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

May combine two claims.

Although certain side effects have been reported more commonly with semaglutide than tirzepatide, trial data suggest differences may reflect variation in background placebo rates, with proportional increase vs placebo similar for the two agents.

“Although certain side effects have been reported more commonly with semaglutide than with tirzepatide, trial data suggest that such differences may be a reflection of variation in background (i.e., placebo group) rates in the enrolled trial populations, with the proportional increase in many side effects when compared to placebo being similar for the 2 agents (Table 2).”

May combine two claims.

In multivariate analyses, factors predicting larger responses with tirzepatide include female sex (2.4 higher odds of achieving a 20% weight reduction), lower baseline hemoglobin A1c (1.62 higher odds), no diagnosed hypertension (1.35 higher odds), and lower ALT (1.17 higher odds).

“In multivariate analyses, factors predicting larger responses with tirzepatide include female sex (2.4 higher odds of achieving a 20% weight reduction), lower baseline hemoglobin A1c (1.62 higher odds), no diagnosed hypertension (1.35 higher odds), and lower ALT (1.17 higher odds) [21];”

• cites [21] Srinath, 2023, SAT660 Predictors of achieving body weight reduction ≥20% with tirzepatide in people with overweight or obesity in SURMOUNT-1, J Endocr SocNot checked yet

  Not checked in the free run.

May combine two claims.

Side effects of GLP-1s are relatively common but usually not severe, more likely within the first weeks of initiation and with dose escalation, and tend to decrease in frequency and severity with continuation of a stable dose.

“Side effects are relatively common but usually not severe. These are more likely to occur within the first weeks of initiation of therapy and with dose escalation. Side effects tend to decrease in frequency and severity with continuation of a stable dose [40].”

• cites [40] Gorgojo-Martinez, 2022, Clinical recommendations to manage gastrointestinal adverse events in patients treated with GLP-1 receptor agonists: a multidisciplinary expert consensus, J Clin Med sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In real-world practice, GLP-1 efficacy for weight reduction is often lower than in trials, for example about 8% for individuals with diabetes and 11% for individuals without diabetes at 60 wk with semaglutide 2.4 mg/d.

“In real-world practice, the efficacy for weight reduction is often lower, for example, about 8% for individuals with diabetes and 11% for individuals without diabetes at 60 wk with semaglutide 2.4 mg/d [4].”

• cites [4] Little, 2023Not checked yet

  Not checked in the free run.

May combine two claims.

Individual responses to GLP-1s vary widely, with some people experiencing minimal weight reduction and others robust reductions of ≥30%.

“Although these findings describe the average response, individual responses can vary widely, highlighting the complexity of obesity as a disease. Some people experience minimal weight reduction with GLP-1s, whereas others have robust weight reductions of ≥30%.”

May combine two claims.

Hemoglobin A1c reduction can occur without weight change, and reduced risk of cardiovascular events appears to emerge before substantial weight reduction.

“For example, hemoglobin A1c reduction can occur without weight change, and reduced risk of cardiovascular events appears to emerge before substantial weight reduction [38,39].”

• cites [38] Bays, 2017, Liraglutide 3.0 mg for weight management: weight-loss dependent and independent effects, Curr Med Res Opin sourceNot checked yet

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• cites [39] Lincoff, 2023, Semaglutide and cardiovascular outcomes in obesity without diabetes, N Engl J Med. sourceNot checked yet

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May combine two claims.

In univariate analyses with semaglutide, female sex (48% greater weight loss in kilograms), younger age (24% greater for age <55 vs. ≥75 y), and higher baseline BMI (23% greater for ≥40 vs. <30 kg/m2) predict larger responses.

“and in univariate (crude) analyses with semaglutide, female sex (48% greater weight loss in kilograms), younger age (24% greater for age <55 vs. ≥75 y), and higher baseline BMI (23% greater for ≥40 vs. <30 kg/m2) [16].”

• cites [16] Ryan, 2024, Long-term weight loss effects of semaglutide in obesity without diabetes in the SELECT trial, Nat Med sourceNot checked yet

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May combine two claims.

GLP-1s delay gastric emptying, leading to bloating, fullness, and nausea.

“GLP-1s delay gastric emptying, leading to bloating, fullness, and nausea [43].”

• cites [43] Filippatos, 2014, Adverse effects of GLP-1 receptor agonists, Rev Diabet Stud sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Many clinical benefits of GLP-1s are weight-dependent, while others appear at least partly weight-independent.

“Although many of these benefits are weight-dependent, others appear at least partly weight-independent.”

May combine two claims.

GI side effects are most frequent and include nausea (25%-44%), diarrhea (19%-30%), vomiting (8%-24%), constipation (17%-24%), and abdominal pain (9%-20%).

“GI side effects are most frequent and include nausea (25%–44%), diarrhea (19%–30%), vomiting (8%–24%), constipation (17%–24%), and abdominal pain (9%–20%) [[41], [42], [43], [44], [45], [46]].”

• cites [41] Nordisk, 2023Not checked yet

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• cites [42] 2023Not checked yet

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• cites [43] Filippatos, 2014, Adverse effects of GLP-1 receptor agonists, Rev Diabet Stud sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Real-world experience has largely mirrored trial data, with GI issues (nausea, diarrhea, vomiting, constipation) being the most frequently reported side effects.

