2025-06-04 タフツ大学
Graphic: Courtesy of the American Journal of Clinical Nutrition
<関連情報>
- https://now.tufts.edu/2025/06/04/long-term-success-glp-1s-hinges-more-just-prescription
- https://ajcn.nutrition.org/article/S0002-9165(25)00240-0/fulltext
肥満症に対するGLP-1療法をサポートするための栄養学的優先事項:米国生活習慣病学会、米国栄養学会、肥満症学会、および肥満学会からの共同勧告 Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society
Dariush Mozaffarian ∙ Monica Agarwal ∙ Monica Aggarwal ∙ … ∙ Deepa Sannidhi ∙ Fatima Cody Stanford ∙ Emily A Callahan
The American Journal of Clinical Nutrition Published:May 30, 2025
DOI:https://doi.org/10.1016/j.ajcnut.2025.04.023
Abstract
Background
Glucagon-like peptide 1 receptor agonists and combination medications (hereafter collectively referred to as GLP-1s) are shifting the treatment landscape for obesity. However, real-world challenges and limited clinician and public knowledge on nutritional and lifestyle interventions can limit GLP-1 efficacy, equitable results, and cost-effectiveness.
Objectives
We aimed to identify pragmatic priorities for nutrition and other lifestyle interventions relevant to GLP-1 treatment of obesity for the practicing clinician.
Methods
An expert group comprising multiple clinical and research disciplines appraised the scientific literature, informed by expert knowledge and clinical experience, to identify and summarize relevant topics, priorities, and emerging directions.
Results
GLP-1s reduce body weight by 5% to 18% in trials, with modestly lower effects in real-world analyses, and multiple demonstrated clinical benefits. Challenges include side effects, especially gastrointestinal; nutritional deficiencies due to calorie reduction; muscle and bone loss; low long-term adherence with subsequent weight regain; and high costs with resulting low cost-effectiveness. Numerous practice guidelines recommend multicomponent, evidence-based nutritional and behavioral therapy for adults with obesity, but use of such therapies with GLP-1s is not widespread. Priorities to address this include: (a) patient-centered initiation of GLP-1s, including goals for weight reduction and health; (b) baseline screening, including usual dietary habits, emotional triggers, disordered eating, and relevant medical conditions; (c) comprehensive exam including muscle strength, function, and body composition assessment; (d) social determinants of health screening; (e) and lifestyle assessment including aerobic activity, strength training, sleep, mental stress, substance use, and social connections. During GLP-1 use, nutritional and medical management of gastrointestinal side effects is critical, as is navigating altered dietary preferences and intakes, preventing nutrient deficiencies, preserving muscle and bone mass through resistance training and appropriate diet, and complementary lifestyle interventions. Supportive strategies include group-based visits, registered dietitian nutritionist counseling, telehealth and digital platforms, and Food is Medicine interventions. Drug access, food and nutrition insecurity, and nutrition and culinary knowledge influence equitable obesity management with GLP-1s. Emerging areas for more study include dietary modulation of endogenous GLP-1, strategies to improve compliance, nutritional priorities for weight maintenance post-cessation, combination or staged intensive lifestyle management, and diagnostic criteria for clinical obesity.
Conclusions
Evidence-based nutritional and lifestyle strategies play a pivotal role to address key challenges around GLP-1 treatment of obesity, making clinicians more effective in advancing their patients’ health.
