With the approval of new-generation antiobesity medications (AOMs) such as semaglutide and tirzepatide, clinicians are witnessing “an average weight reduction of ≥15%,” a level of efficacy previously observed only with bariatric surgery or very low-calorie diets (VLCDs). While these outcomes are promising, they introduce new challenges in ensuring adequate nutritional intake and preventing deficiencies. 

In their 2024 review, Almandoz et al. provide a comprehensive, evidence-based framework for healthcare professionals to assess, monitor, and manage the nutritional needs of patients undergoing pharmacological treatment for obesity. 

Key Risks and the Need for Proactive Monitoring 

The authors emphasize that reduced appetite and caloric intake—common effects of GLP-1 and dual agonist AOMs—can significantly impair the intake of essential nutrients: 

Despite this, no comprehensive guidelines had previously addressed the specific nutritional needs of this patient group, prompting the authors to develop practical recommendations using analogies from VLCDs and bariatric surgery literature. 

Micronutrient and Macronutrient Guidance 

Protein: To prevent lean body mass loss, a minimum protein intake of 60–75 g/day or up to 1.5 g/kg/day is recommended. Older adults and patients at risk of sarcopenia may require even more: 

Fiber & Fluids: Patients often fail to meet fiber targets (25–38 g/day), and hydration is frequently overlooked despite its role in managing common AOM-related side effects such as constipation. The authors recommend >2–3 liters of fluid per day, stressing the increased dehydration risk in older adults and those on very low-carb diets. 

Micronutrients: The publication provides an overview for a wide range of micronutrients, their dietary sources, the symptoms and signs of deficiency and additional considerations, such as; extent of inadequate intake; prevalence of deficiencies in people with obesity; factors that increase the risk for deficiencies.  

Clinical Workflow and Patient Engagement 

Using the 5 A’s framework (Ask, Assess, Advise, Agree, Assist), the authors advocate for personalized, patient-centered, counseling before and during treatment. Nutritional monitoring should be ongoing, especially when appetite is significantly reduced, and referrals to registered dietitians are encouraged: 

The importance of setting realistic expectations is also emphasized, including the potential need for dose adjustments in medications for hypertension or diabetes as weight loss progresses. 

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