Experts outline nutrition recommendations for patients treated with obesity medications

As individuals embark on treatment with anti-obesity medications, they frequently experience a diminished appetite which naturally leads to a reduction in food consumption. Given this reduced intake, ensuring a high quality of diet becomes crucial to meet the nutritional demands within the constraints of lower food consumption. To address these challenges, a team of medical experts has articulated a series of evidence-based nutritional guidelines designed to aid healthcare providers in managing patients on anti-obesity medications. These guidelines are detailed in a comprehensive review published in the journal “Obesity,” titled “Nutritional Considerations with Anti-Obesity Medications.”

Lisa M. Neff, the Executive Director of Global Medical Affairs for Obesity at Eli Lilly and Company, who is also the corresponding author of the review, emphasised the purpose of their findings: “Our evidence-based review aims to equip clinicians with knowledge and tools to help support optimal nutritional and medical outcomes for their patients treated with anti-obesity medications.”

The review advocates for the implementation of the “5A’s Model” (Ask, Assess, Advise, Agree, Assist) in clinical practice. This involves clinicians asking for permission to discuss weight management, conducting thorough assessments—including medical, psychosocial, dietary histories, and physical examinations—and identifying root causes of obesity along with any related complications.

After the assessment, healthcare providers should advise patients on treatment options and set realistic expectations. An agreement should be reached on health and lifestyle goals, with continuous assistance provided to overcome any barriers to effective weight management. Acknowledging the chronic nature of obesity, the review suggests regular follow-ups and referrals to dietitians as necessary.

The nutritional advice detailed in the review includes:

• Energy Intake: Tailor calorie intake based on individual factors such as age, sex, body weight, and activity level, with general recommendations of 1,200 to 1,500 kcal/day for women and 1,500 to 1,800 kcal/day for men during weight loss phases.
  
• Protein: Intake suggestions range from 60 to 75 g/day, with an upper limit of 1.5 g/kg body weight per day, emphasising sources like beans, nuts, seafood, and lean meats. Meal replacements can also be beneficial.
  
• Carbohydrates: Should constitute 45% to 65% of total energy, with a focus on whole grains, fruits, and vegetables, limiting added sugars to under 10%.
  
• Fats: Recommended to make up 20% to 35% of daily intake, with saturated fats kept below 10%, prioritising sources like avocados, fatty fish, and vegetable oils while avoiding high-fat and fried foods.
  
• Fibre: A daily intake of 21–25 g for women and 30–38 g for men is advised, using sources such as fruits, vegetables, and whole grains.
  
• Micronutrients: Emphasis on potassium, calcium, vitamin D, iron (for women of childbearing age), and vitamin B12 (in older adults), with a recommendation for increased fruit and vegetable consumption and possible supplementation.
  
• Fluids: A daily fluid intake of over 2 to 3 litres is encouraged, focusing on water and other low-calorie beverages, while limiting caffeine to avoid its diuretic effects.

Jessica Alvarez, Ph.D., RD, an associate professor of medicine at Emory University School of Medicine, not involved in the research, highlighted the broader implications of the study: “Simply focusing on weight loss is insufficient for optimal health,” she noted. “People with obesity are already at risk for some nutrient deficiencies. This is an important guide acknowledging the need for thorough nutritional assessment before and during treatment with anti-obesity medications.”

Alvarez also pointed out the necessity for detailed dietary guidance to prevent nutrient deficiencies and excessive muscle loss, calling for more rigorous clinical research to establish tailored dietary recommendations for this group.

The review’s methodology included a PubMed search using keywords related to diet, nutrition, and obesity, supplemented by expert consensus and observations from various related studies, including those on bariatric surgery and low-calorie diets. This narrative review underscores the importance of continued monitoring and adaptation of dietary guidelines to suit the evolving landscape of obesity treatment.