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Medscape
05-08-2025
- Health
- Medscape
I Prescribed a GLP-1. Now What?
This transcript has been edited for clarity. We've got another really important one today. We're going to discuss the new joint recommendations from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and the Obesity Society around nutrition and exercise for people prescribed GLP-1 therapy for obesity. This is a critically important area, as GLP-1 receptor agonists and the GLP-1/GIP dual agonist have become one of the most common medicines that we prescribe. These medicines are powerful and can lead to 15% to 22% weight loss with semaglutide and tirzepatide, respectively. A level of weight loss that I'll venture to say we did not imagine could have been possible just a few years ago. But as Spider-Man once famously said, 'With great power comes great responsibility.' We need to make sure we're spending the time that it takes to give proper advice to patients about nutrition and exercise if we want our patients to achieve the optimal health outcomes that they can get from this class of medicines. GLP-1 receptor agonists and the GLP-1/GIP dual agonist have absolutely changed the landscape for treating overweight and obesity but also come with powerful side effects, both short- and long-term. On the good side, these medicines are clearly metabolically healthy. They lead to a decrease in LDL cholesterol and triglycerides, improvement in HDL cholesterol, decreased blood pressure and blood sugar, as well as decreased vascular events in those with existent ASCVD and even improvement in arthritis pain, resolution of obstructive sleep apnea (in half of the people with OSA and obesity that were studied in an important study), and improvement in fibrosis in MASH. Nonetheless, the GLP-1s need to be used carefully and our advice is critically important if the promise of these medicines is to be fulfilled. Prior to starting weight-loss medicines, a comprehensive weight history should be taken, including asking about identifiable influences to gaining weight. We also need to look for evidence of eating disorders, which would affect the decision of whether to start an appetite-suppressing medicine, as well as influence the way that we're going to monitor people once they're on it. In addition, we should ask about mood disorders because weight loss can either exacerbate or improve depression. Finally, ask about risk of sarcopenia and assess for risk of sarcopenia, which is more common with increasing age, chronic illness, and sedentary lifestyles. Let me now discuss symptomatic side effects. First, after starting a GLP-1 receptor agonist, about a third of people during the first 1-3 months will have some degree of nausea, vomiting, diarrhea, or constipation, which are usually described as mild to moderate in degree. In order to mitigate those GI side effects, we can remind people of a few tricks. Eat small meals frequently rather than just one or two large meals a day. Avoid greasy or fatty foods. Practice mindful eating — always has been important, still is. Things like eating slowly and making sure to stop eating when you begin to feel full. In addition, it's important to remind people to consciously stay hydrated because along with suppression of appetite, there can be alterations in thirst mechanism, which is particularly important this time of year. For people who are experiencing a lot of GI side effects, a slower dose titration can be helpful. If nausea is a challenging issue, antinausea medicines, such as prochlorperazine or ondansetron, can be prescribed to help people get through the first few months. If constipation is an issue, increasing fluids and fiber can be encouraged and medications such as polyethylene glycol can be used. Let's move on, now, to potential for nutritional deficiencies. When you decrease the amount you eat substantially, you can decrease the amount of vitamins and minerals that you get. Advise patients to eat nutrient-dense, minimally processed foods, including fruits, vegetables, whole grains, legumes, lean proteins, nuts, and seeds. Supplementation can be considered for at-risk nutrients, such as vitamin D, calcium, and B 12 — or just recommend a multivitamin with minerals. Preservation of muscle and bone is critical. Rapid weight loss can lead to loss of both fat and lean body mass (that is, muscle mass). About a quarter of all the weight that is lost on GLP-1s comes from muscle. It is not the medicines, though, that caused the loss of muscle. It's the rapid weight loss. That same thing happens with a very low-calorie diet, bariatric surgery, or medications. To mitigate the loss of lean body mass, two things are important. The first thing is nutrition. The second thing is exercise. When you're in a calorie deficit, your body needs to get sufficient amino acids to preserve and build muscle mass. While the recommended daily allowance for protein in adults is 0.8 g/kg/d, when someone is at a significant calorie deficit, a higher intake of protein is recommended. There's not clarity in the literature as to the correct amount of protein. Some