European experts stress the importance of dietitian-led care for obesity treatment, highlighting the need for nutritional support and psychological monitoring with new guidelines.
New guidance from the European Association for the Study of Obesity (EASO) emphasizes the critical role of dietitians in managing obesity alongside the use of incretin-based therapies (IBTs), particularly GLP-1 receptor agonists. This consensus statement, presented at the European Congress on Obesity in Istanbul, Turkey, underscores the importance of medical nutritional therapy (MNT) delivered by registered dietitians to complement these drugs and ensure patient safety.
Incretin-based therapies have revolutionized obesity management but can pose significant risks if not managed properly. Dietitians play a pivotal role in providing comprehensive care that goes beyond just medication. They are essential for advising patients on proper nutrition, ensuring adequate intake of proteins, vitamins, and minerals, and adjusting drug dosages to minimize gastrointestinal side effects. Additionally, dietitians help reinforce healthy dietary patterns and facilitate long-term behavioral changes by communicating with respectful, empowering, weight-inclusive approaches.
The statement also highlights the need for nutritional psychology support. While IBTs are generally linked to fat loss, there is growing concern about the impact of these therapies on lean mass, especially in older adults who naturally have less muscle mass. The consensus recommends aiming for a 3:1 ratio of fat loss to lean-mass loss during treatment.
Monitoring body composition and functional capacity is crucial. Existing trials show that up to 30% of weight loss with IBTs comes from non-fat components like muscle, which requires careful assessment. To address this, the statement suggests incorporating measures such as waist circumference or waist-to-height ratio alongside pragmatic assessments of muscle function, such as adjusted handgrip strength or sit-to-stand tests.
Physical activity and exercise are also emphasized in obesity management. Patients should be encouraged to engage in both aerobic and resistance training to prevent lean body mass loss while aiding weight loss and overall health. The statement underscores the importance of understanding that physical activity benefits not only weight but mental health as well.
Socioeconomic considerations are another significant factor. Obesity disproportionately affects minority ethnic groups and lower socioeconomic populations, who often face barriers to accessing specialist services and insurance coverage for obesity treatments. To address these disparities, the consensus recommends expanding insurance coverage for IBTs and improving access to dietitian-led medical nutrition therapy (MNT).
Future research priorities include developing core outcome sets for IBT trials, robust nutritional-safety surveillance systems, strategies to preserve lean mass, and evaluating psychological outcomes. The statement concludes by emphasizing the need for long-term studies on nutritional, functional, and psychological outcomes of obesity treatments.
In summary, the new guidance underscores the importance of dietitian-led care in managing obesity alongside incretin-based therapies. By integrating comprehensive nutritional support with psychological monitoring and physical activity recommendations, healthcare providers can better address the multifaceted nature of obesity management.
