A joint European consensus statement offers guidance regarding nutritional, functional, and psychological considerations when prescribing incretin-based therapies.

The statement “addresses the risk that therapy becomes limited to prescribing, titration, and weight measurement. Although effective, appetite suppression, gastrointestinal symptoms, and rapid weight loss may create nutritional, functional, or psychological challenges. It supports individualized care that maximizes benefit and identifies patients who potentially require additional support,” first author Laurence Dobbie, MB ChB, National Institute for Health and Care Research Academic Clinical Fellow in general practice at King’s College London in London, England, told Medscape Medical News.

The key message, Dobbie said, “is to move beyond weight loss. Patients should remain well nourished, maintain physical function and psychological well-being, and tolerate treatment. The goal is a sustainable, personalized improvement in health and quality of life.”

The statement was issued jointly by the European Association for the Study of Obesity (EASO), the European Federation of the Associations of Dietitians (EFAD), and the European Coalition for People living with Obesity (ECPO). It was published in The Lancet Diabetes & Endocrinology.

“To our knowledge, this is the first European multidisciplinary statement integrating nutrition, physical function and body composition, psychological and mental health, lived experience, and health equity. EASO, EFAD, and ECPO developed it with professionals and people living with obesity,” Dobbie noted.

He added, “We hope clinicians will use it as a practical tool kit to support shared decision-making with patients about initiating, escalating, delaying, reducing, pausing, or discontinuing treatment.”

These are among the document’s recommendations:

• Dietitian-delivered medical nutrition therapy is an important component of care, particularly for those with greater nutritional risk or clinical complexity.
• Monitor beyond body weight and BMI, including waist circumference or waist-to-height ratio, handgrip or sit-to-stand function, and new functional difficulty.
• Nutrition is vital during appetite suppression. During active weight loss, consider approximately 1.0-1.5 g/kg of adjusted body weight per day of protein, with a minimum of 60 g/d in selected patients without contraindications. “Work toward at least 25 g/d of fiber and approximately 2.0-2.5 L/d of fluid. Individualize these targets for comorbidities, particularly chronic kidney disease,” Dobbie advised.
• Actively manage gastrointestinal symptoms. The maximum dose is not always needed, and titration can be delayed. Reduce the dose or pause treatment when appropriate. Persistent vomiting, very low intake, or suspected deficiency requires clinical review.
• Consider monitoring for disordered eating, mood deterioration, and reward substitution. “Reduced appetite and ‘food noise’ may improve aspects of psychology, but there can also be changes in identity, coping, and social connection with a changing relationship with food and weight loss,” Dobbie cautioned.
• Lean mass comprises approximately 24%-30% of weight lost during incretin-based therapy. Randomized trials have not established population-level clinical harm, and cardiometabolic benefits are clear. Monitor higher-risk patients, such as those with older age or frailty, low baseline muscle function, or rapid weight loss, rather than assuming all lean-mass loss is pathologic. “The functional status is vital when interpreting lean-mass loss,” he advised.
• Monitor bone health in those at risk, and counsel patients about maintaining adequate calcium and vitamin D intake.
• Regular physical activity is important, particularly resistance training, to preserve lean body mass, strength, and bone health.

Asked to comment, obesity medicine specialist Peminda K. Cabandugama, MD, a spokesperson for The Obesity Society, told Medscape Medical News, “This is a very comprehensive compendium of guidelines to manage patients treated with incretin-based therapies for weight loss…. It is very useful to have a single document like this to provide general guidance on the management of these patients on incretin-based therapies for weight loss.”

A future idea, he added, “should be to have the document branch off into details on the different facets of weight management to act as more in-depth stand-alone guidelines for specialists and possible future centers of excellence.”

Cabandugama also said he would have preferred that the document had included “strong comments on the need to replace BMI as a measure to start, continue, and possibly stop incretin-based therapies when providing weight-management advice to patients.”

Asked about its usefulness beyond Europe, Cabandugama said, “I do believe that this is a very relevant and useful central document for clinicians in North America as well as to the rest of the world. Future opportunities for global generalizability should be to have branched versions of the statement that can be tailored by obesity experts in each region of the world, such as Asia, the Middle East, and elsewhere. This would help propagate the future of obesity medicine, which is forecast to be more personalized.”

Dobbie has received funding, paid to King’s College London, from Novo Nordisk for independent research investigating the social determinants of obesity care, an honorarium for educational activities from Eli Lilly, and travel funding to present at international conferences from EASO. Cabandugama has reported no disclosures. 

Miriam E. Tucker is a freelance journalist based in the Washington, DC, area. She is a regular contributor to Medscape, with other work appearing in The Washington Post, NPR’s Shots blog, and diaTribe. She is on X @MiriamETucker and Bluesky @miriametucker.bsky.social.