As incretin-based therapies continue to reshape obesity management, obesity and dietitian societies have issued new multidisciplinary recommendations aimed at improving nutritional, functional, and psychological care during treatment. The consensus statement, presented at the European Congress on Obesity 2026, addressed practical challenges surrounding glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and related obesity medications, including lean mass preservation, gastrointestinal adverse events, mental health monitoring, and long-term nutritional safety.
The statement was jointly developed by the European Association for the Study of Obesity, European Federation of the Associations of Dietitians, and European Coalition for People Living with Obesity. Laurence Dobbie and an international group of 26 authors emphasized that incretin-based therapies “represent a paradigm shift in obesity care,” but noted that treatment may also introduce nutritional, functional, and psychological risks requiring multidisciplinary support.
The consensus statement identified dietitian-led medical nutritional therapy as a central component of obesity care during incretin-based treatment. Recommendations included ensuring adequate protein, vitamin, mineral, fiber, and fluid intake while reinforcing healthy dietary patterns and sustainable behavior change. The statement also highlighted the role of dose adjustment strategies to help minimize gastrointestinal adverse events during treatment escalation.
The authors emphasized that psychological support should be integrated into obesity care because many people living with obesity may have pre-existing mental health vulnerabilities. The statement noted that significant weight loss can be accompanied by profound identity changes and potential re-emergence of psychological disorders. The authors recommended screening for mental health conditions and alcohol use disorders before initiation of GLP-1 RA therapy.
The consensus statement also addressed concerns regarding loss of fat-free mass during incretin-based therapy. According to analyses of existing clinical trials, approximately 24-30% of weight loss during incretin-based treatment reflects fat-free mass, most of which is skeletal muscle. However, the long-term health implications remain uncertain, particularly in older adults with lower baseline muscle reserves.
To monitor body composition and functional status, the authors recommended moving beyond body mass index (BMI) alone by incorporating measures of central adiposity, such as waist circumference or waist-to-height ratio, together with pragmatic assessments of muscle function, including adjusted handgrip strength or five-times sit-to-stand testing. Dual-energy x-ray absorptiometry and bioelectrical impedance analysis were recommended where available, particularly for individuals at higher risk of sarcopenia.
The statement proposed a pragmatic target of maintaining an approximate 3:1 ratio of fat loss to lean-mass loss during obesity treatment. The authors also emphasized the importance of resistance training alongside aerobic exercise to help preserve lean body mass during weight reduction.
Socioeconomic disparities in obesity care were also highlighted. The authors noted that minority ethnic populations and individuals with socioeconomic deprivation often face reduced access to specialist obesity services and incretin-based therapies. They stated that public policy should expand access to obesity pharmacotherapy and dietitian-led medical nutritional therapy while addressing persistent stigma surrounding obesity treatment.
The consensus additionally identified major evidence gaps across incretin-based obesity therapy trials. A systematic review of 417 randomized controlled trials showed that fewer than 20% reported dietary intake or nutritional biomarkers, while fewer than 5% reported bone health, micronutrient status, or physical-function outcomes.
The authors stated: “Research priorities include a core outcome set for IBT trials; robust nutritional-safety surveillance; evaluation of muscle function and performance; strategies to preserve lean mass and bone; optimal protein intake during IBT treatment; psychological outcomes and targeted supports; and post-cessation studies.”
They concluded: “IBTs represent a paradigm shift in obesity care; optimal implementation includes dietitian-led medical nutrition therapy with integrated psychological and functional support.” The statement added that priorities include “mitigating gastrointestinal effects, preventing micronutrient deficiencies, and preserving lean mass via adequate protein, fibre, fluids and nutrient-dense foods, alongside resistance training, targeted supplementation and regular monitoring.”
