Newswise - By Jaime Almandoz, MD, Associate Professor Internal medicine in the Endocrinology department
Since obesity drugs such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have become more widely known and prescribed, they have been touted as breakthrough treatments for chronic overweight and obesity.
Anti-obesity drugs work by signaling to the brain that we have eaten and that our stomach is full, allowing patients to feel fuller for longer while eating less and reducing cravings. These powerful mechanisms can result in an average of 15%-20% weight loss, which can be life-changing for many people.
But a common misconception about these drugs is that they are a miracle cure for better health, and that it doesn't necessarily matter what you eat when you take them. Nothing could be further from the truth.
The average American diet is poor quality. It is high in ultra-processed, high-calorie foods and often low in fruits, vegetables, fiber, and essential nutrients. Eating less of a poor quality diet can increase your risk of unintended health effects, including muscle loss, fatigue, and malnutrition.
Decades of successful weight management with bariatric surgery have shown that patients benefit from expert guidance on how to make long-term changes to their diet. Before undergoing bariatric surgery, such as gastric bypass or gastric sleeve, patients have multiple visits with a registered dietitian to develop a healthy eating plan for adequate nutrition after surgery. Additionally, there are guidelines for patients undergoing bariatric surgery to take vitamin supplements and have their vitamin levels checked annually for the rest of their lives.
There are no guidelines yet for anti-obesity drugs although patients now lose about the same amount of weight on these drugs as after bariatric surgery.
Anti-obesity medications, originally developed to treat diabetes, are relatively new to the weight loss world. Unfortunately, people may be prescribed anti-obesity medications by health care providers with little or no training in obesity care, due to the high prevalence of obesity (over 40% of adults) and the lack of clinicians trained in obesity medicine.
Simply telling patients taking these medications to eat less than they currently eat or to eliminate certain foods, such as carbohydrates, can lead to an ineffective cycle of restrictive dieting, poor nutrition, and gastrointestinal complaints such as nausea, constipation, and diarrhea.
At UT Southwestern's Weight Wellness Program, our obesity specialists help patients using anti-obesity medications transform their health with personalized nutrition education and counseling. We guide patients toward sustainable, healthier eating plans.
In collaboration with experts in nutrition, endocrinology, and internal medicine from across the U.S., our team has developed the first set of dietary recommendations for the safe and successful use of anti-obesity medications. Our evidence-based review is designed to help healthcare providers help patients get off to a healthy start on anti-obesity medications and achieve sustainable weight wellness based on their known health status, nutritional needs, and health goals.
6 nutritional building blocks for a healthy diet
Successful weight loss begins with nourishing the body with a balanced, healthy diet. Understanding a patient's baseline health, activity level, cultural traditions, medications, and known nutritional deficiencies can help reduce the risk of potential misadventures with anti-obesity medications, such as not eating enough protein, which can lead to muscle loss and increase the risk of fatigue, weakness, or falls.
Most people can safely get their six core nutritional building blocks by following some general daily dietary recommendations.
Nutritional Building Blocks | Flourish
Personalized eating plans can help Dietary coaching about 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 is not eating enough dietary fiber, we may recommend a fiber supplement and extra hydration to keep the digestive tract moving.
There is no one-size-fits-all diet checklist. Each patient needs a personalized eating plan to meet their needs. However, people taking anti-obesity medications can follow a few basic recommendations to reduce their risk of gastrointestinal side effects:
- Avoid fried and fatty foods
- Limit intake of carbonated drinks, alcohol and spicy foods
- Eat smaller meals and pay attention to signals that you are full
Know the risk factors for malnutrition
When we meet a new patient at the Weight Wellness Program, we spend about an hour discussing their medical history and goals. The patient also meets with a registered dietitian for about an hour. These conversations help us get a more holistic picture so we can create individualized treatment and nutrition plans for each patient.
Most community health clinics and family physicians do not have the time in their schedules or specific training in obesity care to discuss so many nutritional details with their patients. It is very important for patients taking anti-obesity medications to understand how to create a balanced diet that will lead to both weight loss and better health. Simply eating less and skipping meals while taking anti-obesity medications can sometimes do more harm than good.
Consider talking to an obesity specialist or ask your primary care doctor for a referral to a registered dietitian if you have any of the following risk factors for malnutrition when taking obesity medications:
- History of gastrointestinal procedures or bariatric surgery: Gastrointestinal interventions may affect nutrient absorption and may also increase the risk of gastrointestinal side effects from anti-obesity medications.
- Advanced age: Older adults may have health conditions that require special dietary considerations to reduce the risk of muscle loss and fragility. Rapidly losing large amounts of weight may not be safe for older adults.
- Chronic disease: Conditions such as kidney disease, diabetes, and cardiovascular disease may require dietary changes and adjustments in other medications (such as insulin, blood pressure, and thyroid medications) while you are taking medications for obesity and weight loss.
- Unintentional rapid weight loss: Rapid and unintentional weight loss may indicate an underlying health condition or an overdose of anti-obesity medication.
- Dental health problems: Gum disease or missing teeth can make chewing difficult and painful, leaving you with inadequate nutrients and fiber.
By nourishing the body rather than restricting food intake, you can maximize the effectiveness of obesity medications to improve health and quality of life - not just lower the number on the scale.
As patients and providers incorporate anti-obesity medications into their long-term health care plans, conversations must shift away from the blanket, restrictive dietary recommendations of the past. Instead, creating a balanced, evidence-based eating plan that promotes weight loss and healthy lifestyles will be key to building sustainable solutions for patients.
Related reading:
Weight Loss Medications: Top 5 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 Beyond Weight Loss
Anti-obesity drugs bridge the gap between diet and bariatric surgery
Anti-obesity drugs help patients lose weight regained years after bariatric surgery
Nutritional knowledge for patients taking anti-obesity medications