“Real-world experience has largely mirrored these trial data, with GI issues (nausea, diarrhea, vomiting, constipation) being the most frequently reported side effects [47,48].”

• cites [47] Liu, 2022, Association between different GLP-1 receptor agonists and gastrointestinal adverse reactions: a real-world disproportionality study based on FDA adverse event reporting system database, Front Endocrinol (Lausanne) sourceNot checked yet

  Not checked in the free run.

• cites [48] Shetty, 2022, Adverse drug reactions of GLP-1 agonists: a systematic review of case reports, Diabetes Metab Syndr sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Weight reduction that is substantial (≥14%) and rapid (over 3-4 mo) is associated with significant bone loss, whereas more moderate and slower weight reduction may better preserve bone mass.

“Weight reduction that is substantial (≥14%) and rapid (over 3–4 mo) is associated with significant bone loss [71], whereas more moderate and slower weight reduction may better preserve bone mass [72].”

• cites [71] Shapses, 2006, Bone, body weight, and weight reduction: what are the concerns?, J Nutr sourceNot checked yet

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• cites [72] Hunter, 2014, Weight loss and bone mineral density, Curr Opin Endocrinol Diabetes Obes sourceNot checked yet

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May combine two claims.

Ophthalmic complications have been rarely reported with GLP-1s, which could relate to direct toxicity or rapid GLP-1-correction of hyperglycemia.

“Ophthalmic complications have been rarely reported, which could relate to direct toxicity or rapid GLP-1-correction of hyperglycemia [52].”

• cites [52] Katz, 2025, Ophthalmic complications associated with the antidiabetic drugs semaglutide and tirzepatide, JAMA Ophthalmol sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Bone loss with weight reduction is influenced by initial body weight, age, sex, physical activity, extent of energy restriction and protein intake, and rate of weight reduction, with older individuals and females experiencing greater bone loss.

“Bone loss is influenced by initial body weight, age, sex, physical activity, extent of energy restriction and protein intake, and rate of weight reduction, with older individuals and females experiencing greater bone loss [71].”

• cites [71] Shapses, 2006, Bone, body weight, and weight reduction: what are the concerns?, J Nutr sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In the absence of structured nutrition and exercise efforts, loss of muscle and bone may be exacerbated by intermittent use of GLP-1s and weight regain or weight cycling, increasing risk of sarcopenic obesity.

“In the absence of structured nutrition and exercise efforts, loss of muscle and bone may be exacerbated by intermittent use of GLP-1s and weight regain or “weight cycling,” increasing risk of sarcopenic obesity.”

May combine two claims.

Signs of frank nutrient deficiency include fatigue beyond expected levels, excessive hair loss, skin flakiness or itching, muscle weakness, poor wound healing, and unusual bruising.

“Signs of frank nutrient deficiency include fatigue beyond expected levels, excessive hair loss, skin flakiness or itching, muscle weakness, poor wound healing, and unusual bruising [59].”

• cites [59] Raymond, 2022Not checked yet

  Not checked in the free run.

May combine two claims.

Several studies have estimated the cost-effectiveness of GLP-1s for obesity from a healthcare perspective, and all have found that GLP-1 treatment costs exceed healthcare savings.

“Several studies have estimated the cost-effectiveness of GLP-1s for obesity from a healthcare perspective, considering costs for screening and treatment against savings from improved weight and health outcomes and corresponding long-term reductions in healthcare utilization, including downstream accumulated health benefits. All have found that GLP-1 treatment costs exceed healthcare savings.”

May combine two claims.

Reductions in fat mass, lean body mass, and muscle mass correlate with the degree of body weight reduction and are similar to those documented with other obesity therapies that achieve large weight reductions, such as bariatric surgery and very low-calorie restricted diets.

“These reductions in fat mass, lean body mass, and muscle mass correlate with the degree of body weight reduction and are similar to those documented with other obesity therapies that achieve large weight reductions, such as bariatric surgery and very low-calorie restricted diets [65].”

• cites [65] Nuijten, 2022, The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: a systematic review and meta-analysis, Obes Rev sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Medicare does not currently cover GLP-1s for obesity, but recently announced that they will be among the drug classes which the federal government will aim to negotiate in 2025; average price reductions in prior negotiations for other drug classes have ranged from 38% to 79% from the original list price.

“Medicare does not currently cover GLP-1s for obesity, but recently announced that they will be among the drug classes which the federal government will aim to negotiate in 2025; average price reductions in prior negotiations for other drug classes have ranged from 38% to 79% from the original list price [80].”

• cites [80] 2025Not checked yet

  Not checked in the free run.

May combine two claims.

Local and regional compounding pharmacies directly manufacture GLP-1s, with gray literature prices from ∼$1800 to $3000 per year; this is not regulated by the FDA for safety or efficacy.

“Local and regional compounding pharmacies also directly manufacture GLP-1s, with gray literature prices from ∼$1800 to $3000 per year [81]. However, this is not regulated by the FDA for safety or efficacy; and recent FDA guidance has aimed to eliminate this production.”

• cites [81] LandiNot checked yet

  Not checked in the free run.

May combine two claims.

