Obesity medications and precision nutrition: synergistic interventions and integrated approach in obesity management.

PURPOSE OF THE REVIEW: Obesity represents a major global health challenge associated with substantial metabolic, cardiovascular, and oncologic risk. Recent advances in anti-obesity pharmacotherapies, particularly GLP-1 receptor agonists and the dual GIP/GLP-1 agonist, have redefined clinical management by enabling unprecedented weight loss and significant cardiometabolic benefits. This review summarizes current evidence on how incretin-based therapies affect body composition, eating behavior, and long-term weight trajectories, with a focus on the need for nutritional strategies that support lean mass preservation and durable lifestyle changes. RECENT FINDINGS: Although incretin-based therapied effectively reduce body weight, the resulting weight loss includes a decline in fat-free mass, raising potential concerns about skeletal muscle preservation, particularly in vulnerable populations. Protein-enriched meal replacements (MRs) and structured dietary programs, including very low energy ketogenic therapy (VLEKT), have emerged as practical approaches to improve adherence, enhance fat loss, and stimulate muscle protein synthesis during medication-induced caloric restriction. Several studies indicate that MR-based interventions achieve greater weight loss and metabolic improvements than conventional diets, and that EAA-enriched formulations may provide additional advantages for preserving muscle mass. Combining MRs or VLEKT with incretin-based treatments may offer synergistic advantages by coupling pharmacological appetite regulation with controlled nutrient delivery and behavioral support. Structured nutritional interventions remain essential throughout pharmacotherapy and represent valuable alternatives when medications are discontinued or contraindicated. Overall, integrating incretin-based pharmacotherapy with optimized dietary strategies constitutes an approach to care that may enhance long-term effectiveness, promote nutritional rehabilitation, preserve muscle health, and address the needs of individuals at risk of sarcopenia.