by People using anti-obesity medications often have a decreased appetite and reduced food intake, making nutritional quality critical. A new review provides evidence-based nutritional guidelines for clinicians, emphasizing the “5A Model” for effective patient communication and management. Nutritional recommendations include personalized caloric needs, high protein intake, and balanced macronutrients, with ongoing monitoring to manage potential nutritional deficiencies and support optimal health outcomes.
A new review presents nutritional guidelines for patients using anti-obesity medications, emphasizing the importance of maintaining and monitoring diet quality to prevent deficiencies, and highlights the need for more research on new treatments.
People who use anti-obesity medications often find that their appetite decreases, leading to lower food intake. Therefore, the quality of the diet becomes critical as it must meet nutritional requirements with less food consumed. To support this, medical experts have developed a series of evidence-based nutritional guidelines to help clinicians guide patients on anti-obesity medications. These recommendations are detailed in a review published in Obesityflagship journal of The Obesity Society (TOS).
“Our evidence-based review aims to provide clinicians with knowledge and tools to help support optimal nutritional and medical outcomes for their patients treated with anti-obesity medications,” said Eli Lilly and The Company’s Executive Director of Global Medical Affairs – Obesity Lisa M. Neff . Neff is the corresponding author of the review paper.
The 5A Model for Clinical Practice
In the review, the authors recommend the “5A Model” (Ask, Appreciate, Advise, Agree, Help) in working with patients. Clinicians should ask permission before starting a conversation about weight loss and then assess the patient. The assessment should include a complete medical history, including psychosocial, weight, dietary and other lifestyle history; physical examination; appropriate laboratory or imaging studies to assess the underlying causes of obesity, to identify obesity-related complications and to assess nutritional status, including risk of malnutrition.
Clinicians should inform patients about treatment options and discuss expectations for treatment. Clinicians and patients should agree on goals related to health, dietary patterns, other lifestyle patterns, and weight. Clinicians should help patients address challenges and barriers to weight management while taking into account the social determinants of health. Because obesity is a chronic disease that requires a long-term approach, the authors recommend that clinicians arrange for follow-up care and refer patients for additional support as needed, such as seeing a registered dietitian.
Regarding nutritional recommendations for patients taking anti-obesity medications, the authors recommend the following based on healthy dietary patterns:
- Energy intake: Energy needs vary based on age, sex, body weight, level of physical activity, as well as other factors. The recommended minimum targets for energy intake during weight loss should be individualized. In general, it is recommended that an energy intake of 1,200 to 1,500 kcal per day for women and 1,500 to 1,800 kcal/day for men is safe during weight loss.
- Protein: More than 60 to 75 g of protein per day and 0.8 to 1.5 g/kg body weight per day can be recommended. More than 1.5 g/kg body weight per day may be considered on an individual basis. Recommended sources of protein include beans, lentils, and peas; nuts, seeds, and soy products; seafood; lean meat, poultry, low-fat dairy foods, and eggs. Meal replacement products typically containing 15-25 g of protein/serving may be recommended when intake 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 foods 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 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 fruit, vegetables and whole grains. Use of a fiber supplement may be considered when patients are unable to meet fiber goals with food alone.
- Micronutrients: Micronutrients of public health concern for US adults include potassium, calcium, and vitamin D. Additional nutrients of concern include iron for women of childbearing age and vitamin B12 in adults. Individuals with obesity are at increased risk of micronutrient deficiencies such as vitamin D, folate, 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 appropriate.
- Fluids: Targeted fluid intake should be more than 2 to 3 L/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 can facilitate early identification 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 receiving new anti-obesity medications with 15% or more weight reduction efficacy. Further research is needed to address this knowledge gap.
“Focusing on weight loss is not enough for optimal health,” said Jessica Alvarez, PhD, RD, associate professor of medicine, Division of Endocrinology, Metabolism and Lipids, Emory University School of Medicine, Atlanta, Ga. Alvarez was not involved in the research.
She added that “people who are obese are already at risk because of some nutritional deficiencies. This is an important guideline that recognizes the need for a thorough nutritional assessment before and during treatment with anti-obesity medications. Many patients need detailed guidance on what to eat and how much to eat to ensure optimal dietary quality, avoid nutritional deficiencies, and avoid excessive muscle loss while taking anti-obesity medications . This work also highlights the need for rigorous clinical research to establish dietary recommendations specific to people treated with anti-obesity medications.”
The present review was based on PubMed Search using various keywords such as diet, nutrient, nutrition, weight loss, obesity, obesity, 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 according to expert consensus. Nutritional recommendations were based on evidence from the general population, low-calorie diets, and bariatric surgery, including observations of preoperative patients.
Reference: “Nutritional considerations with 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, 10 June 2024, Obesity.
DOI: 10.1002/oby.24067
Other review authors include Jaime P. Almandoz, Southwestern Medical Center, Division of Endocrinology, The University of Texas, Dallas, Texas; Thomas A. Wadden, Department of Psychiatry,
