Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance

Zambrano-Villacres, Raynier; Campuzano-Donoso, Martín; Reytor-González, Claudia; Rossetti, Gianluca; Cobellis, Luigi; Cobellis, Francesco; Pilone, Vincenzo; Simancas-Racines, Daniel; Schiavo, Luigi

doi:10.3390/nu18111751

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Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance

by

Raynier Zambrano-Villacres

^1,†

,

Martín Campuzano-Donoso

^2,†

,

Claudia Reytor-González

^2,†

,

Gianluca Rossetti

³,

Luigi Cobellis

⁴

,

Francesco Cobellis

⁴,

Vincenzo Pilone

⁵,

Daniel Simancas-Racines

^2,*,‡ and

Luigi Schiavo

^6,*,‡

¹

Ciencias de la Salud y Desarrollo Humano, Universidad ECOTEC, Km.13.5, Samborondón 092302, Ecuador

²

Facultad de Ciencias de la Salud y Bienestar Humano, Universidad Tecnológica Indoamérica, Ambato 180150, Ecuador

³

General and Bariatric Surgery Unit, Abano Terme Policlinic, 35031 Padova, Italy

⁴

Unit of General Surgery, Casa Di Cura “Prof. Dott. Luigi Cobellis”, 84078 Vallo della Lucania, Italy

⁵

Public Health Department, University of Naples Federico II, 80131 Naples, Italy

⁶

Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, 84081 Baronissi, Italy

^*

Authors to whom correspondence should be addressed.

^†

These authors equally contributed to this work as co-first.

^‡

These authors equally contributed to this work as co-last.

Nutrients 2026, 18(11), 1751; https://doi.org/10.3390/nu18111751

Submission received: 24 March 2026 / Revised: 18 May 2026 / Accepted: 20 May 2026 / Published: 29 May 2026

(This article belongs to the Section Nutrition and Obesity)

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Abstract

Background: Glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 receptor agonists have transformed obesity treatment, producing substantial weight loss during active therapy. However, real-world effectiveness may be limited by gastrointestinal adverse events, reduced dietary intake, fat-free mass loss as part of total weight reduction, and weight regain after discontinuation. Methods: This narrative review synthesizes current pharmacological, nutritional, gastrointestinal, body-composition, and implementation evidence to propose an evidence-informed nutrition-first framework for patients receiving incretin-based therapy for obesity. Results: We translate pharmacologic mechanisms into practical dietary strategies, including protein prioritization, structured meal patterns, hydration and fiber management, symptom-targeted interventions, resistance-training support, and maintenance planning. Because direct trials of structured nutrition interventions in GLP-1RA- or dual incretin-treated populations remain limited, several recommendations are extrapolated from the broader obesity, caloric restriction, body-composition, gastrointestinal, and expert-consensus literature. Conclusions: Integrating structured nutrition care into pharmacotherapy pathways may help address meal-related symptom burden, support protein and fluid adequacy, identify patients at higher nutritional or body-composition risk, and prepare patients for long-term weight-management behaviors. Embedding practical nutrition management within multidisciplinary obesity care may help translate pharmacologic efficacy into durable, patient-centered outcomes.

Keywords: obesity; GLP-1 receptor agonist; dual incretin therapy; tirzepatide; semaglutide; nutrition therapy; protein intake; gastrointestinal tolerability; lean body mass; weight maintenance

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MDPI and ACS Style

Zambrano-Villacres, R.; Campuzano-Donoso, M.; Reytor-González, C.; Rossetti, G.; Cobellis, L.; Cobellis, F.; Pilone, V.; Simancas-Racines, D.; Schiavo, L. Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance. Nutrients 2026, 18, 1751. https://doi.org/10.3390/nu18111751

AMA Style

Zambrano-Villacres R, Campuzano-Donoso M, Reytor-González C, Rossetti G, Cobellis L, Cobellis F, Pilone V, Simancas-Racines D, Schiavo L. Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance. Nutrients. 2026; 18(11):1751. https://doi.org/10.3390/nu18111751

Chicago/Turabian Style

Zambrano-Villacres, Raynier, Martín Campuzano-Donoso, Claudia Reytor-González, Gianluca Rossetti, Luigi Cobellis, Francesco Cobellis, Vincenzo Pilone, Daniel Simancas-Racines, and Luigi Schiavo. 2026. "Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance" Nutrients 18, no. 11: 1751. https://doi.org/10.3390/nu18111751

APA Style

Zambrano-Villacres, R., Campuzano-Donoso, M., Reytor-González, C., Rossetti, G., Cobellis, L., Cobellis, F., Pilone, V., Simancas-Racines, D., & Schiavo, L. (2026). Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance. Nutrients, 18(11), 1751. https://doi.org/10.3390/nu18111751

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Nutrition-First Support for GLP-1 and Dual Incretin Therapy in Obesity: A Practical Framework for Dietary Management, Symptom Tolerability, and Long-Term Weight Maintenance

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