Guidance on Nutrition and Physical Activity for Patients Using GLP-1 Receptor Agonists to Manage Side Effects

Recent recommendations emphasize the importance of integrating tailored nutrition and physical activity strategies for patients on GLP-1 receptor agonists, such as Ozempic, Wegovy, Rybelsus, Mounjaro, Victoza, and Trulicity, to effectively manage side effects. Harvard T.H. Chan School of Public Health highlights that combining these medications with personalized lifestyle interventions is crucial to mitigate adverse effects like muscle loss, nutritional deficiencies, and excessive weight loss.

GLP-1 medications are increasingly used for weight loss, as they suppress appetite and slow gastric emptying, often leading to reduced protein, micronutrient, and fluid intake. Significant lean mass loss, ranging from 25% to 40% of weight reduction, has been observed across various interventions. To address these concerns, current guidelines recommend regular monitoring of body weight, nutrition, and muscular strength.

Clinicians are advised to conduct monthly weight checks during medication titration phase and quarterly assessments afterward. Patients losing less than 5% of their body weight within 12-16 weeks should be evaluated to determine the need for extended titration, dose adjustments, or medication switches. Signs of excessive weight loss, such as BMI under 18.5, daily caloric intake below 800 kcal, or significant protein restriction, should prompt further investigation into secondary causes or discontinuation of therapy.

Nutritional support should begin with a professional evaluation by a registered dietitian, with follow-ups every two to three months. Nutritional targets include 60-75 grams of protein daily, with increased needs for older adults and postbariatric patients. Calorie recommendations are 1,200–1,500 kcal/day for women and 1,500–1,800 kcal/day for men, emphasizing whole grains, fiber, lean protein, healthy fats, and hydration exceeding 2-3 liters daily. Monitoring for micronutrient deficiencies, especially vitamin D, folate, and iron, is also recommended.

Physical activity plays a key role in preserving lean body mass. A phased approach involves gradual increase in movement, resistance training (60-90 minutes per week), and regular aerobic exercise (30-60 minutes daily), with resistance sessions two to three times weekly. Resistance training during caloric restriction can significantly reduce lean mass loss, with assessments like grip strength and six-minute walk tests helping track ongoing health.

Post-treatment weight regain, estimated at 7-12%, is common within a year after discontinuation. To sustain benefits, gradual tapering and continued monitoring of metabolic health, muscle strength, and dietary habits are advised. If weight regain exceeds 5%, additional interventions may be necessary. The overall goal is to ensure medication benefits are maintained through comprehensive lifestyle and nutritional strategies.

This guidance underscores that optimal outcomes depend on a combination of pharmacologic and non-pharmacologic interventions to promote long-term health in patients using GLP-1 receptor agonists.

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