In a recent review published in Obesity, researchers provide evidence-based suggestions for nutritional evaluation, treatment, and monitoring in patients taking anti-obesity medications (AOMs).

Background

Anti-obesity drugs have made tremendous progress in treating obesity, with an average weight decrease of ≥15%. However, introducing AOMs has resulted in limited dietary advice for patients undergoing these medications.

According to studies, energy consumption is likely to decrease with AOMs, with decreases of up to 345 kcal from baseline in individuals taking AOMs compared to placebo. Patient monitoring and counseling could reduce the possibility of dietary deficits. Additional study is required to close this knowledge gap.

About the review

In the present narrative review, researchers provide dietary advice for patients using new anti-obesity drugs based on PubMed data, including publication reference lists, emphasizing dietary, nutritional, weight reduction, obesity, low-calorie diets, malnutrition, and bariatric recommendations.

Indications, mechanisms, clinical trials, advantages, and adverse effects of AOMs

Recent breakthroughs in AOMs have yielded encouraging outcomes in the treatment of obesity. Clinicians recommend AOMs as a supplement to lifestyle change for those with body mass index (BMI) values of ≥27 kg/m2 with one or more weight-associated concerns or individuals with BMI values of ≥30 kg/m2. Since 2021, novel AOM drugs have developed with increased effectiveness and overall favorable safety profiles.

These new-generation AOMs, such as semaglutide and tirzepatide, work on central nervous system (CNS) tissues to lower body weight by reducing food intake.

Clinical research has demonstrated that tirzepatide and semaglutide help with food control-related aspects, such as fullness, food cravings, and hunger. The Semaglutide Treatment Effect in People with Obesity (STEP)-1 trial reported that patients who received 2.40 mg of semaglutide once weekly lost an average of 15% of their body weight, compared to 2.4% among placebo recipients. Semaglutide medication also reduced cardiometabolic risk indicators such as systolic-type blood pressure, waist circumference, and self-documented physical function.

In a large-scale cardiovascular events study, semaglutide medication resulted in a 20% decrease in severe adverse cardiovascular outcomes in individuals who were obese or overweight with existing cardiovascular disease. The SURMOUNT-1 trial reported that tirzepatide therapy improved cardiometabolic risk indicators such as systolic blood pressure, waist circumference, fasting insulin high-density lipoprotein, and triglycerides. For the treatment of obesity, new medicines such as retatrutide and a combination of semaglutide and cagrilintide outperform conventional drugs.

Nutrient-based guidelines for anti-obesity drug therapy

Healthy diets, including nutrient-dense meals and drinks, are suitable for patients, including those with AOMs, since they provide vital vitamins, minerals, and health-promoting ingredients. Nutrient-rich foods include whole grains, fruits, vegetables, beans, lentils, seafood, eggs, unsalted seeds and nuts, fat-free dairy, lean meats, and poultry.

No one diet pattern has proven superior concerning weight reduction; however, the Mediterranean diet and plant-based diets have repeatedly been linked to better health, including decreased cardiovascular disease and death risks. The United States Department of Agriculture (USDA) offers services to help individuals eat properly and reach their nutritional objectives in a budget-friendly way.

Clinicians recommend calorie intakes of 1,200-1,500 kcal daily for females and 1,500-1,800 kcal daily for males for weight loss, with very low-calorie diets administered only under the direction of a skilled physician. Protein consumption should be between 60 and 75 g/day, with a maximum of 1.5 g/kg of body weight daily. Physical activity can improve muscular strength and function, and meal substitution products can help individuals with AOMs supplement their diets and satisfy their protein requirements.

The ideal macronutrient distribution range for healthy individuals is 45% to 65% of energy consumption, with extreme carbohydrate restriction not recommended owing to potential long-term weight loss hazards and increased urination, dehydration, and electrolyte imbalance. Dietary fiber is essential for general health, with women ingesting 21–25 g/day and men consuming 30 to 38 g/day, depending on age. Obesity frequently leads to micronutrient deficiencies, which techniques such as proper protein consumption and resistance exercise may address. Preventive measures and continuous monitoring can lower the likelihood of medical and dietary issues.

Based on the review findings, authorized and emergent AOMs have dramatically enhanced obesity therapy with improved cardiometabolic risk factors, physical function, and average body weight reductions of ≥15%.

Nutritional evaluation and counseling can assist patients in identifying and managing underlying malnutrition risk factors and setting objectives for crucial nutrients such as protein, dietary fiber, micronutrients, and hydration intake. Continuous monitoring can assist in identifying and managing issues such as insufficient nutritional intake, gastrointestinal problems, and mental disorders. Further research is required to achieve the best nutritional and medical results for AOM-treated individuals.