Supporting patients receiving incretin-based therapies: Key messages from a new European consensus statement

A new consensus statement from EASO, EFAD, and ECPO provides practical considerations to support the safe, effective and equitable use of incretin-based therapies in adults with obesity.

At the 33rd European Congress on Obesity (ECO) 2026, Dr Laurence Dobbie (King’s College London, UK) presented a new consensus statement developed by the European Association for the Study of Obesity (EASO), the European Federation of the Associations of Dietitians (EFAD), and the European Coalition for People Living with Obesity (ECPO), entitled Nutritional, Functional and Psychological Considerations for Incretin-based Therapies in Adults. As the use of incretin-based therapies continues to transform obesity management, the statement highlights the importance of addressing nutritional status, physical function, psychological wellbeing and equitable access alongside pharmacological treatment.

In this interview, Dr Dobbie discusses the rationale behind the multidisciplinary consensus, outlines key considerations for clinicians initiating and monitoring obesity-management medications, and explores the role of shared decision-making in supporting long-term patient outcomes. He also reflects on the practical challenges of implementing these recommendations in routine clinical practice and the steps needed to ensure safe, effective and equitable care for people living with obesity.

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Could you give us a brief overview of the current treatment paradigm for incretin-based therapies, and what unmet needs led to the development of this multidisciplinary consensus statement?

Incretin-based therapies, including GLP-1 receptor agonists and dual GLP-1/GIP receptor agonists, have substantially changed the treatment paradigm for obesity. These agents can produce clinically meaningful weight loss, improve glycemic control, and confer broader cardiometabolic benefits, with emerging evidence of benefit across several obesity-related complications. They are increasingly understood not as short-term weight-loss agents, but as part of long-term chronic disease management for obesity.

However, effective pharmacotherapy also creates new clinical questions. Reduced appetite, rapid weight loss, gastrointestinal adverse effects, and changes in eating behavior may affect nutritional adequacy, functional status, lean mass, psychological wellbeing, and long-term adherence in some individuals. Existing guidance has largely focused on prescribing, eligibility, and cardiometabolic outcomes. The unmet need was therefore to provide pragmatic, multidisciplinary guidance on the wrap-around care that may support patients receiving these therapies, particularly in relation to nutrition, physical function, body composition, psychological adaptation, and equity of access.

The aim of the statement is not to imply that every patient requires intensive multidisciplinary input, but to support proportionate, individualized care that can be tailored to clinical need, patient preference, and local service capacity. For many patients, basic monitoring and standard behavioral support will be sufficient. Others, particularly those with nutritional vulnerability, frailty, rapid weight loss, persistent gastrointestinal symptoms, functional decline, disordered eating, or psychosocial complexity, may benefit from more targeted multidisciplinary input.

How was this consensus developed, and what were the most important considerations in bringing together perspectives from clinicians, dietitians, physiotherapists, psychologists, researchers, and people with lived experience?

The consensus statement was developed through an iterative, multidisciplinary process involving the European Association for the Study of Obesity (EASO), the European Federation of the Associations of Dietitians (EFAD), and the European Coalition for People living with Obesity (ECPO). The work brought together expertise from obesity medicine, endocrinology, general practice, dietetics, nutrition science, physiotherapy, psychology, psychiatry, bone health and lived experience.

A key principle was that the statement should reflect real-world clinical care, recognizing that incretin-based therapies should be delivered within a broader model of long-term, person-centered obesity management. Incretin-based therapies affect appetite, energy intake, gastrointestinal tolerance, weight trajectory, body composition, physical function, food-related coping, and patient identity. No single professional group can fully address these domains in isolation.

An important consideration was balancing scientific evidence with pragmatic expert consensus. In some areas, such as cardiometabolic efficacy, trial evidence is strong. In others, including long-term nutritional status, muscle function, micronutrient risk, psychological adaptation, and post-cessation outcomes, direct evidence remains limited. We therefore used the term “considerations” deliberately. These are evidence-informed issues for clinicians and services to consider, not mandatory recommendations for every patient.

The contribution of people with lived experience was particularly important. It helped ensure that the statement addressed expectation-setting, stigma, identity change, access barriers, and the lived reality of adapting to altered appetite and food reward during treatment.

What are the key nutritional, functional, and psychological considerations clinicians should address when initiating and monitoring obesity-management medications?

Nutritionally, clinicians should ensure that patients receive clear advice on maintaining dietary quality during appetite suppression. This includes attention to adequate protein intake, fiber, hydration, micronutrient risk, and management of gastrointestinal adverse effects such as nausea, reflux, constipation, diarrhea, and vomiting. Patients with older age, frailty, prior metabolic-bariatric surgery, restrictive dietary patterns, food insecurity, persistent gastrointestinal intolerance, very low intake, or rapid or excessive weight loss may require more detailed dietetic assessment and targeted biochemical monitoring.

