How to best optimize patients’ diets with or without GLP-1s

Key takeaways:

• Plant-forward eating may be a preferable dietary intervention for patients not on GLP-1s.
• For patients on GLP-1s, it is important to ensure adequate intake of several components and to minimize adverse effects.

NATIONAL HARBOR, Md. — Approaches to dietary interventions among patients with obesity can differ depending on whether they are also being treated with a GLP-1 receptor agonist, according to a speaker.

At Obesity Medicine 2025, Nate Wood, MD, MHS, Chef, DipABLM, DABOM, director of culinary medicine at Yale School of Medicine, said there are many factors to consider when optimizing diets, which can be confusing.

“You are not the only person out there if you are confused about nutrition,” he said. “We as physicians and health care professionals are confused about this, and I can assure you your patients are confused about it too.”

Dietary interventions without GLP-1s

According to Wood, no single diet is the best for short-term weight loss.

Instead, “what really matters — as we’ve seen from these meta-analyses and systematic reviews of randomized controlled trials — is that you can lose weight on a reduced calorie diet,” he said. “It does not matter how you cut those calories.”

Wood recommended plant-forward eating for patients not on GLP-1s, a dietary approach that emphasizes a greater intake of whole plant-like fruits, vegetables, whole grains and legumes and a reduced intake of ultra-processed foods high in sugar, salt, calories and refined carbs.

The strategies related to this pattern, like swapping meat for legumes and less consumption of fat and sugar, can ultimately reduce calorie density and result in prolonged satiation, lower intake of empty calories and greater mastication time.

Wood also said that the daily calorie goal of a diet should be patients’ total number of calories burned daily minus their set desired pace of weight loss weekly, which he added should be between a half pound to 2 pounds.

He further recommended prioritizing protein — with a minimum daily intake of 0.8 g/kg and a suggested daily intake of 1 to 1.5 g/kg — and said that fat consumed should be mostly unsaturated.

“We do know that protein is more satiating than other forms of [nutrients] like fat or carbohydrates,” he said.

Dietary interventions with GLP-1s

Wood said that patients on GLP-1s “have less of an appetite when losing weight, and we don’t want them to lose weight too quickly because they’re at risk of losing excess muscle and lean mass in addition to losing fat mass.”

He pointed out that ensuring adequate intake of protein, fluid, energy, fiber and micronutrients like vitamin D and calcium can help to mitigate this risk.

“This is a totally new era [where] we have medications so strong that we have to say, ‘We need to make sure you’re eating enough,’” he said.

Wood added that other strategies that may minimize adverse events associated with GLP-1s, such as constipation and vomiting, can include:

• avoiding foods that worsen acid reflux;
• having smaller, more frequent meals; and
• stopping eating when feeling 80% full.

For the last strategy, Wood said to wait an hour and if the hunger is still there, then it is OK to eat.

“Don’t accidentally overshoot when you’re sitting down to eat dinner because these medications can really cause a lot of side effects … if you’re eating large portions of food,” he said.