More research is needed on the nutritional guidelines for patients taking GLP-1 RAs or other anti-obesity medications, but following a nutritionally-dense diet is an important step toward healthy weight loss and overall health. 

Anti-obesity medications like Ozempic® and Mounjaro®, as well combinations of anti-obesity medications such as cagrilintide (an amylin analog) and semaglutide (currently in clinical trials), can offer patients with obesity and/or type 2 diabetes, on average,  a ≥ 15 percent reduction in weight and blood glucose control.¹ These benefits are difficult to ignore, and suggest an ongoing need need for optimizing nutrition to mitigate the risks of, for example, sarcopenic obesity, or other consequences of poor nutrition, in general.

Evidence suggests that anti-obesity medications can result in caloric reductions between 16 – 39 percent², thus it is important to understand the nutritional requirements for patients prescribed anti-obesity medications. When taking anti-obesity medications, following a nutritionally-dense diet is an important step toward healthy weight loss and overall health.

Consequences of Poor Nutrition When Taking Anti-Obesity Medication

As noted in a recent review (n = 10 studies),² comprehensive obesity management requires a broad spectrum of approaches, with nutrition being an important strategic element. The authors do acknowledge that there is a knowledge gap relative to GLP-1 RA mediations and quality and quantity of dietary intake and assert that anti-obesity medications may contribute to reductions in the consumption of micro-and macronutrients.

In this review, the authors note that a standardized test meal followed by an ad libitum lunch, dinner, or snack was the most common measurement of food intake. Two studies included a registered dietician (RDN) who delivered a nutrition or counseling intervention. The overarching finding is that more research is needed to fully understand the qualitative and quantitative changes in caloric intake relative to micro-and macronutrients for patients taking anti-obesity medications.

There were two nutritional concerns identified: inadequate protein intake and inadequate diet quality, e.g., micronutrients, fiber, and fluids. Protein is a macronutrient that is implicated in muscle mass, strength, hair loss, weakness, and skin changes.^1,2 Sarcopenia, the loss of muscle mass, or sarcopenic obesity, is one potential negative outcome.² Sarcopenia is most commonly associated with aging, however, there is evidence that shows it can also emerge in young and middle-aged women.³ Sarcopenic obesity has been associated with quality of life and cardiometabolic complications, though its effects could be mitigated by protein intake.

A hallmark of sarcopenia is reduced muscle mass/skeletal mass and strength. Protein is a key macronutrient, and as such, there is an acceptable macronutrient distribution range (AMDR) for protein. The Recommended Daily Allowance (RDA) will vary by the population, e.g., men, women, age, etc. For most adults of normal weight, the RDA for protein is 0.8 g/kg body weight/day, and USDA guidelines suggest a minimum goal of 46 g/day for healthy women and 56 g/day for healthy men. For patients with obesity, protein intake is recommended to be 60 – 75 g/day and up to as much as 1.5 g/kg body weight/day when contextualized to patients following a Very Low Calorie Diet (VLCD) or bariatric surgery.^4,5,6 Meal replacements with 15g of high-quality protein per serving have been shown to effectively support weight loss while mitigating against loss of muscle mass.¹

Carbohydrates are another key macronutrient. The acceptable macronutrient distribution range (AMDR) for carbohydrates for healthy adults is 45 – 65 percent of their energy intake, which equates to roughly 135 – 245 g/day when following a 1200 – 1500 k/cal diet or 170 – 290 g/day for a when following a 1500 – 1800 k/cal diet. The authors note that severe carbohydrate restriction is not necessary because it does not result in greater weight loss and it may result in the consumption of fewer fruits, vegetables, and whole-grain foods.¹

To date, there does remain a knowledge gap in nutrition guidelines for patients taking a GLP-1 or other anti-obesity medications. For patients with obesity and type 2 diabetes, the American Diabetes Association offers clear guidelines for protein and nutrient dense foods.⁷ Other guidance comes from the Obesity Medicine Association (OMA) and the American College of Cardiology, American Heart Association Task Force on Practice Guidelines.^8,9,10

Implications for Clinical Practice

Despite the knowledge gap, health care professionals can still discuss the parameters of a nutrient-dense diet plan with their patients taking GLP-1 RAs or other anti-obesity medications. Each patient’s nutritional needs may differ based on age, biological sex, physical activity levels, ability to be physical active, and weight loss goals. The Dietary Guidelines for Americans¹¹ and the Healthy Eating Index¹² provide parameters, options, and guidance for helping patients optimize the nutritional value of their food intake.

Health care professionals should work with patients to determine what their daily micro-and macronutrients are and then discuss supporting their food intake while on a GLP-1 RA with scientifically formulated meal replacements or a dietary beverage, such as Biocare, which is designed specifically for people using GLP-1 medications.

Source(s):

1 Nutritional considerations with antiobesity medications

2 Dietary intake by patients taking GLP-w and dual GIP/GLP-1 receptor agonists: A narrative review and discussion of research needs

3 Approaching sarcopenic obesity in young and middle-aged female adults in weight management settings: A narrative review

4 Exercise and nutrition strategies to counteract sarcopenic obesity

5 Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology,

6 Exploration of the protein requirement during weight loss in obese older adults

7 American Diabetes Association

8 Obesity Medicine Association

9 American College of Cardiology

10 The American Heart Association

11 The Dietary Guidelines for Americans

12 The Healthy Eating Index