Antiobesity medicines can help patients, but health professionals must consider food and body needs

© Academy of Nutrition and Dietetics

New medications used to treat Type 2 diabetes and obesity are one of the hottest issues in medicine right now.

But new injections and pills do not negate established and continuing research on the effects that food has on human health, said one leader in nutrition studies.

March is National Nutrition Month and features World Obesity Day. It’s also a good time to reevaluate how to best use the new glucagon-like peptide 1 (GLP-1) agonists along with lifestyle interventions to improve patient health, said Lauri Wright, PhD, RDN, LDN, FAND, president of the Academy of Nutrition and Dietetics.

The Academy plans a white paper this spring on the new medicines. Meanwhile, registered dietitian nutritionists are eager to work alongside physicians and other clinicians to help patients plan their menus to manage weight and other medical conditions that may be affected by it, Wright said.

This month, Wright spoke with Medical Economics about antiobesity medications and recognizing obesity as a complex disease. This transcript has been edited for length and clarity.

Medical Economics: Can you discuss the new antiobesity medicines that have taken off for treatment of Type 2 diabetes and overweight and obesity? How are dietitians working with those?

Lauri Wright, PhD, RDN, LDN, FAND
_{© The Academy of Nutrition and Dietetics}

Lauri Wright, PhD, RDN, LDN, FAND: The new GLP-1 antiobesity medications work. I mean, they are more successful than some of the predecessors of antiobesity meds and they really work on increasing the insulin release, they slow the stomach emptying time and also decrease appetite, so they cause more satiety or feelings of fullness. And it has been a very powerful combination of actions that have really helped people lose weight. But we know that there are side effects from this class of medications. One of the big side effects that we're seeing is muscle loss. So, when you go on an obesity medication you want to lose fat, right? Or many times patients are just thinking, I want to lose weight, but from a health standpoint, we want them to lose the fat. But unfortunately we're seeing a lot of patients lose muscle and that can come from a combination of too rapid weight loss or not eating appropriately. Many people are experiencing some GI issues too. So, what dietitians really are advocating for is that when a patient starts on an antiobesity medication, that they are referred to a dietitian so that we can assist the patient with any of those side effects like muscle wasting. We want to prevent that from happening. Especially in our older patients, when you lose muscle, it's really hard to get it back and that muscle loss can increase the patient's likelihood of falling and hospitalizations. So, we want to help. It's a team. We're working on individualizing the diet so that the patient can reach their health goals and provide a nutritionally dense meal that will keep them healthy and prevent any of those complications or side effects.

Medical Economics: Has the Academy taken a position or a stance on whether insurance companies should expand coverage of the new antiobesity medicines?

Lauri Wright, PhD, RDN, LDN, FAND: What we are encouraging is the individual lifestyle interventions by a registered dietitian, hand in hand. We are not anti-medication, certainly they play a role in helping a patient meet those health goals. But what we are advocating for is that the medications are going to work better, that you're going to have better outcomes, if you work with a registered dietitian in addition to taking the medications.

Medical Economics: With National Nutrition Month and World Obesity Day, why are those so important?

Lauri Wright, PhD, RDN, LDN, FAND: Well, Obesity Awareness Week is, I think, about really thinking and recognizing that obesity is a disease. It's been recognized as a disease and it's very complex. It's not just a lack of willpower. There are many things that contribute to obesity. It's not something you can just will away. If we wouldn't have the rising prevalence of overweight and obesity. You know, only about a third of Americans are normal weight or overweight, the rest are overweight or obese. It's a complex disease and there isn't a one-size-fits-all treatment for it either. And so for some people, as their BMI is increasing and they have other health issues like high blood pressure, stepping up to the antiobesity medications and then even moving into, for some people with extreme obesity, moving into some of the bariatric surgery. We actually have a toolkit that talks about the different levels of care and treatment and at the cornerstone of it is the dietary and lifestyle interventions to help support the patient. What the goal would be is to prevent it before they even had to get on medications or surgeries.

And our National Nutrition Month is something that we have been doing for many years about familiarizing the public about the importance of nutrition for health. And so this year's theme for National Nutrition Month is, going beyond the plate and beyond the table and looking at the other things that go into a kind of farm-to-fork approach to nutrition, from food production and distribution, to navigating grocery stores and the farmers market, the various ways that we can eat and include sustainability. We have a lot of resources for consumers that talk about all these different areas. We, in this busy lifestyle, just think about the food and often just getting food on the table quickly and not kind of backing up and looking at how this is all going to go together to form this whole food system, and a healthier food system is what we would advocate for.