New International Consensus Guides Use of Obesity Drugs Ozempic and Mounjaro

A new international consensus has been published, shifting the focus for users of obesity medications like Ozempic, Wegovy, and Mounjaro from solely weight loss to a more holistic approach to long-term treatment. Developed by European organizations including 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 guidelines were published in The Lancet Diabetes & Endocrinology. The consensus emphasizes preserving muscle mass, ensuring quality nutrition, monitoring mental health, and individualizing treatment decisions regarding dosage. Experts highlight that the treatment is not just about taking the injection and losing weight, but about broader quality of life improvements and managing comorbidities, warning against potential malnutrition and muscle loss from unmonitored weight reduction. The document clarifies that these are recommendations, not mandatory rules, and medical evaluation remains crucial, as more research is needed to answer many questions about these drugs. A key message is that reaching the maximum dosage is not always necessary; individual clinical response, satiety, and tolerance should guide dose adjustments. Patients far from their weight goals or with metabolic diseases may require higher doses, while others might benefit from lower amounts, as real-world data shows significant weight loss even with reduced doses when tailored to the individual. The consensus also addresses when to reduce, pause, or stop medication, stating that decisions should be shared between doctor and patient, considering benefits and risks. Signs prompting re-evaluation include persistent nausea, vomiting, dehydration, rapid weight loss, insufficient nutrient intake, and signs of malnutrition. A prolonged daily intake below 800 calories requires special attention. Stopping medication may occur upon reaching a weight goal, due to worsening tolerance, or when further weight loss is not desirable, especially in older adults. The success of these treatments is not solely measured by the number on the scale. Experts stress that excessive muscle mass loss can lead to weakness and sarcopenia. The benefits extend beyond weight loss to glucose control, reduced cardiovascular risk, and improvement in conditions like fatty liver and sleep apnea. Therefore, monitoring muscle preservation, physical capacity, and nutritional status is as important as tracking weight. To combat muscle loss, the consensus recommends a daily protein intake of 1-1.5 grams per kilogram of adjusted body weight, with a minimum of 60 grams, and highlights strength training, like weightlifting, as central to the strategy for GLP-1 agonist users. Functional capacity, rather than just muscle size, is emphasized as the key outcome, particularly for older adults. The guidelines also caution that reduced appetite can compromise intake of essential nutrients, advocating for nutrient-dense foods over mere calorie restriction, and warning that excessively rapid weight loss can lead to anemia and gallstones.