Picture a common follow-up visit: Six weeks into glucagon-like peptide-1 (GLP-1) treatment, a patient has lost weight and their glucose measures have improved. They describe the nausea as “manageable.” Then you ask what they ate yesterday: coffee until noon, a few bites at lunch, half a dinner, and less water than usual because everything feels too filling. They’ve also stopped walking because they feel weak.

The medication may be working as intended, but is the rest of the care plan keeping pace?

GLP-1 medications have quickly become a common part of care for obesity and other chronic conditions. According to a 2025 KFF survey, 12 percent of U.S. adults reported they were currently taking one, twice as many as just 18 months earlier.

Because GLP-1 medications reduce appetite and can make patients feel full sooner, some may struggle to consume enough energy, protein, fluids, and variety to meet their nutritional needs. Additionally, nutrient gaps may already be present before treatment begins, giving clinicians more reason to monitor nutrient intake of their patients taking GLP-1s.

Nutrition should therefore be a core part of GLP-1 care, though it’s not always built into routine follow-up. These five questions are designed to help prescribing clinicians start the right conversation, spot concerns early, and recognize when a patient needs more specialized nutrition support:

1. What is the patient actually able to eat and drink?

“Are you eating healthy?” rarely tells us much. “Walk me through everything you ate and drank yesterday” is more revealing.

Listen for long gaps between meals, portions that have dwindled to a few bites, little or no protein, fewer fruits and vegetables, and inadequate fluids. Ask what changed after the last dose increase. When patients eat less, they have fewer chances to meet their nutritional needs.

The goal isn’t a perfect diet. It’s to help the patient follow a realistic pattern of nutrient-dense foods that they can tolerate consistently.

2. Are side effects shaping what the patient eats?

Nausea, vomiting, constipation, and diarrhea are common during GLP-1 treatment, especially when treatment begins or the dose increases. A patient who describes these symptoms as “manageable” may still have stopped eating breakfast, drinking fluids during the workday, or eating foods their body once relied on.

Ask how the symptoms have changed the patient’s routine. Mild nausea may improve with smaller, more frequent meals. Constipation may require a deliberate plan for fluids, a gradual increase in fiber as tolerated, movement, and, when appropriate, medical treatment. Persistent vomiting or an inability to maintain hydration, severe or persistent GI symptoms, or persistent or severe abdominal pain should prompt clinical reassessment rather than another generic diet handout. The patient’s titration plan may also need to be revisited.

3. Are we tracking strength as well as weight?

Weight loss, regardless of how it is achieved, can include some loss of lean tissue along with fat. That may matter more for older adults and patients who are sedentary, chronically ill, or already have low muscle mass, especially when weight loss is paired with low protein intake and little resistance exercise. Further loss can reduce strength and mobility, increase the risk of falls, and threaten independence.

Ask the patient whether it has become harder to rise from a chair, climb stairs, carry groceries, or complete a usual workout. When feasible, a sit-to-stand test, grip-strength measure, or body-composition assessment can help track changes in this over time.

Protein needs vary, and protein alone is not a strength plan. When medically appropriate, adequate protein should be distributed across meals and paired with resistance training suited to the patient’s abilities. Protein targets should also be individualized to body size, age, health conditions, and treatment goals.

4. Does this patient’s history change standard nutrition advice?

There’s no universal “GLP-1 diet”: kidney disease, prior bariatric surgery, gastrointestinal disease, food allergies, disordered eating, frailty, and limited food access are among a myriad of variables that can change your recommended approach. Even “eat more protein” needs context.

For patients with diabetes, the medication list matters, too. When food intake drops significantly, patients taking insulin or sulfonylureas may face a greater risk of hypoglycemia. The American Diabetes Association recommends reassessing medications with a higher hypoglycemia risk, including insulin and sulfonylureas, when glucose-lowering treatment changes, and specifically recommends reassessing insulin dosing when a GLP-1 medication is added or its dose is increased. In these cases, nutrition counseling alone may not be enough; glucose levels and the medication regimen may also need to be reviewed.

Review medical history, eating patterns, relevant laboratory findings, food access, and the patient’s goals before or at the start of treatment to identify the best nutrition approach early on. An early referral to a registered dietitian nutritionist (RDN) is especially useful when intake remains poor, symptoms persist, weight falls faster than intended, function declines, or the patient’s medical history complicates nutrition planning.

5. What’s the long-term plan?

Treatment may continue long term, but side effects, medication access, or patient preference can change the plan. Patients need realistic routines for meals, protein, produce, fluids, and physical activity, along with clear instructions about whom to contact if problems arise. Nutrition can’t replace medication or guarantee weight maintenance, but it can provide continuity when a dose changes or treatment is interrupted.

Document food and fluid intake, GI symptoms, strength, and activity at baseline and after dose changes. Persistent health concerns may warrant coordinated support from an RDN or other appropriate specialists.

In my work as a registered dietitian and clinical researcher, I view nutrition support as an essential part of GLP-1 care, not an optional add-on. Weight loss and improved glucose measures are important, but they don’t tell us whether a patient is eating adequately, tolerating treatment, maintaining strength, and functioning well. Making nutrition assessment routine at the start of treatment, after dose changes, and throughout long-term follow-up can help clinicians identify concerns early, coordinate appropriate support, and translate treatment success into lasting improvements in health, strength, and daily function.

Shirin Pourafshar, PhD, MSCR, RDN, is a clinical scientist, registered dietitian, and clinical research manager at Standard Process.

Standard Process is a family-owned company founded in 1929 by Dr. Royal Lee. For nearly a century, it has advanced whole food nutrition and supported health care practitioners.

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Through clinical research, product innovation, and practitioner education at the Standard Process Nutrition Innovation Center, the company continues to advance the science of whole food nutrition. Health care professionals can explore Standard Process’s Clinical Protocols or apply for a professional account to access additional resources and products. The future of nutrition is here.

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