REVIEW PAPER
Medical nutritional therapy during pharmacotherapy for obesity: expert insights
1
Department of Obesity and Metabolic Disorders Treatment and Clinical Dietetics, Poznan University of Medical Sciences, Poznan, Poland
2
Department of Dietetics and Clinical Nutrition, Medical University of Bialystok, Bialystok, Poland
These authors had equal contribution to this work
Submission date: 2024-10-11
Acceptance date: 2024-10-11
Publication date: 2024-12-02
Corresponding author
Matylda Kręgielska-Narożna
Matylda Kręgielska-Narożna Department of Obesity and Metabolic Disorders Treatment and Clinical Dietetics Poznan University of Medical Sciences 82/84 Szamarzewskiego St. 60-569 Poznan, Poland
Matylda Kręgielska-Narożna Department of Obesity and Metabolic Disorders Treatment and Clinical Dietetics Poznan University of Medical Sciences 82/84 Szamarzewskiego St. 60-569 Poznan, Poland
Medical Studies 2024;40(4):371-380
KEYWORDS
TOPICS
ABSTRACT
This manuscript provides a comprehensive overview of expert experiences and perspectives on the role of medical nutrition therapy in enhancing the outcomes of pharmacotherapy for obesity. Through a detailed examination of current practices, challenges, and future directions, this paper seeks to contribute to developing integrated treatment strategies that maximise health benefits for patients with obesity. The findings underscore the importance of a multifaceted approach that includes nutrition, physical activity, and psychological support provided by an interdisciplinary team. Future guidelines should incorporate these comprehensive strategies to improve obesity management effectively.
REFERENCES (76)
2.
Pedersen SD, Manjoo P, Wharton S. Canadian Adult Obesity Clinical Practice Guidelines: Pharmacotherapy for Obesity Management. Available from: https://obesitycanada.ca/guide.... Accessed 21.7.2024.
3.
Coutinho W, Halpern B. Pharmacotherapy for obesity: moving towards efficacy improvement. Diabetol Metab Syndr. 2024 Jan; 16(1): 6.
4.
Bąk-Sosnowska M, Białkowska M, Bogdański P, Cho- miuk T, Gałązka-Sobotka M, Holecki M, Jarosińska A, Jezierska M, Kamiński P, Kłoda K, Kręgielska- Narożna M, Lech M, Mamcarz A, Mastalerz-Migas A, Matyjaszek-Matuszek B, Ostrowska L, Płaczkiewicz- Jankowska E, Stachowska E, Stelmach-Mardas M, Szeli- ga J, Szulińska M, Walczak M, Wyleżoł M. Zalecenia kliniczne dotyczące postępowania u chorych na otyłość 2022 – stanowisko Polskiego Towarzystwa Leczenia Otyłości. Med. Prakt. wyd. specj.; maj 2022: 1-87.
5.
Brown J, Clarke C, Johnson Stoklossa C, Sievenpiper J. Canadian Adult Obesity Clinical Practice Guidelines: Medical Nutrition Therapy in Obesity Management. Available from: https://obesitycanada.ca/guide.... Accessed: 19.07.2024.
6.
Hassapidou M, Vlassopoulos A, Kalliostra M, Govers E, Mulrooney H, Ells L, Salas XR, Muscogiuri G, Darle- ska TH, Busetto L, Yumuk VD, Dicker D, Halford J, Woodward E, Douglas P, Brown J, Brown T. European Association for the Study of Obesity Position statement on medical nutrition therapy for the management of overweight and obesity in adults developed in collaboration with the European Federation of the Associations of Dietitians. Obes Facts. 2023; 16(1): 11-28.
7.
Gajewska D, Lange E, Kęszycka P, Białek-Dratwa A, Gu- dej S, Świąder K, Giermaziak W, Kostelecki G, Kret M, Marlicz W, Pachocka L, Pałkowska-Goździk E, Paśko P, Podgórska-Stawiecka L, Sawaniewska B, Myszkowska-Ryciak J. Recommendations on dietary treatment of obesity in adults: 2024 position of the Polish Society of Dietetics. J Health Inequal. 2024; 10(1): 22-47.
8.
Ulian MD, Aburad L, da Silva Oliveira MS, Pop- pe ACM, Sabatini F, Perez I, Gualano B, Benatti FB, Pin- to AJ, Roble OJ, Vessoni A, de Morais Sato P, Unsain RF, Baeza Scagliusi F. Effects of health at every size® interventions on health-related outcomes of people with overweight and obesity: a systematic review. Obes Rev. 2018; 19(12): 1659-1666.
