Obesity medications can be powerful tools for weight loss and metabolic health but without simultaneous lifestyle medicine interventions, patients risk malnutrition, muscle and bone loss, and diminished health. In this Q&A, Dr. Jasdeep Saluja, chair of ACLM’s GLP-1 committee, explains why nutrition, physical activity, sleep, and stress management are essential to maximizing benefits and managing side effects for people using GLP-1 medications.
Obesity medications, such as GLP-1 receptor agonists, have rapidly changed the landscape of obesity and metabolic disease care, offering many patients meaningful weight loss and improved glycemic control. One in eight adults report currently using GLP-1s and one in five say that have at some point used them. But as their use expands, clinicians are increasingly recognizing that medications alone are not enough.
Clinical trials establishing the efficacy of these medications, including the STEP trials for semaglutide and the SURMOUNT trials for tirzepatide, all paired pharmacotherapy with structured lifestyle interventions, such as dietary counseling and physical activity targets. Lifestyle medicine was built into the evidence base from the beginning. To protect long-term health, maintain the weight loss, and help patients truly thrive, it is increasingly recognized that GLP-1 therapy must continue to be paired with lifestyle medicine.
To explore why this combination is critical, ACLM spoke with Chief Medical Officer and Internist for Aroga Lifestyle Medicine Jasdeep Saluja, MD, FRCPC, DipABLM, DipABOM, who chairs ACLM’s GLP-1 Committee, about how he integrates lifestyle medicine into care for patients using GLP-1 medications.
Recent news stories have raised alarm about the rise in malnutrition as GLP-1 use has grown. When patients begin GLP-1 therapy, how do you talk with them about nutrition, especially when appetite is reduced?
When I meet with patients starting a GLP-1, I emphasize that this is not just a medication journey. It’s a chance to fundamentally rethink how they nourish themselves. Appetite suppression is expected, but that makes the quality of each bite even more important. We shift from thinking about volume to thinking about value, prioritizing nutrient density over caloric density.
I encourage small, frequent meals built around minimally processed foods like beans, leafy greens, lentils, berries, and nuts. Protein becomes especially important for preserving muscle mass, so we incorporate options such as Greek yogurt, tofu, lentil stews, or protein-rich smoothies.
I often describe meals as “high water, high fiber, high value” like soups, stews, and stir-fries packed with vegetables and legumes. Smoothies are also a great tool when hunger is low; they allow patients to add spinach, chia seeds, or unsweetened plant-based milks without feeling overwhelmed. I also encourage front-loading protein earlier in the day and setting gentle eating reminders if food interest drops too much.
What side effects do patients struggle with most, and how do you help them manage these challenges?
Gastrointestinal (GI) side effects, such as nausea, constipation, and bloating, are the most common, especially during dose escalation. I normalize these experiences and reassure patients that they’re often temporary and manageable.
We focus on prevention and practical support. That includes eating smaller meals, avoiding greasy or fried foods during sensitive periods, and staying well hydrated. I also remind patients not to skip meals; prolonged fasting can actually worsen nausea. Ginger or peppermint tea, acupressure bands, and medications like prochlorperazine can be helpful when needed.
For constipation, lifestyle strategies are foundational. Foods rich in soluble and insoluble fiber, such as prunes or ground flax, are often effective, and magnesium citrate can be a gentle additional support.
Beyond GI symptoms, we also watch closely for signs of nutrient deficiencies. When patients are eating less, they are inevitably taking in fewer micronutrients, and deficiencies can develop gradually. I tell patients to pay attention to persistent fatigue or brain fog, which may point to low vitamin B12 or iron. Hair thinning and brittle nails can signal inadequate zinc or biotin. Muscle cramps or bone pain may reflect insufficient vitamin D or calcium. And numbness or tingling in the hands and feet can be an early warning of B12 or thiamine depletion.
A retrospective study of more than 461,000 adults on GLP-1 therapy found that over one in five were diagnosed with a nutritional deficiency within their first year of treatment, with vitamin D being the most common. That is why I recommend baseline bloodwork before starting therapy and periodic monitoring of vitamin D, B12, iron, and thiamine, especially during the first six to twelve months. These findings are not reasons to abandon therapy, but they are clear signals that lifestyle support needs to be strengthened. When patients feel heard and equipped with strategies, they are far more likely to stay on treatment and experience its full benefits.