recommendations actually go up to 1.2-1.6 g/kg/d during active weight reduction. Some experts recommend protein needs to be calculated based on total weight; others recommend based on lean body weight. There's a lack of clarity here. As a reasonable compromise to these varied recommendations, I usually recommend that patients take in about 0.4-0.5 grams of protein per pound of body weight during weight loss. This means that a roughly 200-pound individual should aim to get about 70 or 80 grams of protein daily. Don't fret over the exact amount, but just make sure that you're not way undershooting the right amount. The reality here is that this often requires planning in order to achieve adequate protein intake. I usually recommend to patients that they can try a protein shake in the morning to help them achieve their protein goals. The advisory emphasizes that lower-volume nutrient-dense protein foods can be encouraged. Things like fish, eggs, Greek yogurt, cottage cheese, nuts and seeds, chicken. I want to emphasize that protein alone, though, is not going to be enough to help preserve muscle mass. You need to do resistance exercises, as well. As for bone health, the relationship between GLP-1 use and bone density is complex and unclear. There's some evidence that GLP-1s may actually protect bone density, while it is clear, though, that rapid weight loss leads to a loss of bone density. What is clear is that exercise is critical for the preservation of both lean body mass — meaning muscle — and bone density. So, putting it all together: When GLP-1s or dual agonists are prescribed, in order to have optimal outcomes, they should be prescribed with an exercise program, aiming for strength training at least three times weekly, plus at least 150 minutes of moderate-intensity aerobic exercise weekly, as well, to preserve muscle and bone mass. This is not easy. I'm not saying it is. I am saying it's important. A dietitian can help with nutrition, and a personal trainer or YouTube videos are also resources for learning how to do strength training — that is, resistance exercises. Finally, for a variety of reasons, people often stop taking GLP-1s. It's clear that most people will put weight back on. Maybe not everyone and maybe not all of the weight — that's going to depend on how you approach these lifestyle issues. When you gain weight back, unless you're exercising you will not gain back muscle that has been lost. And muscle is important for health. It's important to utilize the time on the medications to reinforce healthy habits, healthy food choices, and regular exercise, because doing so increases the likelihood of success in keeping at least some of the weight off and diminishes the loss of bone and muscle over time. These are powerful medicines. And to make the best use of them, and for patients to achieve the best outcomes, requires input from us, as clinicians, for a significant commitment on the part of patients to do the work, as long as we provide the knowledge in order to achieve those outcomes. I'm interested in your thoughts. For Medscape, I'm Dr Neil Skolnik.
Medscape
08-07-2025
- Health
- Medscape
New Advisory Offers First Consensus in Prescribing GLP-1s
Anywhere from 6% to 12% of the US population has taken a GLP-1 agonist. But until now there hasn't been a cohesive message among physicians for how to care for this growing patient population. Last month the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society released a joint advisory that included a list of nutritional and lifestyle priorities to help physicians guide patients on their weight-loss journey. Published in late May in the journal Obesity, the priorities included a baseline nutritional assessment, an understanding of patient goals, management of the most common medication side effects, reduced dependence on ultra-processed foods, prevention of nutrient deficiencies, strength training to prevent muscle loss, and other lifestyle factors that might influence weight loss. 'GLP-1s are reshaping the landscape of obesity treatment, but it's clear that medication alone is not a complete solution,' John E. Courtney, PhD, CEO of the American Society for Nutrition, said in a statement. While the medications can powerfully reduce hunger in patients who take them, they work best in conjunction with lifestyle changes, the most important of which is proper nutrition. An Emphasis on Diet Primary care physicians need to work with patients to better understand their diet before prescribing these medications, said lead study author and Advisory Chair Dariush Mozaffarian, MD, PhD, director of the Food is Medicine Institute of Tufts University, Boston. 