New Weight Medications are Game-Changers but no Magic Bullet

Since anti-obesity medications such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound) have become more widely known and prescribed, they are being touted as game-changing treatments for chronic overweight and obese adults.

Anti-obesity medications work by signaling the brain that you have eaten and the stomach is full. Subsequently, a person feels satisfied with less food for longer, and cravings are diminished. These powerful mechanisms can result in an average of 15%-20% body weight loss, which can be life-changing for many people.

However, one common misconception about these medications is that they’re a panacea for better health, and it doesn’t necessarily matter what you eat when you’re taking them. However, nothing could be further from the truth. The average American diet is low-quality. It is high in ultra-processed, calorie-dense foods, and it is often deficient in fruits, vegetables, fiber, and essential nutrients. 

There is a concern that eating less of a low-quality diet could increase the risk of unintended health outcomes, including loss of muscle mass, fatigue, and malnutrition. Data from decades of successful weight management with bariatric surgery have shown that patients benefit from expert guidance on how to change what they eat long-term.

Before patients undergo bariatric surgery such as gastric bypass or gastric sleeve procedures, they have multiple visits with a registered dietitian to create a healthful eating plan for adequate nutrition after surgery. In addition, there are guidelines for patients who get bariatric surgery to take vitamin supplements and have their vitamin levels checked annually for the rest of their lives. No such guidelines exist yet for anti-obesity medications, though patients now lose similar amounts of weight with these medications as they do with bariatric surgery.

Anti-obesity medications, which were initially developed to treat diabetes, are still relatively new in the weight loss world. Unfortunately, due to the high prevalence of obesity (more than 40% of adults) and lack of obesity medicine-trained clinicians, many older adults may be getting anti-obesity medications from providers with little or no training in obesity care.

Simply telling patients using these medications to eat less of what they are currently eating or to eliminate specific types of food such as carbohydrates can create ineffective cycles of restrictive dieting, poor nutrition, and gastrointestinal symptoms such as nausea, constipation, and diarrhea.

At UT Southwestern in Dallas, Texas, there is a weight wellness program that includes obesity specialists who help patients use anti-obesity medications to transform their health with personalized nutrition education and guidance. Basically, they guide individuals toward sustainable and healthier eating plans.

Collaborating with experts in nutrition, endocrinology, and internal medicine from across the U.S., researchers at UT Southwestern created the first set of nutritional recommendations for safe, successful anti-obesity medication use. The recommendations are designed to help guide healthcare providers and their patients achieve a sustainable weight based on their known health conditions, nutritional needs, and health goals.

Simple Rules Still Apply

Successful weight loss starts with feeding the body a balanced and healthful diet. Understanding your baseline health conditions, activity level, cultural traditions, medications, and known nutritional deficits can reduce the risk of potential anti-obesity medication misadventures, such as not eating enough protein. It can lead to losing muscle mass and could increase the risk of fatigue, frailty, or falls.

Personalized eating plans while taking these medications can help individuals reduce the risk of medication-related gastrointestinal side effects, such as bloating, nausea, vomiting, diarrhea, and constipation. In some cases, if a person doesn’t eat enough dietary fiber, a nutritionist may recommend a fiber supplement and extra hydration to help keep the digestive tract moving.

Dr. Ellie Chuang, is an endocrinologist and obesity medicine specialist from Southern New Hampshire Weight Management, and said obesity is a chronic disease similar to diabetes or high blood pressure. “It's a complex disease that is best treated in a multidisciplinary team approach, partnering with the patient to find the best way to help them achieve what I like to call their best weight. I just define that as this healthier place you can get to all around that you can maintain long term with a plan that you're happy to do long-term,” said Dr. Chuang.

There is no dietary checklist that works for everyone. Each adult needs a personalized eating plan to meet their needs. However, people who take anti-obesity medications can follow a few basic recommendations to decrease the risk of gastrointestinal side effects. These include avoiding fried and high-fat foods, limiting intake of carbonated drinks, alcohol, and spicy foods. 

Older adults may have health issues that require special nutritional considerations to decrease the risk of muscle loss and frailty. Rapidly losing large amounts of weight may not be safe for some older adults. Conditions such as kidney disease, diabetes, and cardiovascular disease, may require specialized diets and adjustments in other medications such as insulin, blood pressure and thyroid medications.

Nourishing the body instead of limiting food intake can maximize the effectiveness of anti-obesity medications to improve health and quality of life. Nutritionists say as older adults incorporate anti-obesity medications into their long-term health plans, conversations should pivot away from the generalized, restrictive dietary recommendations of the past. Instead, creating a balanced, evidence-based eating plan that fuels weight loss and a healthy lifestyle will be the key to building sustainable solutions for older adults.

John Schieszer is an award-winning national journalist and radio and podcast broadcaster of The Medical Minute. He can be reached at medicalminutes@gmail.com.