Managing GLP-1 Aspect Results With Lifestyle Interventions

Glucagon-like peptide-1 receptor agonists (GLP-1s) have shortly develop into a cornerstone of weight problems remedy, with scientific trials displaying spectacular outcomes for weight reduction and enhancements in cardiometabolic well being. But as extra sufferers begin these medicines in real-world settings, physicians are working into challenges that transcend vitamin labels and urge for food suppression.

To handle these gaps, 4 main medical societies—the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society—got here collectively to publish a joint advisory providing sensible, multidisciplinary steering for clinicians managing sufferers on GLP-1s for weight problems. The doc covers a variety of issues, together with what to do concerning the excessive charges of GI unwanted effects, how you can shield towards muscle loss, and why protein consumption and resistance coaching must be customary elements of the remedy plan.

In the temporary video above, coauthor of the joint advisory Jonathan Bonnet, MD, MPH, digs into a few of the less-discussed—however no much less essential—challenges that include GLP-1 remedy. He mentioned the predictable GI unwanted effects (eg, nausea, constipation, and reflux) and the way small however significant life-style changes (eg, meal timing, hydration, fiber) could make an enormous distinction in tolerability. He additionally flagged the chance of dropping lean mass, particularly if protein consumption is low and bodily exercise is minimal—one thing physicians is probably not monitoring as carefully as they need to.

The overarching message: GLP-1s don’t work in a vacuum. Without the help of intentional life-style methods—particularly associated to food plan and train—sufferers might wrestle to get the complete good thing about remedy or might expertise avoidable problems. As Bonnet explains, the treatment is highly effective, however it’s not plug-and-play. It requires a plan.

Jonathan Bonnet, MD, MPH, is this system director of medical weight reduction on the scientific useful resource hub weight administration middle at Palo Alto Veteran’s Affairs in Palo Alto, California. He can also be an affiliate professor (affiliate) at Stanford University School of Medicine, and serves on the board of the American Board of Lifestyle Medicine.

The following transcript has been edited for readability, circulation, and magnificence.

Patient Care: In addition to dietary deficiencies, may you undergo a few of the different challenges highlighted within the advisory?

Jonathan Bonnet, MD, MPH: When you are utilizing medicines like these, one apparent situation is unwanted effects. They’re efficient for many individuals, however not everybody. Some folks don’t reply in any respect, and others reply rather well—you get the entire spectrum in between.

There are plenty of GI-related unwanted effects, which is an enormous situation. Many of those will be mitigated with life-style measures. For instance, nausea is the commonest facet impact. Eating smaller meals, consuming extra regularly, and never skipping meals may also help. It usually will get higher over time. Then you’ve obtained issues like constipation and diarrhea—these will be influenced by food plan. Encouraging sufferers to eat high-fiber, high-water meals may also help with constipation. Some sufferers expertise reflux or heartburn, and that will also be managed—like avoiding spicy meals, not consuming too late, and never mendacity down proper after consuming.

So sure, dietary deficiencies are a priority, however while you suppose extra broadly about what these medicines do—they considerably scale back urge for food and general caloric consumption—you continue to want to verify folks get adequate vitamins. Most folks consider nutritional vitamins and minerals, however we even have to think about protein and fiber.

There’s an actual danger of individuals not consuming sufficient protein, and that’s not simply concerning the nutrient itself—it’s about what it does. If somebody isn’t consuming sufficient protein, they may lose muscle mass. That’s the place resistance coaching is available in, to assist protect lean physique mass as folks drop some weight.

And there are different dangers, too—like the price of the treatment and unanswered questions on long-term security. We don’t but know what points may emerge 10 years down the road.

For extra of our dialog with Dr Bonnet, try: Why 4 Medical Societies Issued a Joint Advisory on Nutrition and GLP-1 Therapy for Obesity