EASO, EFAD and ECPO Issue Landmark Consensus: Nutritional and Psychological Support Essential for GLP-1 Obesity Treatment Success
Key Insights
A new European consensus statement published in The Lancet Diabetes & Endocrinology emphasizes that long-term success of incretin-based obesity (search) therapies depends on comprehensive nutritional, functional, and psychological support.
The consensus recommends medical nutrition therapy delivered by qualified dietitians, regular body composition monitoring, and resistance training to mitigate lean mass loss of 24–30% during treatment.
Authors call for pre-treatment mental health screening, ongoing psychological support, and expanded access to multidisciplinary care to address current gaps and reduce health inequalities.
Modern incretin-based therapies (IBTs), including GLP-1 receptor agonists (search), have fundamentally transformed the treatment of obesity (search). Yet a landmark consensus statement published on 8 July 2026 in The Lancet Diabetes & Endocrinology makes clear that these pharmacological advances can only fulfill their potential when embedded within a comprehensive, multidisciplinary care model. The paper, led by Dr Laurence Dobbie of the Department of Population Health Sciences at King's College London with an international team of 26 authors, represents the first Europe-wide coordinated recommendations jointly issued by the European Association for the Study of Obesity (search) (EASO), the European Federation of the Associations of Dietitians (search) (EFAD), and the European Coalition for People Living with Obesity (search) (ECPO).
"These new medications open up new treatment options for many people with obesity (search). However, they can only fulfil their potential when embedded within a comprehensive, multidisciplinary care model. Nutrition therapy, physical activity and psychological support are not optional add-ons, they are essential components of high-quality obesity management," said Maria Wakolbinger from the Center for Public Health at MedUni Vienna (search), co-author of the consensus paper and head of the EASO Nutrition Working Group.
Medical Nutrition Therapy as a Central Pillar
The consensus statement positions medical nutrition therapy (MNT), delivered by registered dietitians, at the core of obesity (search) care alongside IBTs. The authors emphasize that nutritional therapy must ensure adequate intake of protein, vitamins, and minerals while also helping to reduce gastrointestinal side effects through appropriate dose-scaling of obesity drugs. Dietitians play an essential role in reinforcing healthy dietary patterns and facilitating long-term behavior change.
Critically, the statement underscores that MNT should be provided with respectful, empowering, weight-inclusive communication that recognizes health beyond the scales. The authors stress that nutritional therapy should form part of a multidisciplinary treatment plan, not be treated as an ancillary service.
Preserving Muscle Mass and Monitoring Function
Analysis of existing trials shows that 24–30% of weight loss achieved with IBTs consists of fat-free mass, predominantly muscle. The health implications of this loss remain unclear, particularly for older adults who have proportionally less muscle mass at baseline.
The consensus recommends regular monitoring of body composition and physical function, moving beyond BMI alone. Clinicians should incorporate waist circumference or waist-to-height ratio alongside pragmatic measures of muscle function, such as adjusted handgrip strength or the five-times sit-to-stand test. Where available and cost-feasible, dual-energy X-ray absorptiometry (DXA) or bioelectrical impedance analysis (BIA) should be utilized, especially for individuals at higher risk of sarcopenia.
A pragmatic target, where body-composition data are available, is an approximate 3:1 ratio of fat loss to lean-mass loss—meaning for every 4 kg lost, at least 3 kg should be fat and no more than 1 kg fat-free mass. The statement specifically recommends integrating strength training into treatment plans to help reduce lean body mass loss, alongside aerobic exercise.
Addressing Mental Health Throughout Treatment
Although IBTs are generally linked to improved mental health, the consensus warns that many people living with obesity (search) have pre-existing psychological vulnerabilities. During the profound identity changes that can accompany significant weight loss, there is potential for the re-emergence of mental health issues, including eating disorders.
The authors recommend appropriate screening before the start of treatment, as well as ongoing psychological support where necessary. Those trained in mental health within the multidisciplinary care team should remain vigilant for these problems. Additionally, alcohol use disorders should be screened for before initiating GLP-1 treatment.
Gaps in Care and Access
The consensus statement draws attention to significant gaps in current care delivery. In many regions, people with obesity (search) still lack adequate access to multidisciplinary treatment programs or qualified nutritional therapy. Obesity disproportionately affects minority ethnic groups and lower socioeconomic populations, who also have reduced access to specialist services in the UK and to IBTs in North America.
Socioeconomic deprivation and reliance on public insurance are associated with poorer adherence, while private-pay models further exacerbate affordability barriers. The authors note that people with obesity (search) without diagnosed complications are often disadvantaged compared with those with diagnosed obesity-related complications—reflecting persistent stigma surrounding treating obesity as a disease in its own right.
The consensus calls for policy to expand IBT coverage and address stigma, while clinical services should improve access to dietitian-led MNT, which could reduce inequalities and improve both adherence and outcomes.
Research Priorities and Evidence Gaps
A systematic review of 417 IBT randomized controlled trials revealed striking evidence gaps: fewer than 20% reported dietary intake or nutritional biomarkers, and fewer than 5% reported bone, micronutrient, or physical-function outcomes. The authors outline specific research priorities, including development of a core outcome set for IBT trials, robust nutritional-safety surveillance with malnutrition screening tools, evaluation of muscle function and performance outcomes, strategies to preserve lean mass and bone, optimal protein intake during treatment, psychological outcomes and targeted supports, dose-titration methods to reduce discontinuation due to gastrointestinal side effects, and post-cessation and special-population studies.
The authors conclude: "IBTs represent a paradigm shift in obesity (search) care; optimal implementation includes dietitian-led medical nutrition therapy with integrated psychological and functional support. Priorities are mitigating gastrointestinal effects, preventing micronutrient deficiencies, and preserving lean mass via adequate protein, fibre, fluids and nutrient-dense foods, alongside resistance training, targeted supplementation and regular monitoring, with attention to identity, coping and disordered-eating."