People taking anti-obesity medications often experience reduced appetite and reduced food intake, making nutritional quality important. A new review provides clinicians with evidence-based nutritional guidelines and highlights the “5A model” for effective patient communication and management. Nutritional recommendations include individualized caloric requirements, high protein intake, and balanced macronutrients, with ongoing monitoring to manage potential nutritional deficiencies and support optimal health outcomes.
A new review provides nutritional guidelines for patients taking anti-obesity drugs, highlights the importance of maintaining and monitoring dietary quality to prevent deficiencies, and highlights the need for further research into new treatments.
People taking anti-obesity drugs often experience a decreased appetite and eat less. As a result, diet quality is important because they must consume fewer foods to meet their nutritional needs. To support this, medical experts have put together evidence-based dietary guidelines to help clinicians prescribe anti-obesity drugs to their patients. These recommendations are detailed in a review published in 2010. obesityThe flagship journal of the Obesity Society (TOS).
“Our evidence-based review aims to provide clinicians with the knowledge and tools to support optimal nutritional and medical outcomes for patients treated with anti-obesity medications,” said Lisa M. Neff, executive director, Global Medical Affairs, Obesity, Eli Lilly and Company, and corresponding author of the review paper.
The 5A model for clinical practice
In this review, the authors recommend a “5A model” (ask, assess, advise, consent, assist) for working with patients. Clinicians should ask permission before discussing weight loss and then evaluate the patient. The evaluation should include a complete medical history, including psychosocial, weight, diet, and other lifestyle histories, a physical examination, and appropriate laboratory or imaging tests to assess the underlying causes of obesity, identify obesity-related complications, and evaluate nutritional status, including risk for malnutrition.
Clinicians should advise patients about treatment options and discuss treatment expectations. Clinicians and patients should agree on goals related to health, dietary and other lifestyle patterns, and weight. Clinicians should help patients address challenges and barriers to weight management, taking into account social determinants of health. Because obesity is a chronic disease that requires a long-term approach, the authors suggest that clinicians arrange for follow-up care and refer patients for additional support, such as seeing a registered dietitian, if needed.
Regarding nutritional recommendations for patients taking anti-obesity medications, the authors suggest the following, based on healthy eating patterns:
- Energy intake: Energy requirements vary based on an individual’s age, sex, weight, physical activity level, and other factors. Recommended minimum energy intake goals during weight loss should be individualized. In general, a safe energy intake during weight loss is recommended to be 1,200-1,500 kcal/day for women and 1,500-1,800 kcal/day for men.
- Protein: A minimum of 60-75 g of protein per day and 0.8-1.5 g per kg of body weight is recommended. Intakes of 1.5 g or more per day may be considered by the individual. Recommended protein sources include beans, lentils, peas, nuts, seeds, soy products, seafood, lean meat, poultry, low-fat dairy products, and eggs. If intake from whole foods is inadequate, meal replacements, typically containing 15-25 g of protein per meal, may be recommended.
- Carbohydrates: 45%-65% of energy intake. Limit added sugars to less than 10% of energy intake. Recommended sources include whole grains, fruits, vegetables, nuts, seeds, dairy products such as milk and yogurt, and dairy alternatives such as soy milk.
- Fats: 20% to 35% of energy intake. Limit saturated fats to less than 10% of energy intake. Avoid fried and fatty foods to reduce gastrointestinal side effects associated with anti-obesity medications. Good sources of fat include nuts and seeds, avocados, vegetable oils, oily fish, and seafood.
- Fiber: The recommended amount is 21-25 g per day for adult women and 30-38 g per day for adult men depending on age. Good sources of fiber include fruits, vegetables, and whole grains. If you can’t meet your fiber goals through food alone, consider using a fiber supplement.