Discontinuation of GLP-1s is associated with older age (≥65 y), poor weight response, and moderate or severe GI side effects.

“Discontinuation is associated with older age (≥65 y), poor weight response, and moderate or severe GI side effects [74].”

• cites [74] Rodriguez, 2025, Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults With Overweight or Obesity, JAMA Netw Open sourceNot checked yet

  Not checked in the free run.

May combine two claims.

GI side effects may further compromise nutrient absorption and exacerbate preceding or new risk of nutrient insufficiency.

“GI side effects may further compromise nutrient absorption and exacerbate preceding or new risk of nutrient insufficiency.”

May combine two claims.

Rare cases of suicidality have been reported with GLP-1s, although preliminary evaluation using the FDA Adverse Reporting System, post hoc analysis of STEP trials, and 1 large cohort study have not confirmed any definitive link.

“Rare cases of suicidality have been reported, although preliminary evaluation using the FDA Adverse Reporting System, post hoc analysis of the STEP clinical trials, and 1 large cohort study have not confirmed any definitive link; the FDA and European Agencies are monitoring potential risk [[53], [54], [55]].”

• cites [53]Not checked yet

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• cites [54] Wadden, 2024, Psychiatric safety of semaglutide for weight management in people without known major psychopathology: post hoc analysis of the STEP 1, 2, 3, and 5 trials, JAMA Intern Med sourceNot checked yet

  Not checked in the free run.

• cites [55] Shapiro, 2025, Glucagon-like peptide-1 receptor agonists and risk of suicidality among patients with type 2 diabetes: active comparator, new user cohort study, BMJ sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Rare side effects of GLP-1s include gallbladder disease, pancreatitis, acute kidney injury (typically related to hypovolemia), hypersensitivity reactions, and gastroparesis.

“Rare side effects include gallbladder disease, pancreatitis, acute kidney injury (typically related to hypovolemia), hypersensitivity reactions, and gastroparesis [12,41].”

• cites [12] 2024Not checked yet

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• cites [41] Nordisk, 2023Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

According to the USPSTF, the evidence supports referring all adults with obesity to intensive, multicomponent behavioral interventions for both weight reduction and weight maintenance.

“According to the USPSTF, the evidence supports referring all adults with obesity to intensive, multicomponent behavioral interventions for both weight reduction and weight maintenance.”

May combine two claims.

Although health coaching is theoretically reimbursable by some private insurers, employee wellness benefits, Medicare Advantage plans, and state Medicaid programs, the lack of approval of category I Current Procedural Terminology codes for health coaching by the American Medical Association remains a barrier to reimbursement.

“In addition, although health coaching is theoretically reimbursable by some private insurers, employee wellness benefits, Medicare Advantage plans, and state Medicaid programs, the lack of approval of category I Current Procedural Terminology codes for health coaching by the American Medical Association remains a barrier to reimbursement [107,108].”

• cites [107]Not checked yet

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• cites [108]Not checked yet

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May combine two claims.

Multiple studies demonstrate beneficial effects of GLP-1s on food cravings and disordered eating, including reduced food preoccupation or "food noise", reduced emotional eating, less external eating, and fewer binge eating episodes.

“Multiple studies demonstrate beneficial effects on food cravings and disordered eating. This includes reduced food preoccupation or “food noise”, reduced emotional eating, less external eating (i.e., eating that responds to external triggers, irrespective of satiety), and fewer binge eating episodes [56,149].”

• cites [56] Christensen, 2024, Dietary intake by patients taking GLP-1 and dual GIP/GLP-1 receptor agonists: a narrative review and discussion of research needs, Obes PillarsNot checked yet

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• cites [149] Tronieri, 2020, Effects of liraglutide on appetite, food preoccupation, and food liking: results of a randomized controlled trial, Int. J. Obes. (Lond.) sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Serial studies from the US and Europe suggest that energy expenditure from physical activity increased between 1981 and 2017, during the onset of the obesity epidemic, while basal metabolic expenditure declined, implicating other factors such as dietary composition that impact metabolic rate.

“Serial studies from the US and Europe suggest that energy expenditure from physical activity increased between 1981 and 2017, during the onset of the obesity epidemic, while basal metabolic expenditure declined, implicating other factors such as dietary composition that impact metabolic rate [86].”

• cites [86] Speakman, 2023, Total daily energy expenditure has declined over the past three decades due to declining basal expenditure, not reduced activity expenditure, Nature Metabolism sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Although authoritative health and medical entities recommend comprehensive lifestyle modification as part of the treatment plan for obesity, the use of such therapies before or to support GLP-1 use is not widespread in practice.

“Although authoritative health and medical entities recommend comprehensive lifestyle modification as part of the treatment plan for obesity, the use of such therapies before or to support GLP-1 use is not widespread in practice.”

May combine two claims.

High costs, lower adherence in practice, and frequent weight regain after discontinuation each highlight the importance of complementary nutritional and lifestyle counseling to help maximize overall efficacy and cost-effectiveness.

“These high costs, lower adherence in practice, and frequent weight regain after discontinuation, each highlight the importance of complementary nutritional and lifestyle counseling to help maximize overall efficacy and cost-effectiveness [84].”