Functionally, the key issue is not simply weight loss, but the quality of weight loss. Loss of fat-free mass can occur during treatment, although the clinical significance varies and is not fully understood. Clinicians should therefore consider simple pragmatic monitoring, such as weight, waist circumference or waist-to-height ratio, a functional measure such as adjusted handgrip strength or sit-to-stand testing, and a brief question about perceived weakness or difficulty with daily activities. Body composition assessment, such as BIA or DXA, can be considered where available and clinically indicated, particularly in higher-risk patients.

Psychologically, clinicians should recognize that these medications can alter appetite, reward, food cravings, coping strategies, and body image. Many patients experience improvements in wellbeing and quality of life, but some may experience distress, identity change, disordered eating concerns, fear of treatment withdrawal, or challenges related to stigma. Brief enquiry and proportionate psychological screening can help identify patients who may benefit from mental health support.

The statement emphasizes multidisciplinary care and shared decision-making. What factors should be considered when deciding whether to start, delay, pause, down-titrate, or discontinue obesity-management medications?

These decisions should be made through shared decision-making, considering both the risks of treatment and the risks of not treating obesity. Clinicians should consider the patient’s obesity-related complications, treatment goals, previous treatment history, comorbidities, baseline nutritional and functional status, psychological context, preferences, and ability to engage with monitoring and follow-up.

Starting treatment is appropriate for many people when the expected benefits outweigh the risks and the patient understands the likely trajectory of treatment. Delay may be appropriate when there is a need to first address modifiable risks, such as severe uncontrolled gastrointestinal symptoms, significant nutritional vulnerability, unstable eating-disorder symptoms, acute psychological crisis, or unrealistic expectations that may undermine safe treatment. Importantly, delay should not be used as a blanket exclusion, and severe mental illness alone should not automatically preclude access to treatment.

Shared decision-making is particularly critical when considering down-titration, temporary pausing, or discontinuation. For many patients, these therapies can represent a major turning point in their obesity management, improving health, function, confidence, and hope after years of limited treatment options. Stopping or reducing treatment without adequate discussion may therefore be distressing, particularly where patients fear weight regain, loss of metabolic benefit, or a return of food noise. These decisions should be approached sensitively, with clear explanation, acknowledgement of the patient’s concerns, and a plan for ongoing support.

Down-titration or temporary pausing may be appropriate where there are significant gastrointestinal adverse effects, persistent vomiting, dehydration risk, very low intake, emerging nutritional deficiency, rapid or excessive weight loss, or functional decline. Discontinuation may be considered where treatment is unsafe, poorly tolerated despite modification, no longer aligned with patient preferences, or where risks outweigh benefits. However, where treatment is reduced or stopped, this should ideally be planned collaboratively, with consideration of nutritional, psychological, behavioral, and medical support to minimize potential negative consequences.

The overarching principle is proportionality. Treatment plans should be flexible, reviewed over time, and adapted to the patient’s evolving clinical and psychosocial context.

 What challenges do you anticipate in implementing these recommendations in routine clinical practice, and how might barriers relating to access, monitoring, and long-term adherence be overcome?

The main implementation challenge is that obesity services are already under considerable pressure. Access to dietitians, physiotherapists, psychologists, body composition assessment, and specialist obesity services varies substantially between regions and healthcare systems. If recommendations are interpreted as requiring intensive multidisciplinary input for every patient, this could unintentionally worsen inequity by creating additional barriers to treatment.

For that reason, the statement supports a stepped-care model. Most patients should receive clear baseline education, basic monitoring, and structured follow-up. More intensive input should be targeted to those with clinical vulnerability, emerging complications, or patient-identified needs. This allows services to prioritize resources while still recognizing that some patients require more comprehensive support.

Practical solutions include protocolled patient education, training wider multidisciplinary teams to deliver core nutritional and behavioral advice, clear escalation criteria for dietetic or psychological input, simple functional monitoring tools, group-based education, digital follow-up where appropriate, and better integration between primary care, specialist services, and community support.

Long-term adherence also requires expectation-setting from the outset. Patients should understand that obesity is a chronic, relapsing disease, that weight regain is common after treatment cessation, and that pharmacotherapy works best when embedded within a broader plan supporting nutrition, physical function, psychological wellbeing, and sustainable health behaviors.

Finally, implementation must address equity. Cost, commissioning variation, stigma, food insecurity, and service capacity all influence who can access and remain on treatment. A proportionate multidisciplinary model should therefore aim not only to improve safety and effectiveness, but also to reduce disparities in obesity management, so that those with the greatest clinical need can access appropriate treatment and support.