INCRETIN-BASED THERAPIES IN OBESITY TREATMENT: IMPLICATIONS FOR NUTRITIONAL CARE AND A PROPOSED MEDICAL NUTRITION THERAPY PROTOCOL

Abstract

Background - Obesity is a chronic, multifactorial, and highly prevalent disease whose management remains challenging due to its complex pathophysiology and high rates of weight regain. In recent decades, incretin-based therapies - such as semaglutide and tirzepatide - have emerged as effective interventions for weight reduction and cardiometabolic risk control. However, their use has raised concerns regarding the preservation of lean mass, the risk of micronutrient deficiencies, dehydration, and weight regain following treatment discontinuation.
Objective - This study aimed to evaluate the adverse effects associated with incretin-based therapies (IBTs), examine their nutritional implications, and propose an evidence-based Medical Nutrition Therapy (MNT) protocol to optimize clinical outcomes and mitigate potential risks.
Methods - An integrative literature review was conducted across major databases (2019-2025), informed by PRISMA 2020 reporting recommendations.
Results - The findings demonstrate consistent reductions in body weight (up to 20.9% on average), accompanied by a substantial proportion of lean mass loss, accounting for up to 60% of total weight reduction. Additionally, inadequate protein intake and micronutrient deficiencies were reported in more than 20% of individuals across the analyzed studies. An increased risk of dehydration associated with altered fluid intake behavior was also identified, along with weight regain rates of approximately two-thirds of prior weight loss in some studies.
Conclusion - The synthesis of evidence indicates that integrating pharmacotherapy with structured nutritional intervention - implemented through MNT, with emphasis on adequate protein intake, hydration, and micronutrient monitoring - combined with Nutrition Education aimed at fostering critical autonomy in dietary choices, represents a key strategy for preserving lean mass, mitigating nutritional risks, and ensuring the long-term sustainability of clinical outcomes.