ECO 2026
European obesity guideline: pair GLP-1s with nutrition, muscle, mental health
Clinical Takeaway: Prescribing a GLP-1 alone may not be enough. The statement urges clinicians to pair incretin therapy with protein-adequate nutrition, resistance training, and mental health screening, with particular attention to muscle loss in older adults.
GLP-1 receptor agonists have reshaped obesity care, but rapid weight loss raises concerns about muscle, bone, micronutrient status, and psychological wellbeing that prescribing alone does not address. This consensus statement, the first jointly issued by the European Association for the Study of Obesity, the European Federation of the Associations of Dietitians, and the European Coalition for People Living with Obesity, aims to fill that gap with a multidisciplinary framework for incretin-based therapy.
Roughly 24% to 30% of the weight lost on incretin-based therapies is fat-free mass, mostly muscle. The statement proposes a pragmatic target of roughly a 3:1 ratio of fat to lean-mass loss where body composition can be tracked, meaning that for every 4 kg lost, at least 3 kg should come from fat and no more than 1 kg from fat-free mass. Clinicians are encouraged to move beyond BMI alone, adding waist circumference or waist-to-height ratio plus a functional measure such as handgrip strength or the 5-times sit-to-stand test, with DXA or bioelectrical impedance analysis reserved for patients at higher risk of sarcopenia.
Resistance training is positioned as essential, not optional, to limit lean-mass loss during treatment. On the nutrition side, dietitian-led medical nutrition therapy is framed as core to safe care, supporting protein, vitamin, and mineral adequacy and helping manage dose titration to reduce gastrointestinal side effects that drive discontinuation.
The statement also calls for psychological screening before initiation, including for alcohol use disorders, and continued vigilance during treatment. Significant weight loss can prompt identity shifts that may surface pre-existing mental health vulnerabilities or disordered eating patterns.
Access remains uneven with patients from minority ethnic groups and lower-income populations face reduced access to specialist services and incretin therapies, and coverage often favors patients with diagnosed obesity-related complications over those with obesity alone. The authors argue that broader coverage and stigma reduction belong alongside clinical reforms.
The authors point to fruitful future areas of research. A systematic review of 417 incretin-based therapy trials found that fewer than 20% reported dietary intake or nutritional biomarkers, and fewer than 5% reported bone, micronutrient, or physical-function outcomes.
"Incretin-based therapies represent a paradigm shift in obesity care; optimal implementation includes dietitian-led medical nutrition therapy with integrated psychological and functional support,” the authors conclude. “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.”
Source: Dobbie L. ECO 2026. May 14, 2026. Consensus statement on the use of incretin-based therapies in obesity management