• cites [84] Kim, 2024, Balancing innovation and affordability in anti-obesity medications: the role of an alternative weight-maintenance program, Health Aff SchNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

In this writing group's experience, many individuals prescribed GLP-1s have not received meaningful nutrition or other lifestyle guidance preceding, accompanying, or (if the drug is stopped) after the therapy.

“In this writing group’s experience, we observe that many individuals prescribed GLP-1s have not received meaningful nutrition or other lifestyle guidance preceding, accompanying, or (if the drug is stopped) after the therapy.”

May combine two claims.

GLP-1s meaningfully impact total energy intake and food preferences through multiple mechanisms, including peripherally in the gut, centrally in multiple brain regions, and through diet-microbiome-brain interactions.

“GLP-1s meaningfully impact total energy intake and food preferences through multiple mechanisms—an active area of investigation—including peripherally in the gut, centrally in multiple brain regions, and through diet-microbiome–brain interactions [142].”

• cites [142] Chen, 2021, GLP-1 suppresses feeding behaviors and modulates neuronal electrophysiological properties in multiple brain regions, Front. Mol. Neurosci. sourceNot checked yet

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May combine two claims.

Dehydration from severe nausea, vomiting, or diarrhea can cause acute kidney injury, with or without existing kidney disease, as well as heart palpitations.

“Dehydration from severe nausea, vomiting, or diarrhea can cause acute kidney injury, with or without existing kidney disease [140], as well as heart palpitations, so efforts should be made to prevent dehydration.”

• cites [140] Bradshaw, 2018, Acute kidney injury due to diarrheal illness requiring hospitalization: data from the National Inpatient Sample, J. Gen. Intern. Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Preclinical studies suggest that GLP-1 receptor activation may modulate inflammatory and immune responses that affect the brain.

“preclinical studies suggest that GLP-1 receptor activation may modulate inflammatory and immune responses that affect the brain [146].”

• cites [146] Diz-Chaves, 2022, Anti-inflammatory effects of GLP-1 receptor activation in the brain in neurodegenerative diseases, Int. J. Mol. Sci. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The high and rising prevalence of obesity globally is often attributed to poor dietary patterns and insufficient physical activity, which are often related to behaviors learned early in life and developed over time as well as structural barriers to good lifestyle.

“The high and rising prevalence of obesity globally is often attributed to poor dietary patterns and insufficient physical activity, which are often related to behaviors learned early in life and developed over time as well as structural barriers to good lifestyle [85].”

• cites [85] 2012Not checked yet

  Not checked in the free run.

May combine two claims.

GLP-1s reduce energy intake by 16%-39% compared with placebo, related to changes in cravings, hunger, and fullness.

“GLP-1s reduce energy intake by 16%–39% compared with placebo, related to changes in cravings, hunger, and fullness [56,147,148].”

• cites [56] Christensen, 2024, Dietary intake by patients taking GLP-1 and dual GIP/GLP-1 receptor agonists: a narrative review and discussion of research needs, Obes PillarsNot checked yet

  Not checked in the free run.

• cites [147] Wharton, 2023, Two-year effect of semaglutide 2.4 mg on control of eating in adults with overweight/obesity: STEP 5, Obesity, Silver Spring, Md) sourceNot checked yet

  Not checked in the free run.

• cites [148] Heise, 2023, Tirzepatide reduces appetite, energy intake, and fat mass in people with type 2 diabetes, Diabetes Care sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The Diabetes Prevention Program is known to reduce the risk of progression to diabetes and is covered by major payers, but has not been meaningfully scaled due to regulatory and implementation barriers.

“For example, the Diabetes Prevention Program is known to reduce the risk of progression to diabetes and is covered by major payers, but has not been meaningfully scaled due to regulatory and implementation barriers [105,106].”

• cites [105] Halley, 2020, Barriers and facilitators to real-world implementation of the Diabetes Prevention Program in large healthcare systems: Lifestyle coach perspectives, J. Gen. Intern. Med. sourceNot checked yet

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• cites [106] Rawal, 2024, Facilitators and barriers to implementing the Diabetes Prevention Program in rural church settings: a qualitative study using the Consolidated Framework for Implementation Research, J. Rural HealthNot checked yet

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May combine two claims.

There is growing concern for the continued lack of formal medical training in nutrition and obesity and the paucity of basic knowledge and competencies to provide nutrition counseling.

“As GLP-1s are becoming more commonly prescribed for obesity and other health conditions by providers across multiple disciplines, there is growing concern for the continued lack of formal medical training in nutrition and obesity and the paucity of basic knowledge and competencies to provide nutrition counseling [111,112].”

• cites [111] Devries, 2014, A deficiency of nutrition education in medical training, Am. J. Med. sourceNot checked yet

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• cites [112] Harkin, 2019, Physicians' dietary knowledge, attitudes, and counseling practices: the experience of a single health care center at changing the landscape for dietary education, Am. J. Lifestyle Med. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Various dietary patterns have been used with success, with adherence to counseling visits and the selected diet often being the important factors in determining outcomes.

“Various dietary patterns have been used with success, with adherence to counseling visits and the selected diet often being the important factors in determining outcomes [101].”

