Individuals taking anti-obesity medications often experience decreased appetite and reduced food intake, making diet quality critical. A new review provides physicians with evidence-based nutritional guidelines, highlighting the “5A model” for effective patient communication and management. Nutritional recommendations include personalized calorie needs, high protein intake and balanced macronutrients, with ongoing monitoring to manage potential nutrient deficiencies and support optimal health outcomes.
A new review presents dietary guidelines for patients taking anti-obesity medications, highlighting the importance of maintaining diet quality and monitoring to prevent deficiencies, and highlighting the need for further research into new treatments.
People taking anti-obesity medications often notice a decrease in their appetite, leading to lower food intake. Consequently, the quality of the diet becomes crucial, as it must meet nutritional needs with less food consumed. To support this, medical experts have put together a set of evidence-based dietary guidelines to help doctors guide patients through the use of anti-obesity medications. These recommendations are detailed in a review published in Obesitythe flagship journal of The Obesity Society (TOS).
“Our evidence-based assessment aims to equip physicians with knowledge and tools to support optimal nutritional and medical outcomes for their patients treated with anti-obesity medications,” said Eli Lilly and Company Executive Director of Global Medical Affairs – Obesity Lisa M. Neff . Neff is the corresponding author of the review article.
The 5A model for clinical practice
In the review, the authors recommend the “5A model” (Ask, Assess, Advise, Agree, Assist) when working with patients. Doctors should ask permission before starting a weight loss conversation and then assess the patient. The assessment should include a complete medical history, including psychosocial, weight, nutritional, and other lifestyle history; physical examination; appropriate laboratory or imaging studies to assess the root causes of obesity, identify obesity-related complications, and assess nutritional status, including the risk of malnutrition.
Doctors should advise patients about treatment options and discuss expectations for treatment. Doctors and patients must agree on goals related to health, diet, lifestyle patterns, and weight. Clinicians should help patients address challenges and barriers to weight management, taking social determinants of health into account. Because obesity is a chronic disease that requires a long-term approach, the authors suggest that physicians provide follow-up care and refer patients for additional support as needed, such as a visit to a registered dietitian.
As for dietary recommendations for patients taking anti-obesity medications, the authors suggest the following based on healthy dietary patterns:
- Energy Intake: Energy needs vary based on a person’s age, gender, body weight, physical activity level and other factors. Recommended minimum targets for energy intake during weight loss should be personalized. In general, an energy intake of 1,200 to 1,500 kcal/day for women and 1,500 to 1,800 kcal/day for men is recommended as safe during weight loss.
- Protein: More than 60 to 75 g of protein/day and 0.8 to 1.5 g/kg of body weight per day may be recommended. On an individual basis, a dose higher than 1.5 g/kg body weight per day may be considered. Recommended sources of protein include beans, lentils and peas; nuts, seeds and soy products; seafood; lean meat, poultry, low-fat dairy products and eggs. Meal replacement products that typically provide 15-25 g of protein/serving may be recommended if consumption from whole foods is insufficient.
- Carbohydrates: Between 45% and 65% of energy intake. Limit added sugars to less than 10% of energy intake. Recommended sources include whole grains, fruits, vegetables, nuts and seeds, dairy products such as milk and yogurt, and dairy alternatives such as soy milk.
- Fats: between 20% and 35% of energy intake. Limit saturated fat to less than 10% of energy intake. Fried and high-fat foods should be avoided to reduce the gastrointestinal side effects associated with anti-obesity medications. Good sources of fats include nuts and seeds, avocado, vegetable oils, fatty fish and seafood.
- Fiber: The recommended amount is 21-25 g/day for adult women and 30-38 g/day for adult men, depending on age. Good sources of fiber include fruits, vegetables and whole grains. The use of a fiber supplement may be considered if patients cannot achieve fiber goals with food alone.
- Micronutrients: Micronutrients of public health concern for U.S. adults include potassium, calcium, and vitamin D. Additional nutrients of concern include iron for women of childbearing age and vitamin B12 in older adults. People with obesity are at increased risk of micronutrient deficiencies, such as vitamin D, folic acid and thiamine. Guidelines recommend increased intake of fruits, vegetables, low-fat dairy products and fortified soy alternatives. Recommendations also include supplementation with a complete multivitamin, calcium and vitamin D, as needed.
- Fluids: The targeted fluid intake should be greater than 2 to 3 l/day. Recommended sources include water, low-calorie drinks such as unsweetened coffee or tea, or nutrient-rich drinks such as low-fat dairy or soy alternatives. Limiting or avoiding caffeine is recommended during weight loss because of the potential diuretic effect of high caffeine intake.
The authors recommend continued monitoring of dietary intake and nutritional status during treatment with anti-obesity medications. Regular monitoring can facilitate the early recognition and treatment of gastrointestinal symptoms, mood disorders, and inadequate nutrient or fluid intake.
Addressing research gaps and future directions
The authors explain that limited evidence exists to provide dietary recommendations for patients receiving new anti-obesity medications that have an efficacy of 15% or greater in reducing weight. Additional research is needed to close this knowledge gap.
“Simply focusing on weight loss is insufficient for optimal health,” says Jessica Alvarez, PhD, RD, associate professor of medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, Georgia. Alvarez was not associated with the investigation.
She added that “people with obesity are already at risk for certain nutrient deficiencies. This is an important guide that recognizes the need for thorough nutritional assessment before and during treatment with anti-obesity medications. Many patients need detailed guidance on what and how much to eat to ensure optimal diet quality, prevent nutrient deficiencies, and avoid excessive muscle loss while taking anti-obesity medications. This work also highlights the need for rigorous clinical research to develop nutritional recommendations specific to people treated with anti-obesity medications.”
The current review was based on a PubMed search using a variety of keywords such as diet, nutrition, nutrition, weight loss, obesity, obese, very low calorie diet, malnutrition, bariatric, guidelines, and reference. Manuscript reference lists were also reviewed. As this was a narrative review, searches were supplemented with relevant research based on expert consensus. Dietary recommendations were based on evidence from the general population, low-calorie diets, and bariatric surgery, including observations of preoperative patients.
Reference: “Nutritional Considerations in Anti-obesity Medications” by Jaime P. Almandoz, Thomas A. Wadden, Colleen Tewksbury, Caroline M. Apovian, Angela Fitch, Jamy D. Ard, Zhaoping Li, Jesse Richards, W. Scott Butsch, Irina Jouravskaya, Kadie S. Vanderman and Lisa M. Neff, June 10, 2024, Obesity.
DOI: 10.1002/oby.24067
Other authors of the review include Jaime P. Almandoz, Southwestern Medical Center, Division of Endocrinology, University of Texas, Dallas, Texas; Thomas A. Wadden, Department of Psychiatry,