GLP-1 and Obesity Management

This month, we’re taking a closer look at how obesity management is evolving—especially when it comes to GLP-1 receptor agonists. These medications are showing real promise for weight loss and overall health, but the real challenge is figuring out how to fit them into a broader, patient-centered treatment plan.

GLP-1s: Efficacy, Challenges, and the Path Forward

Clinical trials have demonstrated that GLP-1s can lead to substantial body weight reduction, ranging from 5% to 18%, with real-world analyses showing slightly lower but still meaningful effects. Beyond weight loss, GLP-1s offer multiple demonstrated clinical benefits, impacting various aspects of health.

However, their use is not without challenges. Common side effects, particularly gastrointestinal issues, can impact patient experience. The significant calorie reduction they induce necessitates careful attention to potential nutritional deficiencies, and concerns about muscle and bone loss have also emerged. Furthermore, long-term adherence can be a hurdle, often leading to weight regain upon cessation, and their high cost raises questions about cost-effectiveness.

Numerous practice guidelines emphasize the importance of multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity. Yet, the widespread integration of such therapies alongside GLP-1 use remains limited. To bridge this gap and optimize patient outcomes, several priorities must be addressed:

• Patient-Centered Initiation: Tailoring GLP-1 initiation to individual patient goals for weight reduction and overall health is crucial.
• Baseline Screening: A thorough baseline assessment should encompass usual dietary habits, emotional triggers for eating, any history of disordered eating, and relevant medical conditions.
• Comprehensive Exam: Beyond standard assessments, a comprehensive exam should include muscle strength, function, and body composition assessment to identify potential risks.
• Social Determinants of Health (SDOH) Screening: Recognizing the profound impact of SDOH on health, screening for these factors is essential for equitable care.
• Lifestyle Assessment: A holistic lifestyle assessment should cover aerobic activity, strength training, sleep patterns, mental stress levels, substance use, and social connections.

Navigating GLP-1 Use: Holistic Management is Key

During GLP-1 use, proactive and comprehensive management is critical:

• Nutritional and Medical Management of GI Side Effects: Addressing gastrointestinal side effects promptly and effectively, through both nutritional and medical interventions, is paramount for patient comfort and adherence.
• Navigating Altered Dietary Preferences and Intakes: Patients often experience changes in dietary preferences and reduced food intake. Guidance on navigating these shifts while ensuring adequate nutrition is vital.
• Preventing Nutrient Deficiencies: Proactive strategies to prevent nutrient deficiencies, given reduced calorie intake, are essential.
• Preserving Muscle and Bone Mass: Implementing resistance training and providing appropriate dietary and complementary lifestyle interventions are key to preserving muscle and bone mass.

Supportive Strategies and Influencing Factors

To enhance the effectiveness and accessibility of obesity management with GLP-1s, several supportive strategies should be embraced:

• Group-Based Visits: Facilitating peer support and shared learning through group visits can be highly beneficial.
• Registered Dietitian Nutritionist (RDN) Counseling: Expert guidance from RDNs is invaluable for personalized nutrition plans and addressing dietary challenges.
• Telehealth and Digital Platforms: Leveraging technology can improve access to care, especially for those in remote areas or with mobility limitations.
• Food is Medicine Interventions: Integrating “Food is Medicine” programs can address food and nutrition insecurity, supporting overall health and well-being.

It’s important to acknowledge that factors such as drug access, food and nutrition insecurity, and varying levels of nutrition and culinary knowledge significantly influence equitable obesity management with GLP-1s.

Emerging Areas for Further Study

The field of obesity management with GLP-1s is continuously evolving. Several areas warrant further research and exploration:

• Dietary Modulation of Endogenous GLP-1: Understanding how diet can influence the body’s natural production of GLP-1 could open new avenues for intervention.
• Strategies to Improve Compliance: Research into effective strategies to enhance long-term compliance with GLP-1 therapy is crucial for sustained weight management.
• Nutritional Priorities for Weight Maintenance Post-Cessation: Developing clear nutritional guidelines for weight maintenance after discontinuing GLP-1s is essential to prevent weight regain.
• Combination or Staged Intensive Lifestyle Management: Exploring the benefits of combining or staging intensive lifestyle interventions with GLP-1s could optimize outcomes.

Diagnostic Criteria for Clinical Obesity: Re-evaluating and refining diagnostic criteria for clinical obesity could lead to more precise and effective interventions.