{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T19:48:22Z","timestamp":1787600902007,"version":"build-2736575974"},"reference-count":80,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,6,5]],"date-time":"2026-06-05T00:00:00Z","timestamp":1780617600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pharmaceuticals"],"abstract":"<jats:p>The emergence of glucagon-like peptide-1 receptor agonists (GLP-1RAs) and dual incretin-based therapies has fundamentally transformed obesity pharmacotherapy, enabling magnitudes of non-surgical weight loss that were previously unattainable. Yet, the clinical success of these treatments cannot be measured in kilograms alone. Total body weight is a composite, tissue-nonspecific endpoint that fails to distinguish between adipose reduction and losses in skeletal muscle mass, strength, and physical function\u2014compartments of direct relevance to metabolic health, functional independence, and long-term resilience. This narrative review builds on and extends existing conceptualizations of weight loss quality by proposing a clinically oriented, multidimensional framework of high-quality weight loss. Within this framework, preferential adiposity reduction is achieved while preserving skeletal muscle mass, neuromuscular function, dietary adequacy, and cardiometabolic health. We examine the physiological and clinical consequences of lean tissue loss during pharmacological energy restriction, with specific attention to phenotypes at greatest risk (i.e., older adults, individuals with sarcopenic obesity, and those with type 2 diabetes). We then evaluate the evidence supporting precision protein nutrition, dietary fiber adequacy, and gastrointestinal tolerability management as nutritional countermeasures, followed by a mechanistic and clinical analysis of resistance training as the primary exercise strategy for preserving lean mass and function. Finally, we discuss body composition monitoring, integrated multidisciplinary care, and unresolved research gaps. The future of obesity treatment lies not in greater weight loss per se, but in achieving better weight loss\u2014defined as metabolically favorable, functionally responsible, and clinically sustainable. Bone health is treated as a further dimension of high-quality weight loss, since pharmacologically driven energy restriction can adversely affect areal bone mineral density and microarchitecture, and adequate protein intake combined with mechanical loading is required to preserve skeletal integrity alongside lean mass.<\/jats:p>","DOI":"10.3390\/ph19060897","type":"journal-article","created":{"date-parts":[[2026,6,8]],"date-time":"2026-06-08T07:43:02Z","timestamp":1780904582000},"page":"897","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing Weight Loss in the GLP-1 Era: Preserving Muscle Mass, Function and Metabolic Health Through Precision Nutrition and Resistance Training"],"prefix":"10.3390","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-3947-0822","authenticated-orcid":false,"given":"Edgar","family":"Sancho-Haro","sequence":"first","affiliation":[{"name":"Department of Sport Sciences, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-7422-1546","authenticated-orcid":false,"given":"Mario","family":"Mu\u00f1oz-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Sport Sciences, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eneko","family":"Baz-Valle","sequence":"additional","affiliation":[{"name":"Department of Sport Sciences, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-2863-9462","authenticated-orcid":false,"given":"Carlota Valeria","family":"Villanueva-Tobaldo","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 Francisco","family":"Tornero-Aguilera","sequence":"additional","affiliation":[{"name":"Department of Sport Sciences, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7412-7624","authenticated-orcid":false,"given":"Jos\u00e9 Francisco","family":"L\u00f3pez-Gil","sequence":"additional","affiliation":[{"name":"School of Medicine, Universidad Esp\u00edritu Santo, Samborond\u00f3n 09-01-952, Ecuador"},{"name":"Faculty of Health Sciences, Universidad Aut\u00f3noma de Chile, Temuco 4780000, Chile"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0553-6210","authenticated-orcid":false,"given":"Miguel","family":"L\u00f3pez-Moreno","sequence":"additional","affiliation":[{"name":"Department of Nutrition and Dietetics, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"},{"name":"Diet, Planetary Health and Performance, Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0087-4379","authenticated-orcid":false,"given":"Alexandra","family":"Mart\u00edn-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Faculty of Education Sciences, UNIE University, 28015 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2397-2801","authenticated-orcid":false,"given":"Vicente Javier","family":"Clemente-Su\u00e1rez","sequence":"additional","affiliation":[{"name":"Department of Sport Sciences, Faculty of Sport and Health Sciences, Fit Generation Research Institute, AD400 Andorra la Vella, Andorra"},{"name":"Grupo de Investigaci\u00f3n en Cultura, Educaci\u00f3n y Sociedad, Universidad de la Costa, Barranquilla 080002, Colombia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,6,5]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"715","DOI":"10.1111\/obr.12551","article-title":"Obesity: A chronic relapsing progressive disease process. 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