Nutritional Considerations With Antiobesity Medications

This comprehensive review provides guidance on dietary recommendations for patients taking emerging antiobesity medications (AOM), which show an efficacy of ≥15% average weight reduction. The recommendations are based on evidence pertaining to general healthy dietary patterns, bariatric surgery, and low-calorie diets. The review emphasizes clinician identification of preexisting nutritional risk factors in their patients and counseling them on adequate intake of energy, protein, macronutrients, micronutrients, fiber, and fluids.

Energy requirements vary based on a variety of factors, including age, sex, body weight, and physical activity. In general, to achieve weight loss, it is recommended that women consume 1200 to 1500 kcal per day and men consume 1500 to 1800 kcal per day. Protein intake is very important during weight loss; a daily protein intake of 60 g to 75 g, or up to 1.5 g per kg of body weight is generally recommended. Meal replacement products such as bars or shakes can be used to increase protein consumption, especially if appetite decreases as a result of AOM. Severe carbohydrate restriction is not necessary, as it can limit the intake of important nutritional elements such as vegetables, fruits, and whole grains. However, if a low carbohydrate diet is preferred, ample hydration with greater than 2 L per day of fluid intake with consumption of vegetables and fruits containing high amounts of micronutrients and fiber is recommended. Adequate fiber and fluid intake also help alleviate constipation that may occur in patients taking AOM. Fiber intake of 21 g to 25 g per day for women and 30 g to 38 g per day for men is recommended; this can be achieved by taking fiber supplements if one’s diet is inadequate in reaching the recommended fiber intake goal.

Although the evidence guiding intake of dietary fat is limited, foods rich in n-3 polyunsaturated fatty acids, n-6 polyunsaturated fatty acids, and monounsaturated fatty acids should be prioritized. These fatty acids can be found in nuts, seeds, vegetable oils, and fish. In addition, multivitamin supplementation and consumption of foods rich in potassium, calcium, vitamin D, vitamin B12, and iron is recommended. This is especially important in patients who have had malabsorptive gastrointestinal tract disorders or a history of malabsorptive bariatric surgery who have increased risk of fat-soluble vitamin (vitamins A, D, E, and K) deficiency. Careful assessment of patient history, risk factors for nutritional deficiency, and follow-up assessment of nutritional status can help optimize the nutritional and health outcomes of patients on AOM.