by Newswise — By Jaime Almandoz, MD, Associate Professor with Internal Medicine in the Division of Endocrinology
As anti-obesity medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have become more widely known and prescribed, they have been touted as game-changing treatments for chronic overweight and obesity.
Anti-obesity medications work by telling the brain that we have eaten and that the stomach is full, so patients feel satisfied with less food for a longer period, and cravings are reduced. These powerful mechanisms can lead to an average of 15%-20% of body weight, which can be life-changing for many people.
But one common misconception about these medications is that they are a magic bullet for better health, and it doesn’t necessarily matter what you eat while taking them. Nothing could be further from the truth.
The average American diet is low-quality. It is high in ultra-processed, calorie-dense foods and often deficient in fruit, vegetables, fiber and essential nutrients. Eating less of a low-quality diet may increase the risk of unintended health outcomes, including loss of muscle mass, fatigue and malnutrition.
Data from years of successful weight management with bariatric surgery show that patients benefit from expert guidance on how to change what they eat long-term. Before patients undergo bariatric surgery such as gastric bypass or gastric sleeve procedures, they have multiple visits with a registered dietitian to create a healthy eating plan for adequate nutrition after surgery. In addition, there are guidelines for bariatric surgery patients to take vitamin supplements and have their vitamin levels checked annually for the rest of their lives.
There are no such guidelines yet for anti-obesity medicationsalthough patients now lose the same amounts of weight with these medications as they do with bariatric surgery.
Anti-obesity medications, originally developed to treat diabetes, are still relatively new in the weight loss world. Unfortunately, due to the high prevalence of obesity (over 40% of adults) and the lack of medically trained obesity clinicians, people may be receiving anti-obesity medications from poorly trained providers. with or without any training in obesity care.
Simply telling patients using these medications to eat less of what they are currently eating or to eliminate specific types of food such as carbohydrates can result in ineffective cycles of restrictive diets, poor nutrition, and causing gastrointestinal symptoms such as nausea, constipation, and diarrhea.
At UT Southwestern’s Weight Wellness Program, our obesity specialists help patients use anti-obesity medications to transform their health with education and personalized nutritional guidance. We guide patients towards sustainable and healthier eating plans.
Collaborating with experts in nutrition, endocrinology, and internal medicine from across the US, our team created the first set of nutritional recommendations for the safe, successful use of anti-obesity medications. Our evidence-based review is designed to guide providers in helping patients get a healthy start on anti-obesity medications and achieve sustainable weight fitness based on their health conditions, nutritional needs and known health goals.
6 nutritional building blocks for healthy eating
Successful weight loss begins with feeding the body a balanced, healthy diet. Understanding the patient’s baseline health conditions, activity level, cultural traditions, medications, and known nutritional deficiencies can reduce the risk of potential anti-obesity medication adverse events, such as not eating enough protein, which can lead to loss of muscle mass and increase the risk. fatigue, weakness, or collapse.
Most people can get their six main nutritional building blocks safely by following some general daily dietary recommendations.
Building blocks of nutrition | Flower
Personalized eating plans can help with nutrition coaching on what foods to try and how to eat while taking these medications can help patients reduce the 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 does not eat enough dietary fiber, we can recommend a fiber supplement and additional hydration to keep their digestive tract moving.
There is no one diet checklist that works for everyone. Each patient needs a personalized eating plan to meet their needs. However, people taking anti-obesity medications can follow some basic recommendations to reduce the risk of gastrointestinal side effects:
- Avoid fried and high-fat foods
- Limit the intake of carbonated drinks, alcohol, and spicy foods
- Eat smaller meals and be aware of fullness cues
Know the risk factors for malnutrition
When we meet a new patient in the Weight Wellness Program, we spend about an hour talking about their health history and goals. The patient also meets with a registered dietitian for an hour. These conversations help us gain a more holistic view so we can create individualized treatment and nutrition plans for each patient.
Most community health clinics and primary care physicians do not have the time in their schedules or specific training in obesity care to go into this micro-nutrition with their patients. It is very important for patients taking anti-obesity medications to understand how to create a balanced diet that leads to weight loss and better health. Eating less food and skipping meals while taking anti-obesity medication can sometimes do more harm than good.
Consider talking to an obesity specialist or ask your primary care provider for a referral to a registered dietitian if you have any of these risk factors for malnutrition while taking anti-obesity medications:
- History of gastrointestinal procedures or bariatric surgery: Gastrointestinal procedures can alter nutrient absorption and may also increase the risk of gastrointestinal side effects from anti-obesity medications.
- Advanced age: Older adults may have health issues that require special nutritional considerations to reduce the risk of muscle loss and weakness. It may not be safe for older adults to lose large amounts of weight quickly.
- Chronic disease: Conditions such as kidney disease, diabetes, and cardiovascular disease, and taking anti-obesity medications and weight loss may require specialized diets and adjustments in other medications (such as insulin, blood pressure and thyroid medications). lose.
- Unexpected rapid weight loss: Rapid and unintentional weight loss can indicate an underlying health condition or that the dose of the anti-obesity medication is too high.
- Dental health issues: Gum disease or missing teeth can make chewing difficult and painful, leading to a low intake of nutritious and fiber-rich foods.
Nourishing the body instead of limiting food intake can maximize the effectiveness of anti-obesity medications to improve health and quality of life – beyond just reducing the number on the scale.
As patients and providers incorporate anti-obesity medications into their long-term health plans, conversations should evolve from the blanket recommendations of dietary restrictions of the past. Instead, a balanced, evidence-based eating plan that encourages weight loss and a healthy lifestyle will be the key to creating sustainable solutions for patients.
Related reading:
Weight loss medications: The 5 most frequently asked questions
Why it’s so hard to keep off excess weight and how long-term treatment can help
Metabolic reset: Benefits of bariatric surgery over weight loss
Anti-obesity drugs are closing the gap between diet and bariatric surgery
Obesity drugs help patients lose weight regained years after bariatric surgery
Nutritional know-how for patients taking anti-obesity medications
