A recent review published in the Obesity Society’s journal provides clinicians with everything they need to know around nutrition and antiobesity medications (AOMs). This includes evidence-based nutrition recommendations, as well as managing patients at risk of nutritional deficiency; and practical tips to support patients’ efforts to achieve a healthier lifestyle and promote optimal outcomes during treatment with AOMs. We’ve compiled the most prescient takeaways for you here, to equip you with the latest in research to better support patients using these medications.
General Recommendations
When setting a weight target, the goal should be patient-centered, and based on their individual health, goals, and capabilities. It should be clear to the patient that the goal of treatment does not need to be achievement of a “normal” BMI (i.e.,BMI < 25 kg/m2), as this is not possible for everyone and can lead to adverse feelings of guilt and shame.
An assessment of nutritional status should be performed prior to treatment with AOMs. This is highly important given the frequent coexistence of obesity and malnutrition. The assessment will help you understand the patient’s benchmark habits so you can provide tailored recommendations to ensure they are getting adequate nutrients in their diet, even while losing weight with AOMs.
Referral to a registered dietitian for medical nutrition therapy is a powerful way to complement and support obesity therapies, including treatment with AOMs. Regular medical nutrition therapy can support patients with tailored approaches to developing diet and lifestyle habits that are sustainable and support their health.
Nutrition Recommendations
Fluid
Emerging data suggest that GLP-1receptor agonism may reduce thirst and fluid intake in rodents and in adults with primary polydipsia. Additional research is needed to understand whether this effect is also observed in adults with obesity who are treated with AOMs. Patients receiving AOMs should be encouraged to achieve higher fluid intakes (generally 2 to 3 L per day). Always personalize fluid recommendations based on age, body size, health history, and physical activity levels.
Energy
Goals for calorie intake during weight loss should be personalized. Emphasize a healthy eating pattern, including vegetables, fruits, whole grains, lean protein foods, low-fat dairy or dairy alternatives, and healthy fats. Patients with low energy intakes (<1200 kcal/day) may have difficulty meeting nutritional needs with diet alone, but it is important to remember that those with higher energy intakes may also be at risk of deficiencies due to poor diet quality.
Fiber
For patients receiving AOMs who do not currently meet recommended fiber intakes, gradual increases in fiber intake along with adequate fluid intake may reduce constipation-related adverse events.
Protein
Protein should comprise between 10%–35% of energy intake for patients on AOMs; >60–75 g/day and up to 1.5 g/kg body weight/day is recommended; >1.5 g/kg body weight/day may be considered on an individual basis. Patients should be instructed to consume high-protein foods first at each meal to ensure adequate protein intake and mitigate potential losses in lean body mass on GLP-1 RA medications.
Carbohydrates
Carbohydrates should make up between 45%–65% of energy intake for patients on AOMs. Avoid low-carb or ketogenic diets for patients using AOMs, as ketone body production with very low- carbohydrate diets may promote increased urination, dehydration, and electrolyte imbalance.
Fat
Adequate fat intake may promote gallbladder emptying, thereby reducing the risk of cholestasis during weight reduction; whereas consumption of high-fat meals may cause gastric distress.
Micronutrients
Individuals with obesity are at increased risk of additional micronutrient deficiencies. For these patients receiving AOMs, consider supplementation with a complete multivitamin, calcium, and vitamin D as appropriate.
Refer Your Patients to a Registered Dietitian
Culina Health is proud to be trusted by over 1,000 referral partners nationwide. We are in-network with most major insurance plans, and our diverse team of registered dietitians provides patient-centered and evidence-based care that supports and builds upon the work they’re doing with primary care providers and specialists. Learn more about how we make referrals seamless here and email us at partners@culinahealth.com to learn more about referring a patient.
