Why are High Protein Meal Replacements and Healthy Eating Important Considerations during Semaglutide Weight Loss?
— By Dawn M. Sweet, Ph.D
Coupled with a healthy diet, meal replacements ensure nutritional needs are being met when following a weight loss program that includes anti-obesity medications.
Proper nutrition is critical for overall well-being, so meeting nutritional requirements while following any weight loss protocol should be a paramount concern. Successful weight loss involves creating an energy deficit, so consuming high quality calories in the form of protein, fiber, vitamins, and minerals — particularly protein — is key. Preserving lean mass is also an important concern during weight loss because of its role in increasing metabolic rate, which positively affects energy expenditure. It is important to create this energy deficit via a dietary balance of fat, carbohydrate, and protein, with the long-term goal of decreasing fat mass while maintaining lean mass.1 While anti-obesity medications have certainly been efficacious for weight loss, they are not without risks, particularly in the context of compromised nutrition.
Semaglutide, the active ingredient in popular anti-obesity medications such as Ozempic, Rybelsuc, or Wegovy, suppresses one’s appetite, thus potentially restricting the intake of necessary nutrients for overall well-being. Nutritionally formulated meal replacements coupled with a healthy diet can help ensure nutritional needs are being met while pursuing weight loss with anti-obesity medications.
Nutritional Deficits and Risks When Taking Semaglutide
More adverse gastrointestinal events such as nausea, vomiting, and diarrhea have been reported in study participants randomly assigned to the semaglutide group compared to the placebo group.5 For example, in a 2021 double-blind study5, 72.9 percent of participants receiving 2.4 mg of semaglutide experienced adverse gastrointestinal events compared to only 47.1 percent who received the placebo. In a 2020 study6 meta-analysis of 11 randomized control trials, similar adverse gastrointestinal events were observed in participants receiving 2.4mg of semaglutide.
Semaglutide suppresses one’s appetite7, which can further impoverish nutrition intake because it can contribute to a 45 percent or more decrease in caloric intake, according to a Novo-Nordisk-funded study.7 In addition to appetite suppression and adverse gastrointestinal events, there are also anecdotal reports of alterations in the taste of food and changes in food preferences. Researchers are just beginning to explore the effect of semaglutide on taste and food preference.2,3,4 Individually or collectively, these side effects have consequences for ensuring proper nutrition. The appetite suppression effect coupled with the changes in taste preferences further contributes to changes in food intake, most notably decreases in savory foods and dairy, which suggests a reduction in protein intake.8 Protein is critical for muscle, lean body mass, supporting a healthy metabolism and organ health.9,10
Gastric emptying can result in the loss of electrolytes such as potassium and sodium, and deplete the body of necessary vitamins and minerals. The decreased potassium levels associated with gastric emptying, for example, can lead to fatigue, abnormal heart rates, and weakness. Because physical activity is also a key component of weight loss, the weakness and fatigue associated with potassium and sodium deficits may not allow for safe or meaningful physical activity. These are not risks associated with scientifically designed meal replacements. Scientifically designed meal replacements ensure patients with obesity are consuming a balanced nutritional profile that includes protein, fiber, vitamins, and minerals.
The Benefits of Meal Replacements and Protein
Nutritionally formulated meal replacements are a prepared liquid (for example, pudding shakes or drinks) or discrete foods (for example, protein bars) that are used in place of one or two daily meals. Although several meal replacements exist, nutritionally-formulated meal replacements are designed to deliver nutritional benefits to patients with obesity, providing them with the vitamins and minerals needed as part of a healthy diet.6 Nutritionally formulated meal replacements can provide 15-25 grams of protein, 3-6 grams of dietary fiber, vitamins, and minerals to ensure daily nutritional needs are being met and weight loss is happening at a healthy, sustainable pace, particularly when weight loss is medically induced.
When patients’ weight loss is medically induced (e.g., gastric sleeve)12, it is important that nutritional needs are being met in order to support metabolic health and metabolism. Semaglutide is another example of a medically-induced weight loss strategy. Because of its appetite suppressing effect, ensuring sufficient protein intake throughout the day will help preserve lean muscle mass, which is implicated in optimizing the effects of an energy restricted diet. As reported in a 2021 study11, 15-40 percent of weight loss includes decreases in lean mass. Protein is implicated in preserving lean mass, and nutritionally formulated meal replacements ensure daily protein needs are being met.
There is substantial evidence that shows increasing protein intake results in increased muscle mass preservation as well as limits age-related muscle loss. These effects are amplified when the increased protein intake is distributed throughout the day.13 As noted in a 2019 paper13, the RDA for protein is 0.83 g/kg/d, which, is argued, is not being correctly applied — this is the minimum daily RDA and not the optimal RDA for protein. Optimal protein consumption for preservation of lean muscle mass should be increase to 2.5-3.0 g/kg/d for optimal muscle health. Nutritionally formulated meal replacements can help patients taking semaglutide reach this optimal nutritional goal and shore up any shortfalls in daily protein intake.
Another important goal with medically-induced weight loss is helping patients feel satiated.14,15 Protein is more satiating than carbohydrates, and research has shown that increasing daily protein intake facilitated weight loss. For example, a study15 investigating the effects of following a high protein diet and a high fat diet, found that participants in the high protein group (30 percent protein, 60 percent carbohydrate, and 10 percent fat energy) felt more satiated throughout the day compared to those in the high fat group (10 percent protein, 30 percent carbohydrate, and 10 percent fat energy).
Nutritionally formulated meal replacements are an important part of a balanced, healthy diet when a medically-induced weight loss plan includes semaglutide. Meal replacements offer convenience while ensuring patients are meeting their necessary intake of protein, vitamins, and minerals.
Implications for Clinical Practice
While there are many wight loss strategies available to patients with obesity, there is still no one single approach for healthy, sustainable, long-term weight loss. Successful long-term weight loss and weight maintenance requires a multi-prong approach that includes lifestyle changes underpinned by healthy diets and physical activity. Working with patients to develop healthy lifestyle changes is more sustainable long-term and do not have the risks associated with semaglutide. While semaglutide and other anti-obesity medications are effective, they should not be considered the only approach. Rather, attention to the nutritional needs that are foundational to healthy, sustainable weight loss must warrant closer consideration.
Patients should be encouraged to integrate nutritionally formulated meal replacements into their diets prior to taking anti-obesity medications. Nutritionally formulated meal replacements not only jumpstart patients’ weight loss journey by ensuring nutritional and caloric needs are being met but also promote healthy and sustainable energy deficit. Nutritionally formulated meal replacements can offset the side effects of semaglutide. When coupled with weight loss medications, nutritionally formulated meal replacements can help patients optimize weight loss while meeting nutritional needs.
It is vitally important for health care professionals to work with patients to develop a tailored, healthy, and sustainable diet plan that meets each patient’s nutritional needs. While these tailored diet plans may include pharmacological interventions, they must be coupled with an emphasis on adequate protein intake and overall nutritional needs of the patient in mind. Nutritionally formulated meal replacements, coupled with a healthy Low Calorie Diet (LCD) or Very Low Calorie Diet (VLCD) and physical activity will optimally benefit patients.
When proper nutrition is achieved with nutritionally formulated meal replacements and a shift to healthier eating regimens become a staple of your patients’ weight loss program, you are helping your patients avoid unpleasant side of anti-obesity drugs while teaching them to engage in more sustainable weight loss behaviors.