Nutritionally Addressing the Challenges of GLP-1s

Treating Obesity as a Chronic Disease

Visual representation of GLP-1 challenges

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Treating Obesity as a Chronic Disease

Obesity is recognized as a chronic disease by major health organizations, including the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and the American Medical Association (AMA). In the United States, 42.5% of adults have obesity and 33% are overweight.1

Obesity contributes to the onset and worsening of the most common metabolic diseases encountered in primary care, such as T2DM, hypertension, dyslipidemia, and thrombosis, as well as other common complications of obesity such as sleep apnea, mental stress, cardiovascular disease, cancer, and increased mortality and disability-adjusted life-years.1-9

Map showing obese and overweight percentage in the US

Comprehensive Obesity Treatment

The Obesity Medicine Association describes 4 pillars of obesity treatment:

Nutrition Therapy icon

Nutrition Therapy

Physical Activity icon

Physical Activity

Behavioral Counseling icon

Behavioral Counseling

Medical Interventions icon

Medical Interventions

The Obesity Medicine Association describes 4 pillars of obesity treatment: nutrition therapy, physical activity, behavioral counseling, and medical interventions, the latter of which includes pharmacotherapy, complication management, and bariatric procedures. Implementing nutrition therapy and physical activity in patients with obesity and early obesity improves patients' health and body composition, as well as helping with ongoing weight maintenance.

Target Goal icon

Treatment Goals

The goals of treatment focus on reducing adiposity, reducing and preventing adiposity-related complications, preserving muscle mass and function, preserving bone mass, and improving quality of life. However, the unintended medical complications of GLP-1s make this challenging. Fortunately, however, adherence to healthful dietary patterns long-term—along with regular exercise—can help ensure achievement and maintenance of a healthful weight.10,11

Nutritionally Addressing GLP-1 Issues

GLP-1s—Not a Standalone Solution

For patients with obesity attempting weight reduction, treatment strategies should aim to find a balance between reducing adiposity, preserving lean muscle, and maintaining bone health while sustaining long-term weight reduction.

However, the successful implementation of GLP-1 receptor agonist (RA) therapy is not without related challenges; these include loss of lean body mass, impact on bone health, gastrointestinal adverse events (GI AEs), potential risks of undernutrition, and the propensity for weight regain after treatment cessation.12-16

The management of these side effects and nutritional challenges associated with GLP-1 RAs requires careful consideration. And when patients have nausea, they typically gravitate to refined carbohydrates, which can further compromise nutrition/achieving adequate protein goals. Concerns over undernutrition, particularly loss of lean body mass, due to low protein intake—along with decreased fiber intake and dehydration as a contributor to GI AEs—is consistently found throughout the scientific literature.16-20

Illustration of GLP-1 challenges

Benefits of an Expert Registered Dietitian

Optimizing the outcomes of GLP-1 RA therapy urgently requires a comprehensive, multifaceted approach, including a registered dietitian to offer patient education and motivation for improved care. An integrated approach involving patient interactions with a dietitian can play an important role in supporting patients and providing tailored advice on diet modifications, proactive side-effect management, and ultimately improving adherence.20-22

The collaborative approach between physicians and dietitians is important for delivering holistic care that addresses all facets of patient health. This collaboration ensures that patients receive not only medical intervention but also the behavioral and dietary support necessary to make lasting changes. Of course, this multi-disciplinary approach should include exercise or exercise professionals to further improve overall results.23-26

Muscle-Mass Problem

Rapid weight loss, regardless of how it is attained, is typically a combination of fat and muscle mass. While fat loss is the purpose of the intervention, losing muscle is often an undesirable effect of weight loss. Of the weight lost with GLP-1 medications, 25%–40% might be from muscle mass. Loss of muscle leads to reductions in strength and balance, increasing the risk of fatigue, lower bone density, and injury. This is a potentially more serious problem in older adults, who already have a greater risk of osteoporosis, sarcopenia, and related falls because of the aging process. Importantly, loss of muscle mass is a function of rapid weight loss and not specific to GLP-1, but this issue must still be considered a potential downside to using these highly effective medications.

Fortunately, much of the loss of muscle with rapid weight loss can be avoided if lifestyle behaviors, particularly dietary modifications and regular exercise, are adopted during the weight-loss program.27-32

Low muscle mass also contributes to reduced resting-energy expenditure, physical activity, and physical fitness, which promote physical inactivity. This impedes further fat reduction and the maintenance of weight reduction. Skeletal muscle loss can also cause a reduction in resting metabolic rate that can contribute to increased fat accumulation, leading to weight recurrence. Adipose tissue deposits in bone and muscle are also thought to reduce bone and muscle mass, thereby further increasing adiposity.33-37

Preserving Muscle-Mass

Adequate Protein is Particularly Important When It Comes to Muscle Maintenance.
Preserving muscle during weight reduction can be accomplished with nutritional interventions, such as ensuring adequate dietary protein intake, and physical activity interventions, such as aerobic exercise and resistance training. Patients over 65 years should be monitored closely for sarcopenia during weight reduction, especially when taking obesity medications.34,36

One way the reduction in muscle quantity with GLP-1 therapies can be minimized is by dietary modification, such as a moderate increase in protein intake. A dietary approach that includes incorporation of high protein content may preserve lean mass better than a dietary approach with lower protein content. This can be especially important for older adults at higher risk for sarcopenia and loss of muscle mass. Increasing protein intake is especially important for GLP-1–based treatments, as there may be a shift in food preferences toward lower intake of high-nutritional-quality protein compared with a standard calorie-restricted diet. A high-protein diet may also reduce adaptive thermogenesis and induce a negative energy balance to help maintain weight loss in the long term.33-38

