Published Jul 21, 2026 | 7:00 AM ⚊ Updated Jul 21, 2026 | 7:00 AM
GLP-1 receptor agonists such as semaglutide mimic a hormone that regulates blood sugar and reduces appetite.
Synopsis: A panel of leading Indian endocrinologists has issued the country’s first nutrition consensus for GLP-1 weight-loss drugs, warning of muscle loss, nutrient deficiencies and weight regain without structured dietary support. The recommendations call for personalised nutrition, higher protein intake, resistance exercise and long-term follow-up tailored to Indian patients with obesity and diabetes.
The growing popularity of GLP-1-based medicines for obesity and type 2 diabetes has prompted a panel of India’s leading endocrinologists and diabetologists to issue the country’s first consensus recommendations on nutrition for patients taking these drugs, warning that weight loss without adequate nutritional support could come at the cost of muscle mass, bone health and long-term metabolic benefits.
Published in the journal Obesity Pillars, the consensus paper provides 44 evidence-based recommendations for doctors and patients using glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and dual GIP/GLP-1 receptor agonists, collectively referred to as GLP-based therapies (GBTs). The document comes at a time when medicines such as semaglutide and tirzepatide are increasingly being prescribed in India for both diabetes and obesity.
The experts said the medicines have transformed obesity management by reducing appetite, slowing gastric emptying and producing clinically significant weight loss while lowering cardiovascular and kidney disease risks. However, they cautioned that appetite suppression also reduces food intake, increasing the risk of protein and micronutrient deficiencies unless nutrition is actively monitored.
“There is a need for structured nutritional support for individuals on GBTs, especially for Asian Indians, considering their diverse dietary intake and the high risk of sarcopenia,” the experts said. “Implementing culturally driven nutritional recommendations, including diabetes-specific nutrition formula as an adjunct along with lifestyle modifications, can support optimizing long-term patient-centric outcomes.”
Also Read: How AI-powered handheld devices are bringing breast and cervical cancer screening to Telangana PHCs
While international recommendations exist on nutrition during GLP-1 therapy, the panel said Indian patients present unique challenges because of regional dietary patterns and the high prevalence of underlying nutritional deficiencies.
The recommendations were developed using a modified Delphi process involving two rounds of anonymous voting by 13 endocrinologists and diabetologists from across India. Of the 44 statements drafted, 43 achieved high or moderate consensus.
The consensus was authored by Dr Shashank R Joshi, Dr Anoop Misra, Dr Ambrish Mithal, Dr Banshi Saboo, Dr Krishna G Seshadri, Dr Subhankar Chowdhury, Dr Ganapathi Bantwal, Dr Bipin Sethi, Dr Jothydev Kesavadev, Dr Arpan Dev Bhattacharya, Dr Manash P Baruah, Dr Ajay Budhwar and Dr Viswanathan Mohan, with support from Abbott Nutrition International, India.
According to the paper, Indians commonly consume diets rich in refined cereals and carbohydrates but relatively low in high-quality protein. Deficiencies of vitamin D, vitamin B12, iron and folic acid are already widespread in the population, increasing the likelihood that reduced food intake during GLP-1 therapy could worsen nutritional status.
The authors also highlighted that South Asians generally have lower baseline muscle mass than Western populations despite often having similar or lower body mass indices, making them more vulnerable to sarcopenia, or progressive muscle loss.
“Clinicians should recommend an early, structured, culturally tailored nutritional intervention for individuals on GBTs,” the paper states.
The consensus notes that GLP-1-based therapies reduce calorie intake by approximately 16 percent to 39 percent, which contributes to weight loss but also limits the intake of proteins, vitamins and minerals essential for maintaining muscle and bone health.
“Reduced appetite and caloric intake during GBT can lead to macro- and micronutrient deficiencies if not monitored,” the experts said. They added that “rapid weight loss associated with GBT may increase the risk of lean muscle mass loss and compromise bone health.”
The paper cites evidence showing that around 20 percent of patients develop nutritional deficiencies during the first year of therapy. Vitamin D deficiency increased from 7.5 percent at six months to 13.6 percent at one year, while iron stores declined substantially and vitamin B12 deficiency also became more common.
Gastrointestinal side effects, including nausea, vomiting, constipation and diarrhoea, further reduce food intake, making nutritional monitoring even more important, the authors said.
Among the strongest messages in the consensus is that not all weight loss is desirable.
Studies reviewed by the panel showed that approximately one-fourth of the weight lost during GLP-1 therapy may come from lean muscle mass. Some clinical trials reported lean muscle losses ranging from 2 kg to 3 kg during treatment, although improvements in muscle quality and strength were observed in some patients.
The concern is particularly relevant in India because sarcopenia already affects an estimated 14.2 percent to 39.2 percent of adults in some populations, with one in four affected individuals also living with sarcopenic obesity. Older adults and people with diabetes face an even greater risk.
“Adequate and good-quality protein intake should be prioritised to preserve lean mass during weight loss,” the experts said.
They also stressed that “combining nutrition therapy with resistance exercise enhances metabolic outcomes and prevents muscle loss.”
The panel recommends that nutritional assessment should become standard practice before prescribing GLP-1 medicines.
“A comprehensive baseline nutritional assessment is essential before initiating GBT,” the experts said. They also recommended evaluating muscle strength using functional tests such as hand-grip strength and chair stand tests in patients at high risk of sarcopenia.
Doctors should continue monitoring dietary intake, gastrointestinal symptoms, muscle strength and micronutrient status throughout treatment.
The consensus also recommends personalised nutrition plans, behavioural counselling and periodic follow-up rather than relying solely on medication.
“Nutritional adequacy monitoring should be done on a timely basis alongside GBT monitoring,” the experts said.
Rather than following restrictive diets, the experts recommend balanced meals containing complex carbohydrates, high-quality protein and healthy fats.
Patients should eat four to five smaller meals a day instead of large portions, consume lean meat, milk, dairy products, tofu or pulses for protein, choose predominantly monounsaturated fats such as groundnut, sesame or olive oil, and gradually increase fibre intake while maintaining adequate hydration of at least 2 litres daily.
They also recommend eating slowly, stopping when comfortably full and choosing cooking methods such as steaming, boiling and grilling to minimise gastrointestinal symptoms.
Where patients cannot meet nutritional requirements through food alone, the panel suggests that diabetes-specific nutritional formulations may be considered as partial or total meal replacements under medical supervision.
The experts warned that stopping GLP-1 medicines without continued nutritional support can quickly reverse many of their benefits.
“Individuals who discontinue the GBT may regain approximately two-thirds of their prior weight loss within one year due to inadequate lifestyle and nutritional support,” the paper states.
Evidence reviewed by the panel also showed that blood sugar, blood pressure and cholesterol levels tend to worsen again after treatment discontinuation.
For this reason, the experts recommend continuing dietary counselling and structured lifestyle interventions even after medication is stopped.
“Clinicians prescribing GBTs to people with diabetes and obesity should plan structured care that includes comprehensive nutritional and lifestyle counselling throughout the treatment journey, before, during and after pharmacotherapy,” they said.
