Optimizing GLP-1 therapies for obesity and diabetes management.

Abstract

Glucagon-like peptide-1 (GLP-1) therapies are highly effective for weight loss and metabolic improvement in obesity and type 2 diabetes management. However, their use poses clinical challenges, including loss of lean muscle mass and gastrointestinal side effects, both of which may affect adherence and long-term outcomes. This commentary synthesizes current evidence and expert perspectives, drawing on presentations from the 42nd International Symposium on Diabetes and Nutrition by the Diabetes and Nutrition Study Group, to develop practical recommendations for integrating nutrition and physical activity with GLP-1 therapies for obesity and diabetes management. We summarize consensus recommendations from a global working group, organized into seven thematic modules, to guide alignment of GLP-1 therapies with dietary and lifestyle interventions across the key stages of the weight management journey. Evidence from several clinical trials demonstrate that the combination of GLP-1 therapies with structured dietary and exercise interventions results in additive weight loss effects compared with either strategy alone. Strategies to preserve lean mass with GLP-1 therapies include achieving protein intakes >1.2 g/kg/day, evenly distributed across meals, combined with aerobic activity and structured resistance training. Specific recommendations are provided to minimize nausea, vomiting, diarrhea, and constipation associated with GLP-1 therapies, as well as to prevent and manage complications such as, cholelithiasis and gastroesophageal reflux disease. Future research priorities include examining the impact of GLP-1 therapies on dietary habits and physical activity levels, improving muscle health assessment, and testing pharmacologic adjuncts to limit lean mass loss. Maximizing the benefits of GLP-1 therapies require a multidisciplinary approach that integrates evidence-based nutrition, physical activity, and proactive management of gastrointestinal side effects. Such an approach can enhance adherence, preserve functional capacity, and sustain the long-term benefits of these therapies.