Lean mass loss comparison: control vs high protein diet

Another strategy for maintaining muscle mass during weight loss is with exercise. While both endurance- and resistance-type exercise help, resistance-type exercise has been shown to also improve muscle strength. A prior systematic review demonstrated that exercise can be an effective tool to help men and women with overweight and obesity preserve fat-free mass after moderate energy-restriction–induced weight loss, which may be important for combating sarcopenic obesity in this population, especially among older adults. Combining protein supplementation with resistance training exercise may further induce increases in lean body mass compared with resistance training alone in older adults. There are preclinical data suggesting that GLP-1 therapy and exercise synergistically attenuate vascular inflammation and enhance metabolic insulin action in early diet-induced obesity.19,37,39-43

Adherence and Side Effects

Gastrointestinal Adverse Events icon

Gastrointestinal Adverse Events

In patients taking GLP-1s, GI AEs (eg, nausea, diarrhea, vomiting, and constipation) are commonly reported—leading to discontinuation in some cases.

GI AEs affect patient compliance and quality of life, but can be managed and mitigated with side-effect support such as advising smaller, more frequent meals and incorporating more liquids to ease nausea.

Constipation has also been a problem, but can be managed by incorporating more dietary fiber, hydration, and physical activity.15,16

Bone Density and Protein Spacing icon

Bone Density and Protein Spacing

The treatment of obesity can decrease bone density, as substantial weight reduction (≥14%) over 3 to 4 months is associated with significant bone loss.37

Adequate protein is required to minimize muscle or bone-mass loss during weight reduction, with current data suggesting that protein spaced every 3 to 4 hours is more effective at eliciting muscle protein synthesis than protein spaced less frequently or that is derived from plant sources.44

Improving Adherence

The Low Adherence of GLP-1s

Most real-world patients on a GLP-1 do not persist for more than 3 months. In fact, a recent report from Blue Cross Blue Shield Association followed 169,000 patients and found that only 42% were still on their GLP-1 at 12 weeks.

A similar real-world study of commercially insured patients with obesity showed less than 33% were still adhering to GLP-1 prescription at 1 year making most patients who begin using GLP-1 prone to weight regain.3

Proper Nutrition icon

Proper Nutrition Can Improve Side Effects & Adherence

There are myriad unwanted side effects that can impact medication persistence. Over 95% of patients using GLP-1 medications report AEs. Gastrointestinal distress is the most common side effect, reported by more than 80%. Constipation, diarrhea, and vomiting are more commonly seen with GLP-1 use than with placebo. Many of these intestinal side effects are more likely to occur during the early, dose-escalation phase of GLP-1 utilization. Proper nutrition—especially protein and fiber—can help address side effects and adherence.19,20

Health and Well-Being Coaching icon

Health and Well-Being Coaching

There is strong clinical evidence that Health and Well-Being Coaching (HWC) can assist patients in their long-term efforts to lose weight and maintain weight loss through healthy lifestyle behaviors. There is also preliminary evidence for integrating GLP-1 with HWC for beneficial lifestyle changes. Moreover, HWC is shown to facilitate patient medication adherence as documented via pharmacy claims. If lack of adherence to prescription and weight regain due to resuming prior lifestyle habits are the largest obstacles to GLP-1 program success, then a HWC can improve long-term effectiveness of these medications.23

Optimizing Weight Loss With GLP-1 Ready

Integrating GLP-1 Ready foods with the GLP-1 Ready program boosts weight-loss results, improves patient health, and simplifies treatment plans. These convenient, nutritionally balanced meals enhance patient adherence, streamline dietary guidance, and support a holistic approach to weight management. Designed for safety and efficacy, GLP-1 Ready foods easily provide a trusted, structured solution for doctors aiming to improve patient outcomes.

With high-protein foods—including shakes, bars, and snacks—designed to maintain muscle mass and address nutritional deficiencies in a way conducive to improved adherence, patients experience sustained progress.

With GLP-1 Ready, it's protein first and fiber forward, with more nutrition (nutrients and vitamins) in every bite along with support for proper hydration. In driving the focus to protein first and fiber forward, there's a reduction in higher-CHO, higher-sugar, higher fat food sources—which ultimately may be the macronutrient combination that supports mitigation of side effects. In addition, more protein and fiber can reduce the insulin secretagogue properties of GLP-1s, which can otherwise contribute to nausea, dizziness, and fatigue.

Muscle & Nutrition Support

Rapid weight loss often leads to muscle loss and nutrient depletion—but not with us. Our program supports patients' bodies every step of the way:

  • High-Quality, On-the-Go Protein - Essential for preserving lean muscle mass, promoting satiety, reducing hunger, and improving adherence.
  • Fiber-Rich Foods - Promoting digestive health, side-effect management, and improved weight-loss outcomes.
  • Hydration Support - To prevent dehydration and mitigate side effects.
  • Key Nutrients - To support hair, skin, nail, bone, and brain health with collagen, calcium, and key vitamins.
  • Balanced Nutrition - Meaning fewer energy crashes, better focus, and more stamina.

Professional Support & Tools

  • Registered Dietitian Support - For personalized support and professional guidance.
  • Ongoing Educational Series - Delivered directly to patients' inboxes, providing important guidance on how to make the most of their GLP-1 therapy.
  • Tracking App - For patients to monitor their progress.

Empowering Patients Through Intentional Nutrition

Intentional Nutrition is a purposeful, strategic approach to fueling the body with the right nutrients at the right time. It's about helping patients add the essential components of a balanced diet—high-quality protein, fiber, vitamins, and minerals—to support their body's natural processes and enhance their overall health.

Instead of focusing on what to restrict, Intentional Nutrition emphasizes what patients can and should add to their diets. It's a positive, empowering approach that ensures patients are receiving the nutrients they need—especially while on GLP-1 medications, which often reduce appetite and affect digestion.

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