Do Patients Receiving GLP-1 Receptor Agonists for Weight Loss Require Structured Dietetic Care? Lessons from Metabolic and Bariatric Surgery (MBS) Pathways.

BACKGROUND

Glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual incretin therapies have significantly advanced obesity management by facilitating clinically significant weight loss and enhancing cardiometabolic outcomes. Nevertheless, their growing application calls for careful consideration of nutritional and behavioural factors, including decreased dietary intake, gastrointestinal symptoms, loss of lean mass, micronutrient deficiencies, and potential weight regain following treatment cessation.

METHODS

This narrative review synthesises evidence from clinical trials, observational studies, reviews, professional guidelines, and MBS nutrition protocols to evaluate the role of structured dietetic care in adults receiving GLP-1 RAs or related incretin-based therapies for weight management. MBS pathways provide a comparative framework for investigating how established principles of nutritional assessment, monitoring, and dietetic follow-up may inform pharmacological treatments of obesity.

RESULTS

The literature indicates that pharmacological weight-loss treatments should not be administered solely as prescription-based treatments. Structured dietetic care can facilitate nutritional assessment, personalised dietary interventions, the management of gastrointestinal symptoms, protein optimisation, behavioural counselling, physical activity support, and long-term weight maintenance. MBS pathways illustrate the role of dietitians in pre-, peri-, and post-major weight-loss interventions through assessment, guidance on supplementation, dietary progression, biochemical monitoring, and long-term maintenance. Although these principles require adaptation rather than direct application to GLP-1 RA pathways, they offer a valuable system for integrating dietitians into comprehensive obesity pharmacotherapy.

CONCLUSIONS

Structured dietetic care should be regarded as a fundamental component of the pharmacological management of obesity, especially as GLP-1 RAs and incretin-based therapies become more prevalent. Dietitians are well positioned to help optimise nutritional adequacy, preserve lean mass, manage gastrointestinal symptoms, and support sustained weight maintenance. Future research should investigate effective models for delivering dietetic care alongside incretin-based therapies, including strategies to identify patients who need more intensive support.