity in Calibrate and HumanCo; and chapter royalties from UpToDate. Dr Apovian reports research funding from PCORI and GI Dynamics, Inc.; and Advisory boards for Altimmune, Inc., Arrowhead Pharmaceuticals, Inc., BioAge, Biolinq Incorporated, Caribou Biosciences, Inc., CinFina Pharma, Inc., Covidien LP, Cowen and Company, LLC, Currax Pharmaceuticals, LLC, EPG Communication Holdings Ltd., Form Health, Inc., Fractyl Health, Inc., Lilly USA, LLC, L-Nutra, Inc., Mediflix Inc., NeuroBo Pharmaceuticals, Inc., Neurocrine Biosciences, Inc., NodThera Limited, Nutrisystem, OptumRx, Inc., Pain Script Corporation, Palatin Technologies, Inc., Pursuit By You, Redesign Health Inc., ReShape Lifesciences Inc., Riverview School, Roman Health Ventures Inc., Scholar Rock, Inc., Terns, Inc., Verily Life Sciences LLC, Veru Inc., Vida Health, Inc., Wave Life Sciences, Xeno Biosciences and Zyversa Therapeutics, Inc. Dr Butsch reports Advisory boards for Eli Lilly, Novo Nordisk, Abbott and Boehringer Ingelheim. S. Christensen reports Advisory boards and speakers bureau for Novo Nordisk and speakers bureau for Eli Lilly. Dr Kane reports research funding by the Ardmore Institute of Health. Dr Stanford reports research funding from the National Institutes of Health; and scientific Advisory boards for Eli Lilly, Novo Nordisk, Amgen, Pfizer, Currax, Calibrate, Vida Health, Ilant Health, Mellicell, Sweetch, Doximity, GoodRx, Empros Pharma, Clearmind Medicine, and Apnimed. Dr. Alexander reports Advisory board for Novo Nordisk and Speaker’s Bureau for Eli Lilly. The other authors report no disclosures.

Figures

**Figure 1.**
Key elements of nutritional priorities to support GLP-1 therapy for obesity.

See this image and copyright information in PMC

References

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[1] Shi I, Khan SS, Yeh RW, Ho JE, Dahabreh IJ, Kazi DS. Semaglutide eligibility across all current indications for US adults. JAMA Cardiol. 2025;10(1):96-98. - PMC - PubMed

[2] Shi I, Khan SS, Yeh RW, Ho JE, Dahabreh IJ, Kazi DS. Semaglutide eligibility across all current indications for US adults. JAMA Cardiol. 2025;10(1):96-98. - PMC - PubMed

[3] Montero A, Sparks G, Presiado M, Hamel L. KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 Drugs. Kaiser Family Foundation (KFF); 2021.

[4] Montero A, Sparks G, Presiado M, Hamel L. KFF Health Tracking Poll May 2024: The Public’s Use and Views of GLP-1 Drugs. Kaiser Family Foundation (KFF); 2021.

[5] Mozaffarian D. GLP-1 agonists for obesity—a new recipe for success? JAMA. 2024;331(12):1007-1008. - PubMed

[6] Mozaffarian D. GLP-1 agonists for obesity—a new recipe for success? JAMA. 2024;331(12):1007-1008. - PubMed

[7] Little D, Deckert J, Bartelt K, Ganesh M, Stamp T. Weight change with semaglutide, epic research; 2023.

[8] Little D, Deckert J, Bartelt K, Ganesh M, Stamp T. Weight change with semaglutide, epic research; 2023.

[9] Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP-1 receptor agonist discontinuation among patients with obesity and/or type 2 diabetes. JAMA Netw Open. 2024;7(5):e2413172. - PMC - PubMed

[10] Do D, Lee T, Peasah SK, Good CB, Inneh A, Patel U. GLP-1 receptor agonist discontinuation among patients with obesity and/or type 2 diabetes. JAMA Netw Open. 2024;7(5):e2413172. - PMC - PubMed

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

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