A new class of medications has become a popular choice for individuals struggling with obesity, but nutrition experts have concerns that the resulting suppression of appetite from taking these medications may, in turn, lead to malnutrition among some patients.
With their appetite lessened, “patients may struggle with maintaining a balanced diet, which can lead to deficiencies in essential nutrients,” said Christine Goukasian, MS, RDN, a registered dietitian with UCLA Health’s Medical Weight Management Program.
These new medications, GLP-1 agonists that include well-known names like Ozempic, are not primarily intended for weight loss; they were approved by the FDA for treatment of diabetes. But because their effects have proven to be successful in helping people lose weight, they often are prescribed off-label for that purpose.
Goukasian explained that GLP-1 medications decrease appetite by delaying gastric emptying —when contents of the stomach pass into the small intestine — thus helping patients to feel full longer.
Nutritional Challenges and the Risk of Malnourishment
Because patients feel full longer, they may not eat in a manner that provides them with sufficient nutritional intake, Goukasian said. To counter that, she emphasized the importance of focusing on a balanced intake of protein, fiber and hydration while taking these medications.
"Patients on weight-loss medications need a good source of protein and fiber regularly,” she said. "They need a well-balanced diet that includes lean protein, fruits, vegetables and whole grains such as quinoa, buckwheat and barley — which are really good for you and are high both in fiber and protein and keep you full."
Protein and Strength Training: Key Components
For patients taking GLP-1 medications, maintaining muscle mass also is crucial. Goukasian underscored the importance of protein intake and strength training to prevent muscle loss.
"We emphasize exercise combined with protein intake for weight loss and muscle preservation, focusing on balance and variety in meal planning," she said. A diet rich in protein helps preserve muscle mass, which is essential for overall health and metabolism.
Hydration and Personalized Nutrition Plans
Hydration plays a pivotal role in overall health, especially for those on weight-loss medications. "I would say the majority of my patients either don't like water or don't drink enough water," Goukasian said. "So, making sure they’re getting plenty of water — at least 8 cups a day — is crucial. Water is a huge component for weight loss."
A dietitian plays an important role for patients on weight-loss medications. "We have to make sure they’re staying hydrated. We have to know if they have any food allergies or food aversions, what their preferences are, so we can know what kind of meal plan to put together for them," Goukasian said.
Addressing Emotional Eating and Cravings
While weight-loss medications can help suppress emotional eating and cravings, which often are common challenges for patients struggling with their weight, Goukasian stressed the importance of establishing healthy eating habits to maintain long-term success.
"Some weight-loss medications are short term, however, the GLP-1 medications are long-term. Most people who get off them have the likelihood of regaining the weight they’ve lost because the hunger comes back," she explained. This underscores the necessity of making sustainable lifestyle changes to keep the weight off.
Managing Side Effects
Patients on GLP-1 drugs may experience side effects like nausea, vomiting and constipation, particularly if they are not getting enough fiber. In addition, one of the major side effects is muscle atrophy. Goukasian said many of the side effects happen because of the common misconception among patients on weight loss medication that eating less is good for them.
“I hear patients say, ‘It’s great. I’m not eating because I’m not hungry.’ That’s wrong,” Goukasian said. “We want you to still eat, because we want you to be nourished. We just want you eating the right things.”