• cites [101] Sacks, 2009, Comparison of weight-loss diets with different compositions of fat, protein, and carbohydrates, N. Engl. J. Med. sourceNot checked yet

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May combine two claims.

Low cost-effectiveness of GLP-1s is related to plateauing of weight benefits but continued high costs of treatment, as well as weight regain following any cessation of use.

“with low cost-effectiveness related to plateauing of weight benefits but continued high costs of treatment, as well as weight regain following any cessation of use.”

May combine two claims.

Foods high in protein or fat can further slow gastric emptying, which can promote weight reduction and metabolism but also worsen constipation, potentially requiring temporary limitation of these foods.

“Foods high in protein or fat can further slow gastric emptying, which can promote weight reduction and metabolism but also worsen constipation, potentially requiring temporary limitation of these foods [141].”

• cites [141] Gentinetta, 2024, Dietary recommendations for the management of gastrointestinal symptoms in patients treated with GLP-1 receptor agonist, Diabetes Metab. Syndr. Obes. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Smaller, more frequent meals and avoiding fatty or high fiber foods during the first few days of treatment can help alleviate GI symptoms.

“Smaller, more frequent meals and avoiding fatty or high fiber foods during the first few days of treatment can help alleviate symptoms [45].”

• cites [45] Wharton, 2022, Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice, Postgrad Med sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Specific nutrient goals can vary by age, sex, and life stage as well as comorbidities or clinical conditions.

“Specific nutrient goals can vary by age, sex, and life stage (e.g., infancy, childhood, adolescence, pregnancy, lactation, older adulthood) [102] as well as comorbidities or clinical conditions.”

• cites [102] National Institutes of Health. Nutrient Recommendations: Dietary Reference Intakes (DRI). National Institutes of Health.Not checked yet

  Not checked in the free run.

May combine two claims.

Excess dietary protein, above muscle needs for repair or growth, can be converted to fat by the liver and increase visceral adiposity.

“Excess dietary protein, above muscle needs for repair or growth, can be converted to fat by the liver and increase visceral adiposity [167].”

• cites [167] Charidemou, 2019, A randomized 3-way crossover study indicates that high-protein feeding induces de novo lipogenesis in healthy humans, JCI Insight sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A structured, comprehensive nutrition and lifestyle program could help augment the weight reduction efficacy of GLP-1s, although findings have been mixed.

“A structured, comprehensive nutrition and lifestyle program could help augment the weight reduction efficacy of GLP-1s, although findings have been mixed.”

May combine two claims.

Aerobic and resistance training exercises also improve insulin sensitivity, vascular function, and oxidative stress, critical for long-term cardiometabolic health.

“Aerobic and resistance training exercises also improve insulin sensitivity, vascular function, and oxidative stress, critical for long-term cardiometabolic health [172].”

• cites [172] Liu, 2023, Liraglutide and exercise synergistically attenuate vascular inflammation and enhance metabolic insulin action in early diet-induced obesity, Diabetes sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Chronic stress may promote obesity development through sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation that elevates cortisol levels, interferes with insulin sensitivity, promotes energy storage, and creates food cravings for ultraprocessed "comfort foods".

“Mental stress should be addressed among individuals with obesity, as chronic stress may promote obesity development through the sympathetic nervous system and hypothalamic-pituitary-adrenal axis activation that elevates cortisol levels, interferes with insulin sensitivity, promotes energy storage, and creates food cravings for ultraprocessed “comfort foods” [189]”

• cites [189] Scott, 2012, Effects of chronic social stress on obesity, Curr. Obes. Rep. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In a recent randomized trial, one year of combined GLP-1 therapy with exercise training preserved bone mineral density, while GLP-1 therapy alone decreased bone mineral density.

“In a recent randomized trial, one year of combined GLP-1 therapy with exercise training preserved bone mineral density, while GLP-1 therapy alone decreased bone mineral density [170].”

• cites [170] Jensen, 2024, Bone health after exercise alone, GLP-1 receptor agonist treatment, or combination treatment: a secondary analysis of a randomized clinical trial, JAMA Netw. Open sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

All these technologies monitor muscle mass but not muscle health, quality, or function.

“All these technologies monitor muscle mass but not muscle health, quality, or function.”

May combine two claims.

Poor sleep is associated with insulin resistance, increased hunger, and weight gain, which might reduce some benefits of GLP-1s.

“Poor sleep is associated with insulin resistance, increased hunger, and weight gain, which might reduce some benefits of GLP-1s [183].”

• cites [183] Beccuti, 2011, Sleep and obesity, Curr. Opin. Clin. Nutr. Metab. CareNot checked yet

  Not checked in the free run.

May combine two claims.

The influences of GLP-1s on preferences for specific foods are less rigorously documented, with varying study results.

“However, these influences are less rigorously documented, with varying study results.”

May combine two claims.

Estimated fat-free mass may be best for determining protein needs, although there is still no consensus on the optimal approach.

“Estimated fat-free mass may be best for determining protein needs, although there is still no consensus on the optimal approach.”

Classified as probably not a substantial claim. May combine two claims.

Among food sources, plant sources, dairy, seafood, eggs, and lean poultry should generally be encouraged based on their links to general health, with red and processed meats considered in moderation or minimized given links to type 2 diabetes, cardiovascular disease, and colorectal cancer in general populations.