'These medications are approved as an adjunct to nutrition and lifestyle therapy and right now they're being used as a first line in most cases,' said Mozaffarian. Asking a simple set of questions about what patients eat in a day, whether they snack, and whether they eat out at restaurants can provide physicians with a good idea of a patient's diet pitfalls. Dariush Mozaffarian, MD, PhD Other barriers to healthy eating can include cost but also knowledge of how to prepare healthy meals, proper cooking equipment, culture, and food traditions around healthy eating. Additionally, some patients might not live near grocery stores. A study published last year in the journal Obesity Pillars found that physicians and dietitians can help patients maximize long-term weight loss results by providing them with personalized guidance. For example, apps that can help patients track nutrition and daily caloric intake as well as personalized advice that can help highlight their dietary sticking points. Additionally, about half of all patients have significant gastrointestinal issues on these medications and eating a healthy, well-balanced diet can help them to stave off some of the most common side effects, including constipation, nausea, and vomiting, said Mozaffarian. This includes tricks of the trade like drinking ample water, eating small meals, getting enough fiber, and avoiding fatty foods. Ramping up dosages of the medications more slowly can also help patients to avoid these symptoms. Reducing Dependence on Ultra-Processed Foods 'Many patients not only eat less but their preferences for foods change and one of the most common themes is that they no longer crave ultra-processed foods that are very sweet or contain artificial ingredients,' said Mozaffarian. These are the foods that can be high in fat and contain chemicals that make people want to keep eating them. There's also research to show that ultra-processed foods are increasing some of the comorbidities that go along with weight gain like diabetes and nonalcoholic fatty liver disease. Some of the chemicals in these foods might also be driving effects on the gut microbiome and intestinal health, said Carolynn Francavilla, MD, a nationally recognized obesity physician who owns and operates Green Mountain Partners for Health and Colorado Weight Care, both in Denver. Staving Off Nutrient Deficiencies What's more, some research has shown that many patients aren't getting ample nutrition because their appetite is so suppressed. One study released in April in Frontiers in Nutrition found that patients on GLP-1s were not getting sufficient amounts of fiber, calcium, iron, magnesium, potassium, and choline as well as vitamins A, C, D, and E. Carolynn Francavilla, MD Focusing on minimally processed foods can help patients to avoid deficiencies that come with the medications. When a patient's diet is drastically reduced, it can make it difficult to get enough protein as well as essential micronutrients. Carefully planning meals to fit in enough protein as well as fruits, vegetables, and whole grains is a great way to ensure that patients avoid deficiencies. However, some processed foods, for example, meal replacement shakes and bars might help patients get enough nutrients when they don't have the appetite they once did. 'These should be an exception because for some patients they can help fill in the gaps,' said Francavilla. Other Lifestyle Factors That Help Optimize Weight Loss Patents not only lose fat on GLP-1s but also lose bone and muscle if they don't participate in strength training at least twice weekly. And as mentioned above, protein, calcium, and vitamin D are also very important for reducing the bone and muscle loss that can lead to frailty later in life. The advisory also names other lifestyle factors like sleep, mental stress, substance use, and social connections as important priorities that can help patients maximize long-term success on these medications. 'GLP-1s help more than all the prior generations of obesity drugs, but that doesn't obviate the need for good physical activity and managing all the other stressors in one's life,' said Ziyad Al-Aly, MD, an assistant professor in the Division of General Medicine & Geriatrics at Washington University School of Medicine in St. Louis. Ziyad Al-Aly, MD Sleep is especially important and can often be overlooked. A wide breadth of research shows that sleep deprivation plays a role in weight loss. A study published in the April 2022 issue of the journal Nutrients found that individuals who slept for 5.5 hours per night lost less fat than those who slept for 8.5 hours per night. Al-Aly noted that one of the lesser known side effects of these medications is that they can cause sleep disturbance. This means that sleep hygiene, for example, going to bed at the same time nightly, avoiding screen time before bed, and avoiding caffeine later in the day are particularly important for those taking these medications. Substance use can also be problematic because while some research has shown that these medications impact the brain reward center, thereby reducing addictive behavior like alcohol abuse, patients who still drink too much are at a much greater risk for dangerous nutrient deficiencies. Physicians need to ensure that their patients are aware of these risks. This advisory is tremendously helpful for physicians in providing a unified message, said Al-Aly. 'This is exactly what prescribers and doctors in patient communities really need, not only to help patients reach dramatic weight loss but to take into account their long-term risk factors and health.'
