Changes in food cravings, dietary quality, body composition, and dietary intake during GLP-1 receptor agonist therapy: The CRAVE study.

Objective: To evaluate changes in diet quality, food cravings, dietary intake, and body composition during 24 weeks of GLP-1 RA OMM therapy in a real-world clinical setting. Methods: In this prospective observational study, adults with obesity initiating semaglutide or tirzepatide were followed for 24 weeks (analytic n = 28). Participants did not receive structured nutrition intervention. Dietary intake was assessed using food records, and diet quality was evaluated using the Healthy Eating Index (HEI-2020). Food cravings were measured using the Food Cravings Inventory-III questionnaire. Body composition was assessed via bioelectrical impedance analysis. Results: GLP-1 RA OMM therapy was associated with significant reductions in body weight, adiposity, and BIA-estimated skeletal muscle mass (all P < 0.001); with approximately one-quarter of weight loss attributable to estimated skeletal muscle mass. Total energy intake decreased significantly, with parallel reductions in macronutrient intake. Higher absolute protein intake was associated with greater preservation of estimated skeletal muscle mass (r = 0.41, P = 0.0498). Diet quality did not significantly improve in our sample and food cravings were unchanged overall, although higher baseline cravings were associated with greater reductions over time (r = -0.69, P < 0.001). Significant declines in intake were observed across multiple micronutrients. Conclusions: In this small prospective cohort, GLP-1 RA OMM therapy in a real-world setting without structured nutrition support, was associated with substantial weight and fat loss accompanied by reductions in estimated skeletal muscle mass, energy intake, and micronutrient consumption, without improvement in diet quality or food cravings. Given the modest sample size and participant attrition, these findings should be considered exploratory and hypothesis-generating. The observed changes in dietary intake and body composition may highlight a critical gap in obesity management that warrants further investigation in larger, adequately powered studies to evaluate the role of nutrition-focused care, particularly strategies targeting protein adequacy and nutrient density during pharmacologic weight loss. Clinical trials registration: NCT06467604.