“Among food sources, plant sources (e.g., beans, peas, lentils, whole grains), dairy, seafood, eggs, and lean poultry should generally be encouraged based on their links to general health, with red and processed meats considered in moderation or minimized given links to type 2 diabetes, cardiovascular disease, and colorectal cancer in general populations [60].”

• cites [60] 2024Not checked yet

  Not checked in the free run.

May combine two claims.

A protein intake of 1.5 g per kilogram of lean body mass (FFM) per day is considered more accurate but requires body composition data for precise calculation.

“A protein intake of 1.5 g per kilogram of lean body mass (FFM) per day is considered more accurate but requires body composition data for precise calculation [166].”

• cites [166] Grosicki, 2024, Sculpting success: the importance of diet and physical activity to support skeletal muscle health during weight loss with new generation anti-obesity medications, Curr. Dev. Nutr. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

GLP-1s may act both centrally and peripherally to reduce downstream impacts of chronic stress and obesity and alter food reward pathways in positive ways.

“GLP-1s may act both centrally and peripherally to reduce these downstream impacts of chronic stress and obesity and alter food reward pathways in positive ways [132].”

• cites [132] Guerrero-Hreins, 2021, The therapeutic potential of GLP-1 analogues for stress-related eating and role of GLP-1 in stress, emotion and mood: a review, Prog. Neuropsychopharmacol. Biol. Psychiatry sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Different studies suggest reduced cravings for savory foods and high-fat foods; sweet, savory, or dairy foods; salty, spicy, starchy, or dairy foods; and sweets, carbohydrates, starches, and fast-food fats.

“Different studies suggest reduced cravings for savory foods and high-fat foods [150,151]; sweet, savory, or dairy foods [144]; salty, spicy, starchy, or dairy foods [147]; and sweets, carbohydrates, starches, and fast-food fats [154].”

• cites [150] Blundell, 2017, Effects of once-weekly semaglutide on appetite, energy intake, control of eating, food preference and body weight in subjects with obesity, Diabetes Obes. Metab. sourceNot checked yet

  Not checked in the free run.

• cites [151] Gibbons, 2021, Effects of oral semaglutide on energy intake, food preference, appetite, control of eating and body weight in subjects with type 2 diabetes, Diabetes Obes. Metab. sourceNot checked yet

  Not checked in the free run.

• cites [144] Bettadapura, 2024, Changes in food preferences and ingestive behaviors after glucagon-like peptide-1 analog treatment: techniques and opportunities, Int. J. Obes. (Lond.)Not checked yet

  Not checked in the free run.

• cites [147] Wharton, 2023, Two-year effect of semaglutide 2.4 mg on control of eating in adults with overweight/obesity: STEP 5, Obesity, Silver Spring, Md) sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

A challenge in interpreting the impact of lifestyle strategies in these trials is lack of standardization on how "intensive" lifestyle intervention is defined or implemented.

“A challenge in interpreting the impact of the lifestyle strategies in these trials is lack of standardization on how “intensive” lifestyle intervention is defined or implemented.”

Classified as probably not a substantial claim.

Higher protein targets, such as 1.2-1.6 g/kg/d, have been proposed during active weight reduction.

“Higher targets, such as 1.2–1.6 g/kg/d, have also been proposed during active weight reduction [162,163].”

• cites [162] Dekker, 2022, Calculation of protein requirements; a comparison of calculations based on bodyweight and fat free mass, Clin. Nutr. ESPEN sourceNot checked yet

  Not checked in the free run.

• cites [163] Leidy, 2015, The role of protein in weight loss and maintenance, Am. J. Clin. Nutr. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Protein-rich foods can be consumed first in a meal to increase the likelihood of sufficient consumption.

“Protein-rich foods can be consumed first in a meal to increase the likelihood of sufficient consumption.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Enhanced mindfulness may also help individuals cope with GLP-1 side effects.

“Enhanced mindfulness may also help individuals cope with GLP-1 side effects [192].”

• cites [192] Greeson, 2019, Mindfulness and physical disease: a concise review, Curr. Opin. Psychol. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Some muscle strength measures are less sensitive to change (e.g., handgrip strength) or not feasible to conduct in a clinical setting (e.g., quadricep isometric strength).

“Still, some are less sensitive to change (e.g., handgrip strength) or not feasible to conduct in a clinical setting (e.g., quadricep isometric strength).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Small, frequent meals may be effective when hunger and food interest are low.

“Small, frequent meals may be effective when hunger and food interest are low [58].”

• cites [58] Almandoz, 2024, Nutritional considerations with antiobesity medications, Obesity (Silver Spring) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Sit-to-stand, stair climb, and timed-up-and-go measures can be helpful in older adults, but these measures may be less able to detect changes in younger individuals.

“Sit-to-stand, stair climb, and timed-up-and-go measures can be helpful in older adults, but these measures may be less able to detect changes in younger individuals.”

Classified as probably not a substantial claim. May combine two claims.

Protein intake in adults should not fall below 0.4-0.5 g/kg/d, as this can lead to muscle atrophy and functional impairments, whereas prolonged intake at or above 2 g/kg/d should be avoided due to potential adverse health effects.