Yahoo
11-06-2025
- Entertainment
- Yahoo
Meet the first Mrs. Telugu USA from Baton Rouge
BATON ROUGE, La. (Louisiana First)— Over 200 people applied, 41 finalists were selected, but one Baton Rouge woman walked away with the Mrs. Telugu USA crown. Dr. Thirumalini Dasari, who practices rheumatology and obesity medicine, is the face of the Telugu American community, one of the fastest-growing southeastern communities in the United States, with 1.2 to 1.5 million people. 'We Telugu people are contributing to the U.S. both intellectually, economically, socially, and culturally, making a mark on the global platform,' said Dasari. In May, Dasari participated in the first Telugu pageant held in Dallas, Texas. She said over 500 people were in attendance to witness history. Dasari, who also hosted Miss World in India, said she's been competing since she was a child. Although each pageant is unique, she walks about with something different. The national winner said she spent eight months preparing for this moment. 'It was history… I'm your pilot queen from Baton Rouge, Louisiana,' said Dasari. The Mrs. Telugu crown itself represents more than a victory; Dasari said it's a testament to strength, culture, and timeless elegance. This crown of heritage was designed in South America, replicating other pageant crowns like Miss Universe. 'Pageantry has been a cornerstone of grace and entertainment… to show women's confidence and capabilities, and that's something that I've learned through the journey of my own pageantry. I think that's a great thing to happen so that we as women can have a voice,' said Dasari. Now that Dasari wears the prestigious crown, her work doesn't end on stage. Now she plans to continue her work as a cultural ambassador with plans to partner with the American Heart Association, the Obesity Medicine Association and other groups to bring awareness to chronic diseases among other projects. 'I would like to put forward a project called 'Cultural Sustainability,' where I'm bringing the arts from India and showing it to the global platform, the craftsmanship,' said Dasari. Opal Suchata Chuangsri from Thailand crowned Miss World 2025 BMW's new flagship SUV to debut in US 10 Chinese nationals detained after ICE operation at Baton Rouge massage parlors What to know about the new 'Nimbus' COVID variant Meet the first Mrs. Telugu USA from Baton Rouge House GOP approves 'technical changes' to Trump agenda bill Copyright 2025 Nexstar Media, Inc. All rights reserved. This material may not be published, broadcast, rewritten, or redistributed.
Medscape
04-06-2025
- Health
- Medscape
Advisory: Nutrition Priorities for GLP-1 Use in Obesity
Four clinical organizations jointly released a clinical advisory with evidence-based nutrition and lifestyle interventions to enhance glucagon-like peptide 1 (GLP-1) treatment outcomes for obesity. METHODOLOGY: An expert group comprised of multiple clinical and research disciplines assessed the literature to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment for obesity. Based on the group's findings, The Obesity Society, American College of Lifestyle Medicine, American Society for Nutrition, and the Obesity Medicine Association simultaneously published 'Nutritional Priorities to Support GLP-1 Therapy for Obesity' in their own peer-reviewed journals. The consensus-based clinical advisory reflects an interdisciplinary collaboration to help clinicians support patients receiving GLP-1 treatment with evidence-based nutritional and behavioral strategies. TAKEAWAY: The expert group found that GLP-1s reduced body weight by 5%-18% in trials, with modestly lower effects in real-world analyses, and multiple clinical benefits. Challenges included side effects, especially gastrointestinal (GI); nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence and subsequent weight regain; as well as high costs resulting in low cost-effectiveness. The group recommended eight priorities to address the challenges: (1) Patient-centered initiation of therapy; (2) careful baseline nutritional assessment; (3) management of GI side effects, (4) personalized, nutrient-dense, minimally processed diets; (5) prevention of micronutrient deficiencies; (6) adequate protein intake and strength training to preserve lean mass; (7) leveraging a good diet to maximize weight reduction; and (8) promoting other lifestyle changes around activity, sleep, mental stress, substance use, and social connections to maximize long-term success. IN PRACTICE: 'Medical therapy for obesity and lifestyle changes go and-in-hand,' Marc-Andre Cornier, MD, The Obesity Society president, said in an accompanying press release. 'This guidance lays a nutrition roadmap to help providers support their patients on sustainable and lasting weight reduction journeys. It underscores the importance of nutrition on quality of life and is an important contribution to the literature about incorporating lifestyle interventions into obesity care.' SOURCE: The clinical advisory, led by Advisory Chair Dariush Mozaffarian, MD, DrPH, of Tufts University, Boston, was published simultaneously in Obesity , American Journal of Lifestyle Medicine , The American Journal of Clinical Nutrition , and Obesity Pillars . LIMITATIONS: Recommendations are based on a literature review and a consensus among expert group members. DISCLOSURES: Mozaffarian reported research funding from the National Institutes of Health, Kaiser Permanente Fund at the East Bay Community Foundation, National Association of Chain Drug Stores Foundation, Google Health, and The Rockefeller Foundation; scientific advisory board, Beren Therapeutics, Brightseed, Calibrate, Elysium Health, Filtricine, HumanCo, Instacart Health, January Inc., WndrHLTH; scientific consulting, Amazon Health; equity in Calibrate and HumanCo; and chapter royalties from UpToDate.