Do you see patients deprioritizing exercise once weight loss begins?
Yes, that happens frequently. Some patients assume that because the medication is working, exercise is less important. I gently reframe that idea. Exercise is not about the number on the scale. It is about preserving muscle, protecting bones, supporting mental health, and building long-term metabolic resilience.
During GLP-1-associated weight loss, studies suggest that roughly 25% of weight lost, and in some cases up to 40%, can come from lean mass rather than fat. That proportion is influenced by protein intake, physical activity, and age. I explain that preserving muscle is a way of protecting your health capital.
I typically recommend strength training two to three times per week, along with at least 150 minutes of moderate aerobic activity weekly. Walking, resistance bands, and bodyweight exercises all count. We focus on function and consistency, not perfection.
Anchoring movement to purpose also matters. When patients connect exercise to better energy, stronger bones, and improved glucose regulation, it shifts from something they “should” do to something they “want” to do.
How do sleep and stress fit into care for patients using GLP-1 medications?
In lifestyle medicine, we take a systems-based view of health. Sleep, stress management, physical activity, nutrition, and connectedness are deeply interconnected, and for patients on GLP-1s, these pillars are foundational.
Poor sleep increases hunger hormones, worsens insulin resistance, and drives cravings for ultra-processed foods. Chronic stress activates the HPA axis and often leads to emotional eating, which can undermine both the metabolic and quality-of-life benefits of GLP-1 therapy.
We routinely screen for sleep disorders, refer patients to behavioral sleep specialists when needed, and use mindfulness and cognitive behavioral strategies to address stress. I often remind patients that this journey is less about weight loss and more about thriving. The medication can give people the breathing room to build healthier habits, but those habits are what sustain the progress long after the prescription is written.
Absolutely. Many of my patients report that their relationship with alcohol shifts once they start GLP-1 therapy. Sometimes they simply lose interest; other times they notice their tolerance drops or they feel the effects more quickly.
Emerging research supports what we are seeing clinically. A 2025 randomized trial published in JAMA Psychiatry found that low-dose semaglutide reduced alcohol craving and the number of drinks consumed on drinking days in adults with alcohol use disorder. A systematic review and meta-analysis in eClinicalMedicine, pooling fourteen studies, found that GLP-1 receptor agonists, particularly semaglutide and liraglutide, were associated with reduced alcohol consumption, lower relapse rates, and fewer alcohol-related diagnoses.
This creates a genuine clinical opening. In lifestyle medicine, we recognize risky substance use as one of the six pillars, and I think a GLP-1 prescription gives us a natural moment to have that conversation. When a patient is already rethinking their relationship with food, sleep, and movement, it is a short step to ask, “Have you thought about how alcohol fits into your health goals?”
From a metabolic perspective, alcohol adds empty calories, disrupts sleep architecture, worsens insulin resistance, and contributes to fatty liver disease, all of which can undermine the very outcomes GLP-1 therapy is designed to achieve. Whether or not a patient meets criteria for alcohol use disorder, this is a chance to explore moderation or abstinence as part of a broader lifestyle reset. I encourage clinicians not to let this moment pass.
Learn more: In 2025, the American College of Lifestyle Medicine joined the American Society for Nutrition (ASN), the Obesity Medicine Association (OMA), and The Obesity Society (TOS) to release the joint clinical advisory “Nutritional Priorities to Support GLP-1 Therapy for Obesity.” Dr. Saluja is a co-author of this advisory, which outlines eight nutritional priorities for clinicians supporting patients on GLP-1 therapy, including substance use and social connections as key components of comprehensive care.
Toolkit
Putting This Approach Into Practice
ACLM members can apply these principles using the Obesity Medications & Lifestyle Medicine Toolkit, which translates the concepts discussed here into evidence‑informed, practical guidance for supporting patients using GLP‑1 and other obesity medications—while protecting muscle, nutrition, and long‑term health.