“Protein intake in adults should not fall below 0.4–0.5 g/kg/d, as this can lead to muscle atrophy and functional impairments, whereas prolonged intake at or above 2 g/kg/d should be avoided due to potential adverse health effects [165].”

• cites [165] Heymsfield, 2024, Guidance on energy and macronutrients across the life span, N. Engl. J. Med. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S4 (based). May combine two claims.

Setting an absolute protein target of 80-120 g/d, or 16%-24% energy on a 2000 kcal/d diet, may enhance adherence while ensuring adequate intake.

“Alternatively, setting an absolute protein target of 80–120 g/d, or 16%–24% energy on a 2000 kcal/d diet, may enhance adherence while ensuring adequate intake.”

May combine two claims.

In a study of ~1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic compared with White individuals and among those living in lower versus higher income households.

“In a study of ∼1.2 million commercially insured U.S. individuals with diabetes from 2015 to 2019, lower GLP-1 use was seen among Asian, Black, and Hispanic, compared with White, individuals and among those living in lower versus higher income households [237].”

• cites [237] Eberly, 2021, Racial, ethnic, and socioeconomic inequities in glucagon-like peptide-1 receptor agonist use among patients with diabetes in the US, JAMA Health Forum sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Although limited direct evidence has evaluated use of GLP-1s with or without RDN-provided MNT, the SCALE, STEP 1, SURMOUNT, and STEP 3 trials each demonstrated substantial weight reduction by combining GLP-1s with regular counseling sessions by RDNs or other qualified healthcare professionals.

“Although limited direct evidence has evaluated use of GLP-1s with or without RDN-provided MNT, the SCALE [13], STEP 1 [14], SURMOUNT [15], and STEP 3 [178] trials each demonstrated substantial weight reduction by combining GLP-1s with regular counseling sessions by RDNs or other qualified healthcare professionals (such lifestyle support was also provided to the placebo group in each trial).”

• cites [13] Pi-Sunyer, 2015, A randomized, controlled trial of 3.0 mg of liraglutide in weight management, N Engl J Med sourceNot checked yet

  Not checked in the free run.

• cites [14] Wilding, 2021, Once-weekly semaglutide in adults with overweight or obesity, N Engl J Med sourceNot checked yet

  Not checked in the free run.

• cites [15] Jastreboff, 2022, Tirzepatide once weekly for the treatment of obesity, N Engl J Med sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Telehealth and digital platforms can help address barriers posed by in-person visits, enhance patient engagement, and promote adherence to nutritional and lifestyle recommendations.

“These tools can help address barriers posed by in-person visits, enhance patient engagement, and promote adherence to nutritional and lifestyle recommendations [[226], [227], [228], [229]].”

• cites [226] Ezeamii, 2024, Revolutionizing healthcare: how telemedicine is improving patient outcomes and expanding access to care, CureusNot checked yet

  Not checked in the free run.

• cites [227] Kelly, 2016, Telehealth methods to deliver dietary interventions in adults with chronic disease: a systematic review and meta-analysis, Am. J. Clin. Nutr. sourceNot checked yet

  Not checked in the free run.

• cites [228] Bashshur, 2014, The empirical foundations of telemedicine interventions for chronic disease management, Telemed. e-Health sourceNot checked yet

  Not checked in the free run.

May combine two claims.

One retrospective study identified higher likelihood of prescribing obesity management medication as well as higher relative weight reduction with GMVs versus individual medical visits.

“One retrospective study identified higher likelihood of prescribing obesity management medication as well as higher relative weight reduction with GMVs versus individual medical visits [211].”

• cites [211] Shibuya, 2020, Association between shared medical appointments and weight loss outcomes and anti-obesity medication use in patients with obesity, Obes. Sci. Pract. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Team-based care, including registered dietitian nutritionists, exercise physiologists, and health coaches, can be very helpful but is not always available depending on health system circumstances and payer policies.

“Team-based care, including registered dietitian nutritionists (RDNs), exercise physiologists, and health coaches, can be very helpful [204] but is not always available to clinicians or individuals depending on health system circumstances and payer policies.”

• cites [204] Kane, 2024, Opportunities for general internal medicine to promote equity in obesity care, J. Gen. Intern. Med.Not checked yet

  Not checked in the free run.

May combine two claims.

Long periods of fasting without sufficient protein intake or dietary variety can lead to nutritional inadequacy, clinical nutrient deficiencies, loss of fat-free mass, and reduced resting energy expenditure.

“Long periods of fasting without sufficient protein intake or dietary variety can lead to nutritional inadequacy, clinical nutrient deficiencies, loss of fat-free mass, and reduced resting energy expenditure [297].”

• cites [297] Agagunduz, 2021, Effect of intermittent fasting (18/6) on energy expenditure, nutritional status, and body composition in healthy adults, Evid. Based Complement. Alternat. Med. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

Pairing GLP-1 use with RDN dietary counseling should support medication adherence, help prevent or manage GI side effects, promote adequacy of nutrient intake, and support engagement in other behaviors that enhance long-term weight management and overall health.

“Pairing GLP-1 use with RDN dietary counseling should support medication adherence, help prevent or manage GI side effects (particularly during medication initiation and dose increases), promote adequacy of nutrient intake, and support engagement in other behaviors (e.g., regular physical activity, adequate sleep, goal-setting) that enhance long-term weight management and overall health.”