9.
Koliaki C, Spinos T, Spinou M, Brinia ME, Mitsopoulou D, Katsilambros N. Defining the optimal dietary approach for safe, effective and sustainable weight loss in overweight and obese adults. Healthcare. 2018; 6(3): 73.
10.
Johnston BC, Kanters S, Bandayrel K, Wu P, Naji F, Siemieniuk RA, Ball GDC, Busse JW, Thorlund K, Guyatt G, Jansen JP, Mills EJ. Comparison of weight loss among named diet programs in overweight and obese adults a meta-analysis. JAMA. 2014; 312(9): 923-933.
11.
Mallard SR, Howe AS, Houghton LA. Vitamin D status and weight loss: a systematic review and meta-analysis of randomized and nonrandomized controlled weight-loss trials. Am J Clin Nutr. 2016; 104(4): 1151-1159.
12.
Zhao L, Zhang X, Shen Y, Fang X, Wang Y, Wang F. Obesity and iron deficiency: a quantitative meta-analysis. Obes Rev. 2015; 16(12): 1081-1093.
13.
Maguire D, Talwar D, Shiels PG, McMillan D. The role of thiamine dependent enzymes in obesity and obesity related chronic disease states: a systematic review. Clin Nutr ESPEN. 2018; 25: 8-17.
14.
Wiebe N, Field CJ, Tonelli M. A systematic review of the vitamin B12, folate and homocysteine triad across body mass index. Obes Rev. 2018; 19(11): 16081618.
15.
Williams L, Barnes K, Ball L, Ross L, Sladdin I, Mitchell L. How effective are dietitians in weight management? A systematic review and meta-analysis of randomized controlled trials. Healthcare. 2019; 7(1): 20.
16.
Almandoz JP, Wadden TA, Tewksbury C, Apovian CM, Fitch A, Ard JD, Li Z, Richards J, Butsch WS, Jouravskaya I, Vanderman KS, Neff LM. Nutritional considerations with antiobesity medications. Obesity (Silver Spring). 2024; 32(9): 1613-1631.
17.
Magkos F, Fraterrigo G, Yoshino J, Luecking C, Kirbach K, Kelly SC, de Las Fuentes L, He S, Okunade AL, Patter- son BW, Klein S. Effects of moderate and subsequent progressive weight loss on metabolic function and adipose tissue biology in humans with obesity. Cell Metab. 2016 Apr; 23(4): 591-601.
18.
Cava E, Yeat NC, Mittendorfer B. Preserving healthy muscle during weight loss. Adv Nutr. 2017 May; 8(3): 511-519.
19.
Leidy HJ, Carnell NS, Mattes RD, Campbell WW. Higher protein intake preserves lean mass and satiety with weight loss in pre-obese and obese women. Obesity (Silver Spring). 2007 Feb; 15(2): 421-429.
20.
Weiss EP, Racette SB, Villareal DT, Fontana L, Steger- May K, Schechtman KB, Klein S, Ehsani AA, Hollo- szy JO; Washington University School of Medicine CALERIE Group. Lower extremity muscle size and strength and aerobic capacity decrease with caloric restriction but not with exercise-induced weight loss. J Appl Physiol (1985) 2007 Feb; 102(2): 634-640.
21.
Hoie LH, Bruusgaard D, Thom E. Reduction of body mass and change in body composition on a very low calorie diet. Int J Obes Relat Metab Disord. 1993 Jan; 17(1): 17-20.
22.
Willoughby D, Hewlings S, Kalman D. Body composition changes in weight loss: strategies and supplementation for maintaining lean body mass, a brief review. Nutrients. 2018 Dec; 10(12): 1876.
23.
Hunter GR, Singh H, Carter SJ, Bryan DR, Fisher G. Sarcopenia and its implications for metabolic health. J Obes. 2019 Mar; 2019: 8031705.
24.
Dearos Sanchis M, Voltas Arribas B, Carrasco-Querol N, Sauras Colón E, Sánchez Juan C. Impacto en la pérdida de peso y la composición corporal de una intervención de educación alimentaria asociada al tratamiento con liraglutida para el abordaje de la obesidad [Impact on weight loss and body composition of a food education intervention associated with Liraglutide treatment to address obesity]. Nutr Hosp. 2024 Jun; 41(3): 585-593.
25.