- Micronutrients: Micronutrients of public health concern for U.S. adults include potassium, calcium, and vitamin D. Other nutrients of concern include iron in women of childbearing age and vitamin B12 in older adults. People who are obese are at higher risk of micronutrient deficiencies, including vitamin D, folate, and thiamine. Guidelines recommend increased intake of fruits, vegetables, low-fat dairy products, and fortified soy alternatives. Supplementation with a comprehensive multivitamin, calcium, and vitamin D is also recommended if needed.
- Fluids: Aim for fluid intake of at least 2-3 L per day. Recommended fluid sources include water, low-calorie beverages such as unsweetened coffee or tea, or nutrient-dense beverages such as low-fat dairy or soy alternatives. Large amounts of caffeine can cause a diuretic effect, so it is recommended to limit or avoid caffeine while losing weight.
The authors recommend continuous monitoring of dietary intake and nutritional status during treatment with antiobesity drugs. Regular monitoring allows for early recognition and management of gastrointestinal symptoms, mood disorders, and inadequate nutrient or fluid intake.
Addressing research gaps and future directions
The authors explain that there is limited evidence to guide nutritional recommendations for patients taking newer anti-obesity medications that have a weight loss effect of 15% or more, and further research is needed to fill this knowledge gap.
“Simply focusing on weight loss is not enough for optimal health,” said Jessica Alvarez, PhD, a nutritionist and associate professor of medicine in the department of endocrinology, metabolism and lipids at Emory University School of Medicine in Atlanta, Georgia, who was not involved in the study.
She added, “Obese people are already at risk of some nutritional deficiencies. This is an important guide that acknowledges the need for a thorough nutritional assessment before and during treatment with anti-obesity drugs. Many patients need detailed guidance on what and how much to eat while taking anti-obesity drugs to ensure optimal diet quality, avoid nutritional deficiencies and avoid excessive muscle loss. This study also highlights the need for rigorous clinical studies to establish dietary recommendations specific to people undergoing treatment with anti-obesity drugs.”
The current review is based on a PubMed search using various keywords including diet, nutrition, nutrition, weight loss, obesity, obesity, very low calorie diet, malnutrition, obesity treatment, guidelines, and references. Reference lists of manuscripts were also reviewed. As this is a narrative review, the search was augmented with relevant studies by expert consensus. Nutrition recommendations are based on evidence from the general population, low calorie diets, and bariatric surgery, and preoperative patient observations.
Reference: “Nutritional Considerations for Antiobesity Medications,” Jamie P. Armandos, Thomas A. Wadden, Colleen Tewksbury, Caroline M. Apovian, Angela Fitch, Jamie D. Ard, Chaoping Li, Jesse Richards, W. Scott Bucci, Irina Zhoravskaya, Kady S. Vanderman, Lisa M. Neff, June 10, 2024, obesity.
DOI: 10.1002/oby.24067
Other authors of the review include Jaime P. Armandos, of the Department of Endocrinology, University of Texas Southwestern Medical Center, Dallas, Texas, and Thomas A. Wadden, of the Department of Psychiatry, Dallas, Texas. University of PennsylvaniaPhiladelphia, PA; Colleen Tewksbury, Department of Surgery, University of Pennsylvania, Philadelphia, PA; Caroline M. Apovian, Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women’s Hospital, Boston, MA; Angela Fitch, Knownwell, Boston, MA; Jamie D. Ard, Department of Epidemiology and Preventive Medicine and Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Chaoping Li, Center for Human Nutrition, University of California, Los Angeles, Los Angeles, CA; Jesse Richards, Department of Internal Medicine, University of Oklahoma School of Medicine, Tulsa, OK; W. Scott Bucci, Obesity and Metabolism Institute, Cleveland Clinic, Cleveland, OH; Irina Zhoravskaya, Eli Lilly and Company, Indianapolis, IN; Kady S. Vanderman, Syneos Health, Morrisville, NC
The authors declared multiple conflicts of interest; see review for details.
This study was funded by Eli Lilly and Company. Writing assistance was provided by Syneos Health, also supported by Eli Lilly and Company.