May combine two claims.

Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs.

“Compared to conventional visits, GMVs have demonstrated improved dietary habits, improved sleep, greater patient satisfaction, better glycemic and blood pressure control among individuals with diabetes mellitus, modest but significant weight reduction improvement, particularly in females and older adults, and reduced healthcare costs [[207], [208], [209], [210]].”

• cites [[207], [208], [209], [210]]Not checked yet

  Not checked in the free run.

May combine two claims.

Nutrient supplementation with fiber, resistant starch, and unsaturated fats are the most studied supplements in animal and small-scale human trials, often showing increased circulating GLP-1 concentrations and associated metabolic improvements.

“Nutrient supplementation with fiber, resistant starch, and unsaturated fats are the most studied supplements in both animal studies and small-scale human trials—often showing increased circulating GLP-1 concentrations and associated metabolic improvements [269].”

• cites [269] Rui, 2013, Brain regulation of energy balance and body weight, Rev. Endocr. Metab. Disord. sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

RDNs who provide MNT for obesity care can follow evidence-based practice guidelines and earn a board-certified specialist credential in obesity and weight management.

“RDNs who provide MNT for obesity care can follow evidence-based practice guidelines [220] and earn a board-certified specialist credential in obesity and weight management [221].”

• cites [220] Morgan-Bathke, 2023, Medical nutrition therapy interventions provided by dietitians for adult overweight and obesity management: an Academy of Nutrition and Dietetics evidence-based practice guideline, J. Acad. Nutr. Diet. sourceNot checked yet

  Not checked in the free run.

• cites [221]Not checked yet

  Not checked in the free run.

May combine two claims.

Medicare covers MNT only for individuals with diabetes, chronic kidney disease, and 36 months post-kidney transplant, and for only 3 h during the first year of referral and 2 h annually thereafter.

“Medicare covers MNT only for individuals with diagnoses of diabetes, chronic kidney disease, and 36 months post-kidney transplant, and for only 3 h during the first year of referral and 2 h annually thereafter [223].”

• cites [223] US Congress. United States Code: Social Security Act, U.S.C. § 1395x: Definitions. From Title 42 -The Public Health and Welfare. Chapter 7-Social Security. Subchapter XVII-Health Insurance for Aged And Disabled. Part E-Miscellaneous Provisions.Not checked yet

  Not checked in the free run.

May combine two claims.

In both traditional fee-for-service and value-based health delivery models, GMVs can increase access to healthcare professionals, promote in-depth, unrushed medical visits, promote social connection and support, and improve individual engagement and outcomes.

“In both traditional fee-for-service and value-based health delivery models, GMVs can increase access to healthcare professionals, promote in-depth, unrushed medical visits, promote social connection and support, and improve individual engagement and outcomes [206].”

• cites [206] Lacagnina, 2021, Lifestyle medicine shared medical appointments, Am. J. Lifestyle Med. sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

A recent expert group concluded that BMI-based measures can misclassify adiposity-both underestimate and overestimate-and thus undermine effective clinical care and policy development.

“A recent expert group reviewed the utility of BMI-based measures for assessing individual health and concluded that these can misclassify (both underestimate and overestimate) adiposity—and thus undermine effective clinical care and policy development [271].”

• cites [271] Rubino, 2025, Definition and diagnostic criteria of clinical obesity, Lancet. Diabetes, EndocrinolNot checked yet

  Not checked in the free run.

May combine two claims.

In controlled trials, RDN-delivered MNT modestly but meaningfully improves dietary quality, body weight, waist circumference, glycemic control, blood pressure, and blood cholesterol levels.

“In controlled trials, RDN-delivered MNT modestly but meaningfully improves dietary quality, body weight, waist circumference, glycemic control, blood pressure, and blood cholesterol levels [[216], [217], [218], [219]].”

• cites [[216], [217], [218], [219]]Not checked yet

  Not checked in the free run.

May combine two claims.

Robust social networks improve health outcomes by reducing stress, increasing motivation, and encouraging accountability.

“Robust social networks improve health outcomes by reducing stress, increasing motivation, and encouraging accountability [198,199].”

• cites [198] Lin, 2019, Social network structure is predictive of health and wellness, PLoS One sourceNot checked yet

  Not checked in the free run.

• cites [199] Martino, 2017, The connection prescription: using the power of social interactions and the deep desire for connectedness to empower health and wellness, Am. J. Lifestyle Med. sourceNot checked yet

  Not checked in the free run.

May combine two claims.

In a recent phase 2 randomized trial, 9 wk of low-dose semaglutide in 48 outpatient participants with alcohol use disorder led to reductions in some but not all measures of alcohol use and craving, and led to reductions in tobacco use in the subgroup of current smokers.

“In a recent phase 2 randomized trial, 9 wk of low-dose semaglutide in 48 outpatient participants with alcohol use disorder led to reductions in some but not all measures of alcohol use and craving. They led to reductions in tobacco use in the subgroup of current smokers [33].”

• cites [33] Hendershot, 2025, Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial, JAMA Psychiatry sourceNot checked yet

  Not checked in the free run.