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Long-term Success of GLP-1s Hinges on More Than Just a Prescription

A comprehensive program of nutritional and lifestyle counseling is critical to maximize overall efficacy and improve cost-effectiveness of GLP-1s for obesity 
News Staff | Tue, Jun 3, 2025

GLP-1 (glucagon-like peptide-1) therapies can be powerful tools in managing obesity, with patients taking these medications seeing weight reductions of 5–18% in clinical trials, along with increased metabolism and benefits to their overall heart health. However, GLP-1s can come with challenges, including gastrointestinal side effects, risk of micronutrient deficiencies, muscle and bone loss, poor long-term follow through with weight regain if stopped, and high costs. A thoughtful and comprehensive nutrition and lifestyle program can help address these challenges and increase the efficacy and cost-effectiveness of GLP-1s. 

Dariush Mozaffarian, cardiologist and director of the Food is Medicine Institute at the Gerald J. and Dorothy R. Friedman School of Nutrition Science and Policy at Tufts University, recently served as lead chair and author of a clinical advisory titled “Nutritional Priorities to Support GLP-1 Therapy for Obesity,” published across four peer-reviewed journals and issued by four leading organizations in lifestyle medicine, obesity medicine, and nutrition—the American College of Lifestyle Medicine (ACLM), the American Society for Nutrition (ASN), the Obesity Medicine Association (OMA), and The Obesity Society (TOS). 

This consensus-based guidance, which includes an outline of eight key nutritional priorities to support patients on GLP-1 medications, reflects the top interdisciplinary recommendations to help clinicians support patients receiving GLP-1 receptor agonists for obesity care with evidence-based nutritional and behavioral strategies.  

Mozaffarian took time to answer questions about the new clinical advisory and how individuals and clinicians can integrate nutrition and lifestyle interventions into GLP-1 treatment to increase their chances for success. 

Tufts Now: Why is it important for people taking GLP-1s to incorporate nutrition and lifestyle interventions into their routine, and what happens if they don’t? 

Dariush Mozaffarian: GLP-1s have captured national attention for their ability to help people achieve significant weight reduction, but successful weight loss requires more than a prescription. GLP-1s are FDA-approved as an adjunct to nutrition and lifestyle therapy. In practice, all too often nutrition and lifestyle are an afterthought—or even ignored. 

This amplifies the many challenges associated with GLP-1s, like gastrointestinal side effects, nutrient inadequacies, muscle and bone loss, low long-term adherence, weight regain, and high costs. These challenges contribute to many patients stopping GLP-1 therapy. Up to half of people prescribed a GLP-1 stop taking it by one year, and 85% stop by two years. Weight regain is very common after stopping a GLP-1—on average, up to two-thirds of the lost weight is regained within one year. And, most regained weight will be fat, rather than lost muscle and bone. 

GLP-1 therapy is an investment that needs a strategy to protect it. Nutrition and lifestyle counseling and healthy behaviors should be the patient’s and clinician’s foundation to maximize overall benefits and cost-effectiveness of GLP-1s for obesity.   

What are the key nutritional priorities that emerged out of the work of this group? 

We identified eight nutritional priorities, outlined in the advisory, to help individuals use GLP-1 medications effectively and sustainably:  

  • Start with a patient-centered approach that respects individual needs, goals and preferences.
  • Conduct a baseline nutrition assessment to identify potential risks and create a strong foundation for care.
  • Manage gastrointestinal side effects, such as nausea or constipation, to ensure adherence and comfort.
  • Support patients in navigating their dietary preferences and maintaining adequate intake.
  • Prevent and address potential nutrient inadequacies and deficiencies.
  • Preserve muscle and bone mass through adequate protein intake and physical activity.
  • Maximize healthy, sustainable weight loss through nourishing food choices.
  • Emphasize the importance of holistic lifestyle—encouraging regular movement, quality sleep, stress management, reduced substance use, and strong social connections—to support overall well-being and long-term success. 

These priorities are intended to help clinicians provide practical, real-world nutrition and lifestyle counseling to increase benefits, reduce risks, and improve long-term outcomes for their patients using GLP-1s.

What role do Food is Medicine interventions play in meeting these nutritional priorities? 

A focus on nutrition is largely missing from the healthcare system. Food is Medicine (FIM) interventions reflect the critical link between nutrition and health, integrated into healthcare delivery. These programs provide medically tailored meals, groceries, and produce to support disease management, in combination with nutrition and culinary education, as part of a patient’s healthcare treatment plan. 

FIM interventions can help overcome many common barriers to healthful eating, including cost, time, access, and knowledge. As an example of a combined GLP-1 + FIM intervention, eligible patients could receive both GLP-1 therapy and a FIM intervention emphasizing foods to support weight maintenance, reduce side effects, minimize loss of muscle and bone mass, and promote nutrient adequacy. After 12 to 18 months, some patients may even be able to stop the GLP-1 drug and use FIM programming for weight maintenance. Others may require episodic re-use or long-term use of GLP-1 drugs to help with weight maintenance. 

fruits and vegetables on display at a market
Some studies have shown that eating a meal high in saturated fat or trans fat causes inflammation markers to shoot up, if only temporarily. But unsaturated fats, and omega-3 fatty acids in particular, seem to be protective. Photo: Shutterstock

Food is Medicine 101

The Food is Medicine 101 continuing education course through University College aims to educate health professionals on the critical link between nutrition and health and its application to the healthcare setting.

How can clinicians best support their patients taking GLP-1s to practically apply these nutrition and lifestyle interventions into their daily lives?   

Clinicians play a pivotal role in helping patients translate the promise of GLP-1 medications into lasting health. That means going beyond prescriptions to build care plans that integrate nutrition and lifestyle counseling—before, during, and after the active weight reduction phase. Team-based care, including registered dietitian nutritionists (RDNs), exercise physiologists, and health coaches, can be very helpful, but these are not always available depending on health system circumstances and payer policies. 

Clinicians can also support patients through continuing education around nutrition and lifestyle medicine fundamentals, like our new FIM course or these free online courses from the American College of Lifestyle Medicine. The average medical school provides limited nutrition education throughout a student’s four years, and nutrition-related competencies are often absent from most medical specialties in graduate medical education. This has produced a physician workforce that is often unprepared to address poor diet—the leading risk factor for death and disability in the U.S. A goal of this advisory is to raise awareness and understanding of the role and importance of nutrition in health so that physicians can emphasize this to their patients and refer them to other members of the care team, such as registered dietitians, for thorough counseling. 

This work was supported by the National Institutes of Health under award numbers 2R01HL115189, P30DK04056, UE5DK137285, and U24 DK132733, and by the National Clinician Scholars Program at the Duke Clinical and Translational Science Institute. Complete information on authors, methodology and conflicts of interest is available in the published paper. The content is the sole responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or Duke Clinical and Translational Science Institute.