Obesity medications can have side-effects that increase the risk of adverse nutrition related outcomes and treatment cessation, especially the newer GLP-1RA and GIP-RA incretins which have major appetite suppressing effects. Anticipatory guidance can help prevent or manage diet-related side-effects and lower risks of both subclinical and clinical nutrient deficiencies of protein, dietary fibre, specific vitamins and minerals. Examples of potential nutrient deficiency diseases include oral stomatitis and cheilosis (riboflavin deficiency), pellagra (niacin deficiency), beriberi (thiamine deficiency), scurvy (vitamin C deficiency) and iron-deficiency anaemia. Individuals taking obesity medications can also be more susceptible to protein-energy malnutrition, sarcopenia and accelerated bone loss, while rapid weight loss can increase the risk of gall bladder disease, gall stones and hyperuricaemia.
Obesity medication induced side-effects with nutrition-related consequences vary by drug type and can include dry mouth, nausea, indigestion, vomiting, diarrhoea, constipation, elevated blood pressure and/or heart rate, insomnia. Many of these are especially common in GLP-1/GIP-RA class medications. Supportive nutrition strategies can prevent or reduce the risk or severity of some of these.
During obesity management, attention to both side-effects secondary to medication use and nutritional adequacy of dietary patterns can optimise nutrition and health related outcomes and well-being. Provision of nutrition support by trained health professionals, particularly registered dietitians, for individuals taking obesity treatment medication and/or those prescribed low or very-low energy diets, very low energy diets is recommended. However, given there is no requirement to refer patients prescribed these drugs for nutrition support, there is a risk this may be viewed as low-value care, especially if weight loss is regarded as the primary outcome.
A range of dietary intervention for obesity management are supported by evidence. Ongoing support and review as required should be anticipated and recommended to optimise nutrition and adiposity -related health and well-being long-term.