This transcript has been edited for clarity.
This is Dr JoAnn Manson, professor of medicine at Harvard Medical School and Brigham and Women’s Hospital. I’d like to talk with you about a recent Clinical Insights article in JAMA Internal Medicine, which is a very brief, succinct, two-page article about improving outcomes of patients on GLP-1 medications by integrating diet and physical activity guidance. The bottom line: Lifestyle factors remain crucial for patients on GLP-1 medications to optimize outcomes. This paper also comes with a companion JAMA Patient Page that contains patient-friendly and accessible information to help patients utilize these takeaways.
I’d like to acknowledge that I’m a co-author of the Clinical Insights article and Patient Page.
Now, we know that the GLP-1 medications and dual receptor agonist medications are very effective in terms of weight loss, achieving about 20% weight loss or more. But we also know from randomized trials that loss of muscle mass and lean body mass is also quite common, sometimes accounting for 25% or more of the total weight loss. Also, gastrointestinal symptoms — such as nausea, constipation, and reflux — can limit the use of these medications, lead to drug discontinuation, and subsequently results in weight regain.
So, the goal of the Clinical Insights article and Patient Page is to help improve patient outcomes, avoid muscle loss, and avoid the gastrointestinal symptoms that can lead to drug discontinuation. The article provides information on how to incorporate a healthy diet while on GLP-1s, which consists of a largely plant-based diet that ensures adequate protein intake and adequate hydration — sometimes requiring 2-3 liters of water, or more, per day.
These publications also help identify situations in which patients may benefit from micronutrient supplementation and, importantly, provide guidance on physical activity. Aerobic exercise is recommended but, in particular, resistance activities and muscle-strengthening activities can help mitigate the muscle loss and the lean body mass loss that commonly occurs on these medications.
The Clinical Insights article and accompanying Patient Page also provide information on ways to minimize the likelihood of having gastrointestinal symptoms that would limit GLP-1 use.
Overall, we hope that this information will be a good resource that will result in better care for patients on GLP-1 medications and better outcomes.