Guidance for Patients Taking GLP-1 Medications for Weight Loss: Nutrition, Hydration, and Lifestyle Strategies.

As glucagon-like peptide-1 (GLP-1) receptor agonists like semaglutide and tirzepatide become increasingly popular for obesity management, proper dietary and lifestyle guidance becomes essential for maximizing their benefits and mitigating side effects. In a recent Patient Page published by JAMA Internal Medicine, experts from Harvard Medical School and affiliated institutions summarize key recommendations for patients using these medications for weight loss.

These GLP-1 therapies act by reducing appetite, increasing satiety, slowing gastric emptying, and improving glycemic control. However, they are also associated with potential adverse effects such as nausea, heartburn, constipation, and muscle mass loss. To address these issues, the authors introduce the MEAL plan—an easy-to-follow framework focused on Muscle maintenance, Energy balance, Avoiding side effects, and Liquid intake.

MEAL Plan Highlights

• Muscle Maintenance: Because GLP-1 therapies may lead to unintentional loss of lean body mass, meals should start with 20–30g of high-quality protein (e.g., fish, legumes, tofu). Moderately active individuals should target 1.0–1.5g of protein per kg of body weight daily. Protein shakes are recommended when appetite is significantly suppressed.
• Energy Balance: Small meals with healthy snacks—like nuts, yogurt, and fruit—help maintain energy levels. Emphasis is placed on complex carbohydrates (oatmeal, sweet potatoes) and healthy fats (olive oil, avocado), while avoiding refined carbs and sugar-sweetened beverages.
• Avoiding Side Effects:
• Nausea: Eat low-fat, bland foods (e.g., whole-grain toast) and avoid fried or heavily processed foods. Ginger tea or fruit can be helpful.
• Heartburn: Reduce meal size, avoid lying down after eating, and avoid spicy or acidic foods.
• Constipation: Increase both soluble and insoluble fiber (oats, apple, vegetable skins, nuts), along with sufficient water intake. Laxatives or stool softeners may be needed.
• Liquid Intake: Hydration is crucial, as GLP-1 medications can increase the risk of dehydration. A daily fluid intake of 2–3 liters (8–12 cups) is advised, primarily water. Hydrating foods like watermelon, cucumber, and soups are encouraged, while limiting caffeine and alcohol.

Additional Recommendations

• Diet Cautions: Extremely low-calorie or restrictive diets are discouraged due to risks of dehydration, fatigue, and nutrient deficiencies. Strict vegan diets may lack essential nutrients like B12, iron, and complete proteins.
• Exercise Strategy: A three-tiered physical activity plan is encouraged:

1. Gradual increase of moderate aerobic activity (e.g., brisk walking) up to 150 minutes weekly.
2. Strength training twice to three times per week (e.g., squats, lunges, resistance bands).
3. Maintenance phase of 30–60 minutes of activity daily, including resistance work.

• Sustaining Weight Loss: Discontinuing medication may result in weight regain. The best preventive measure is continuing a structured lifestyle plan that includes regular physical activity, resistance training, and a balanced, protein-rich diet.
• Monitoring Progress: Patients are encouraged to track food intake and physical activity using apps, food diaries, or photos. Sharing this data with healthcare providers can support more personalized care.

These guidelines reflect an evidence-informed, patient-centered approach to the use of GLP-1 agonists and dual incretin therapies, helping to ensure safe and effective use while supporting long-term health outcomes.

Editorial note: This content was developed with the support of artificial intelligence technologies to optimize the writing and structuring of the information. All material was carefully reviewed, validated, and supplemented by human experts prior to publication, ensuring scientific accuracy and adherence to good editorial practices.

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