Newswise — Jaime Almandoz, MD, Associate Professor Department of Endocrinology, Internal Medicine
As antiobesity drugs such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) become more widely known and prescribed, they are being touted as breakthrough treatments for chronic overweight and obesity.
Anti-obesity medications work by signaling to the brain that we have eaten and that our stomach is full, so patients feel fuller for longer with less food and cravings are reduced. These powerful mechanisms can result in an average loss of 15-20% of body weight, which can be life-changing for many people.
But a common misconception about these medications is that they are a magic bullet for better health and that it doesn’t necessarily matter what you eat while you’re taking them. Nothing could be further from the truth.
The average American’s diet is low-quality. It’s high in ultra-processed, calorie-dense foods and is often deficient in fruits, vegetables, fiber, and essential nutrients. Eating less from a low-quality diet can increase the risk of adverse health outcomes, such as loss of muscle mass, fatigue, and malnutrition.
Decades of successful weight management data with bariatric surgery have shown that patients benefit from expert guidance on how to change what they eat in the long term. Before undergoing bariatric surgery, such as gastric bypass or gastric sleeve procedures, patients have multiple sessions with a registered dietitian to create a healthy eating plan for adequate nutrition after surgery. There are also guidelines for patients who have bariatric surgery to take vitamin supplements and have their vitamin levels checked annually for the rest of their lives.
No such guidelines yet exist for anti-obesity drugsHowever, patients now lose weight with these medications in amounts similar to those lost through bariatric surgery.
Originally developed to treat diabetes, anti-obesity medications are still relatively new to the weight loss world. Unfortunately, due to the high prevalence of obesity (over 40% of adults) and the lack of clinicians trained in obesity medicine, people may be receiving anti-obesity medications from providers who have little or no training in obesity care.
Telling patients using these medications to simply eat less of what they currently eat or to eliminate certain types of foods, such as carbohydrates, can lead to ineffective cycles of restrictive diets, malnutrition, and gastrointestinal symptoms such as nausea, constipation, and diarrhea.
At UT Southwestern’s Weight Health Program, our obesity specialists help patients use anti-obesity medications to transform their health through personalized nutrition education and guidance. We guide patients toward sustainable, healthier eating plans.
Our team, collaborating with nutrition, endocrinology, and internal medicine experts from across the U.S., has created the first-ever nutritional recommendations for safe and successful antiobesity medication use. Our evidence-based review is designed to help providers get patients off to a healthy start with antiobesity medications and achieve sustainable weight health based on known health conditions, nutritional needs, and health goals.
6 nutritional building blocks for a healthy diet
Successful weight loss begins with feeding the body a balanced, healthy diet. Understanding a patient’s underlying health conditions, activity level, cultural traditions, medications, and known nutritional deficiencies can reduce the risk of potential anti-obesity medication accidents, such as not consuming enough protein, which can lead to loss of muscle mass and increase the risk of fatigue, weakness, or falls.
Most people can safely get all six essential nutrients by following some general daily dietary recommendations.
Nutritional building blocks | Flourish
Personalized nutrition plans can help Nutritional coaching on what foods to try and how to eat them while taking these medications can help patients reduce their risk of medication-related gastrointestinal side effects, such as bloating, nausea, vomiting, diarrhea, and constipation. For example, if we know in advance that a patient is not eating enough dietary fiber, we may recommend a fiber supplement and extra fluids to keep the digestive system moving.
There is no one diet checklist that works for everyone. Every patient needs a personalized nutrition plan to meet their needs. However, people taking anti-obesity medications can follow a few basic recommendations to reduce the risk of gastrointestinal side effects:
- Avoid fried and high-fat foods
- Limit consumption of carbonated drinks, alcohol, and spicy foods
- Eat smaller meals and be aware of signs of fullness
Learn the risk factors for malnutrition
When we meet with a new patient in the Weight Health Program, we spend about an hour talking about their health history and goals. The patient also meets with a registered dietitian for about an hour. These meetings help us gain a more holistic perspective so we can create personalized treatment and nutrition plans for each patient.
Most community health clinics and primary care physicians do not have the time in their schedules or the specialized training in obesity care to go into this much nutritional detail with their patients. It is very important for patients taking anti-obesity medications to understand how to create a balanced diet that leads to both weight loss and better health. Simply eating less and skipping meals while taking anti-obesity medications can sometimes do more harm than good.
If you have any of the following risk factors for malnutrition while taking an anti-obesity medication, consider seeing an obesity specialist or ask your primary care provider to refer you to a registered dietitian:
- History of gastrointestinal procedures or bariatric surgery: Gastrointestinal procedures may alter nutrient absorption and also increase the risk of gastrointestinal side effects of antiobesity medications.
- Advanced age: Older adults may have health conditions that require special dietary considerations to reduce the risk of muscle loss and weakness. Rapidly losing large amounts of weight may not be safe for older adults.
- Chronic disease: Conditions such as kidney disease, diabetes and cardiovascular disease may require special diets and adjustments to other medications (such as insulin, blood pressure and thyroid medications) while taking an anti-obesity medication and losing weight.
- Unwanted rapid weight loss: Rapid and unintended weight loss may be a sign of an underlying health problem or may indicate that the dose of anti-obesity medication is too high.
- Dental health problems: Gum disease or missing teeth can make chewing difficult and painful, resulting in a decreased intake of nutrient- and fiber-rich foods.
Nourishing the body rather than restricting food intake can improve your health and quality of life by maximizing the effectiveness of anti-obesity medications—beyond simply reducing the number on the scale.
As patients and providers incorporate antiobesity medications into their long-term health plans, conversations must shift away from the generalized, restrictive diet recommendations of the past. Instead, creating a balanced, evidence-based eating plan that supports weight loss and a healthy lifestyle will be key to creating sustainable solutions for patients.
Related readings:
Weight loss pills: 5 most frequently asked questions
Why is it so difficult to keep off excess weight and how can long-term treatment help?
Metabolic reset: Benefits of bariatric surgery beyond weight loss
Anti-obesity drugs bridge the gap between diet and bariatric surgery
Obesity drugs help patients lose weight they regain years after bariatric surgery
Nutritional information for patients taking anti-obesity medications