Smith SR, Fujioka K, Gupta AK, Billes SK, Burns C, Kim D, Dunayevich E, Greenway FL. Combination therapy with naltrexone and bupropion for obesity reduces total and visceral adiposity. Diabetes Obes Metab. 2013 Sep; 15(9): 863-866.
26.
Pandey A, Patel KV, Segar MW, Ayers C, Linge J, Lein- hard OD, Anker SD, Butler J, Verma S, Joshi PH, Nee- land IJ. Effect of liraglutide on thigh muscle fat and muscle composition in adults with overweight or obesity: results from a randomized clinical trial. J Cachexia Sarcopenia Muscle. 2024 Jun; 15(3): 1072-1083.
27.
Perna S, Guido D, Bologna C, Solerte SB, Guerriero F, Isu A, Rondanelli M. Liraglutide and obesity in elderly: efficacy in fat loss and safety in order to prevent sarcopenia. A perspective case series study. Aging Clin Exp Res. 2016 Dec; 28(6): 1251-1257.
28.
Bikou A, Dermiki-Gkana F, Penteris M, Constantinides TK, Kontogiorgis C. A systematic review of the effect of semaglutide on lean mass: insights from clinical trials. Expert Opin Pharmacother. 2024 Apr; 25(5): 611-619.
29.
Yabe D, Kawamori D, Seino Y, Oura T, Takeuchi M. Change in pharmacodynamic variables following once-weekly tirzepatide treatment versus dulaglutide in Japanese patients with type 2 diabetes (SURPASS J-mono substudy). Diabetes Obes Metab. 2023 Feb; 25(2): 398-406.
30.
Tirzepatide achieves significant weight loss without adverse effects on muscle composition (SURPASS-3 MRI) https://www.easd.org/media-cen... &sfmc_sub=77326945&l=327_HTML&u=1738265&mid=110007893&jb=1#!resources/tirzepatide-achieves-significant-weight-loss-without-adverse-effects-on-muscle-composition-surpass-3-mri-d33f2a13-d83e-4112-8763-621e82d3e128.
31.
Locatelli JC, Costa JG, Haynes A, Naylor LH, Fegan PG, Yeap BB, Green DJ. Incretin-based weight loss pharmacotherapy: can resistance exercise optimize changes in body composition? Diabetes Care. 2024 Apr; 47(10); 1718-1730.
32.
Sardeli AV, Komatsu TR, Mori MA, Gáspari AF, Chacon-Mikahil MPT. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients. 2018 Mar; 10(4): 423.
33.
Paddon-Jones D, Leidy H. Dietary protein and muscle in older persons. Curr Opin Clin Nutr Metab Care. 2014 Jan; 17(1): 5-11.
34.
Simonson M, Boirie Y, Guillet C. Protein, amino acids and obesity treatment. Rev Endocr Metab Disord. 2020 Sep; 21(3): 341-353.
35.
Leidy HJ, Clifton PM, Astrup A, Wycherley TP, Westerterp-Plantenga MS, Luscombe-Marsh ND, Woods SC, Mattes RD. The role of protein in weight loss and maintenance. Am J Clin Nutr. 2015 Jun; 101(6): 1320S-1329S.
36.
Pellegrini M, Rahimi F, Boschetti S, Devecchi A, De Francesco A, Mancino MV, Toppino M, Morino M, Fanni G, Ponzo V, Marzola E, Abbate Daga G, Broglio F, Ghigo E, Bo S. Pre-operative micronutrient deficiencies in patients with severe obesity candidates for bariatric surgery. J Endocrinol Invest. 2021; 44(7): 1413-1423.
37.
Damms-Machado A, Weser G, Bischoff SC. Micronutrient deficiency in obese subjects undergoing low calorie diet. Nutr J. 2012; 11: 34.
38.
Aasheim ET, Hofso D, Hjelmesaeth J, Birkeland KI, Bohmer T. Vitamin status in morbidly obese patients: a cross-sectional study. Am J Clin Nutr. 2008; 87(2): 362-369.
39.
Astrup A, Bugel S. Overfed but undernourished: recognizing nutritional inadequacies/deficiencies in patients with overweight or obesity. Int J Obes (Lond). 2019; 43(2): 219-232.
40.
Wilson T, Temple NJ, Bray GA. Nutrition Guide for Physicians and Related Heathcare Professions. 3rd ed. Springer Nature 2022.
41.
Jarosz M, Rychlik E, Stoś K, Charzewska J (eds.) Human nutrition standards for the Polish population and their application. National Institute of Public Health - National Institute of Hygiene, 2020.
42.
Blumberg JB, Frei BB, Fulgoni VL, