Individuals using anti-obesity medications often experience decreased appetite and reduced food intake, making diet quality important. A new review offers clinicians evidence-based nutrition guidelines that highlight 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 provides nutritional guidelines for patients taking anti-obesity medications, highlights the importance of maintaining diet quality and monitoring to prevent deficiencies, and highlights the need for more research into new treatments.
People who use anti-obesity medications often find that their appetite decreases, leading to less food intake. As a result, the quality of the diet becomes important as nutritional needs must be met by consuming less food. To support this, medical experts have compiled a set of evidence-based nutritional guidelines to help clinicians guide patients on anti-obesity medications. These recommendations are detailed in a published review. ObesityFlagship journal of the Obesity Society (TOS).
“Our evidence-based review aims to equip clinicians with information and tools to help support optimal nutritional and medical outcomes for their patients treated with anti-obesity medications,” said Lisa M. Neff, Executive Director of Global Medical Affairs – Obesity, Eli Lilly and Company. . Neff is the corresponding author of the review article.
5A’s Clinical Practice Model
In the review, the authors recommend the “5A Model” (Ask, Assess, Advise, Accept, Help) when working with patients. Clinicians should obtain permission and then evaluate the patient before discussing weight loss. Evaluation; must include a complete medical history, including psychosocial, weight, nutritional, and other lifestyle history; Physical examination; Laboratory or imaging studies appropriate to evaluate root causes of obesity, identify obesity-related complications, and assess nutritional status, including risk of malnutrition.
Clinicians should advise patients about treatment options and discuss treatment expectations. Clinicians and patients must agree on goals related to health, dietary patterns, other lifestyle patterns, and weight. Clinicians should assist patients in addressing challenges and barriers to weight management by considering social determinants of health. Because obesity is a chronic disease that requires a long-term approach, the authors recommend that clinicians arrange follow-up care and refer patients for additional support, such as seeing a registered dietitian.
As for nutritional recommendations for patients taking anti-obesity medications, the authors recommend the following based on healthy eating patterns:
- Energy intake: Energy requirements vary depending on an individual’s age, gender, body weight, physical activity level, and other factors. Recommended minimum targets for energy intake during weight loss should be individualized. In general, it is recommended that energy intake of 1,200 to 1,500 kcal/day for women and 1,500 to 1,800 kcal/day for men is safe during weight loss.
- Protein: No more than 60 to 75 g of protein per day and 0.8 to 1.5 g/kg body weight per day may be recommended. More than 1.5 g/kg of body weight per day can be considered individually. Recommended sources of protein include beans, lentils and peas; nuts, seeds and soy products; Sea products; lean meat, poultry, low-fat dairy products and eggs. When consumption of whole foods is inadequate, meal replacement products that typically contain 15-25 g of protein per serving may be recommended.
- Carbohydrates: 45% to 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: 20% to 35% of energy intake. Limit saturated fats to less than 10% of energy intake. Fried and high-fat foods should be avoided to reduce gastrointestinal side effects associated with anti-obesity medications. Good sources of fats include nuts and seeds, avocados, 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. In cases where patients cannot reach their fiber goals with food alone, the use of fiber supplements may be considered.
- Micronutrients: Micronutrients of public health concern for U.S. adults include potassium, calcium, and vitamin D. Other nutrients of concern include iron for women of childbearing age and vitamin B12 for older adults. Individuals with obesity are at high risk for micronutrient deficiencies such as vitamin D, folate and thiamine. The guidelines recommend increasing consumption of fruits, vegetables, low-fat dairy products and fortified soy alternatives. Recommendations also include a complete multivitamin, calcium and vitamin D supplementation as appropriate.
- Fluids: Target fluid intake should be no more than 2 to 3 L per day. Recommended sources include water, low-calorie beverages such as unsweetened coffee or tea, or nutrient-dense beverages such as low-fat dairy or soy alternatives. It is recommended to limit or avoid caffeine during weight loss due to the potential diuretic effect of high caffeine intake.
The authors recommend continuous monitoring of dietary intake and nutritional status during treatment with anti-obesity medications. Regular monitoring may facilitate early recognition and management of gastrointestinal symptoms, mood disorders, and inadequate nutritional or fluid intake.
Addressing Research Gaps and Future Directions
The authors explain that limited evidence is available to guide nutritional recommendations for patients taking new anti-obesity medications with 15% or greater efficacy in weight loss. Additional research is needed to address this knowledge gap.
“Focusing solely on weight loss is inadequate for optimal health,” said Jessica Alvarez, PhD, RD, Associate Professor of Medicine, Department of Endocrinology, Metabolism, and Lipids, Emory University School of Medicine, Atlanta, GA. research.
He added that obese people are already at risk for some nutrient deficiencies. This is an important guideline that recognizes the need for comprehensive nutritional assessment before and during treatment with anti-obesity medications. Most patients need detailed guidance on what and how much to eat to ensure optimal nutritional quality, prevent nutrient deficiencies, and prevent excessive muscle wasting while taking anti-obesity medications. “This study also highlights the need for rigorous clinical research to create tailored nutritional recommendations for people being treated with anti-obesity medications.”
The current review was based on a PubMed Search using various keywords such as diet, nutrition, nutrition, weight loss, obesity, obese, very low-calorie diet, malnutrition, bariatric, guidelines, and reference. Article reference lists were also reviewed. Since this was a narrative review, searches were augmented with relevant research based on expert consensus. Nutritional recommendations were based on evidence from the general population, low-calorie diets, and bariatric surgery, including observations of patients before surgery.
Reference: 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, “Nutritional considerations regarding antiobesity drugs”, 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, Department of Endocrinology, Southwestern Medical Center, University of Texas at Dallas, Texas; Thomas A. Wadden, Department of Psychiatry,