Yahoo
31-05-2025
- Health
- Yahoo
Food and fitness make or break success on weight loss meds, report finds
Drugs like Wegovy and Zepbound -- GLP-1 medications typically used to treat obesity -- can lead to impressive weight loss. But a new joint advisory from four major medical groups warns that without proper nutrition and lifestyle support, people may face muscle loss, weight regain, and high long-term costs once they take themselves off GLP-1 medications. Experts from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association and The Obesity Society contributed to the report, which noted that only about half of users continue taking their GLP-1 medication after one year and only about 15% remain on treatment after two years. Many people stop taking GLP-1 medications due to side effects, cost or disappointing results -- and when they do, they often regain weight, making long-term success depend on consistent use and a healthy diet, the report stated. The report aims to guide both clinicians and patients on nutrition and lifestyle changes to improve long-term outcomes while taking a GLP-1. "We really wanted to bring in four major societies together that focus on nutrition, lifestyle, [and] obesity and come with a consensus statement on how nutrition should be thought about when prescribing these drugs," Dr. Dariush Mozaffarian, a cardiologist, director of the Food is Medicine Institute at Tufts University, and the report's lead author, told ABC News. Mozaffarian explained that for someone to achieve success on a GLP-1, they need to commit to comprehensive lifestyle changes. "The FDA says these drugs are approved for use as an adjunct to lifestyle therapy," he said. "In fact, they are prescribed the other way around with lifestyle therapy being the adjunct if being thought about at all. Doctors are not following either society guidelines or FDA guidelines if they are prescribing [GLP-1s] without lifestyle therapy." Understanding diet, nutritional needs while on weight loss drugs Before starting GLP-1 medications, the report recommended that patients work with their doctors to set goals that focus on overall health, not just weight loss. It's also important to check for any stomach or bone issues that could lead to side effects like nausea, vomiting, or muscle and bone loss, the report stated. "Registered dietitians can play really key roles in comprehensive obesity care by providing medical nutrition therapy to support GLP-1 therapy," said Emily A. Callahan, registered dietitian nutritionist and director of policy strategy for the Food is Medicine Institute. "The evidence space is growing that shows when registered dietitians deliver medical nutrition therapy, it has been associated with improvements in body weight, waist circumference, blood pressure and glycemic control." People should usually start GLP-1 medications at the lowest dose and slowly increase as needed, the report said. Patients should also be aware that nausea is common when taking these drugs and this may trigger cravings for sugary, high-calorie comfort foods that work against weight loss. To stay on track, the report recommended eating small, frequent meals and focusing on minimally processed, nutrient-rich foods. The report called for exercising special caution for anyone following an intermittent fasting diet or a low-carbohydrate "keto diet" that limits foods like breads, pastas and fruit to put the body into a state called ketosis, where it burns fat for fuel instead of carbs. These individuals might be especially vulnerable to gastrointestinal side effects, the report said. The report also advised people who may not be getting enough nutrients to consider taking supplements like vitamin D, calcium and multivitamins, while increasing protein intake by 50-100% from foods such as fish, eggs, nuts and seeds. This is especially important for those eating less while on GLP-1s, since lower food intake can make it harder to get all the nutrients the body needs. The report also underscored the importance of maintaining muscle mass and bone density while losing weight. Since weight loss can also lead to muscle loss -- especially in older adults -- the report advised doing a full body strength training routine at least three times a week and getting 150 minutes of moderate cardio each week. Josh Gad opens up for 1st time about taking weight loss drug: 'It is life-changing' Focusing on nutrition, physical activity and other healthy lifestyle habits should give GLP-1 users a greater chance of achieving their goals, the report concluded. "GLP-1s have the best chance of helping people achieve and sustain lasting weight reduction when they are paired with strong nutrition guidance and lifestyle support," said Callahan. Dr. Brendan Huang serves as the chief resident physician in adult neurology at Northwell Health and is also a member of the ABC News Medical Unit. Food and fitness make or break success on weight loss meds, report finds originally appeared on
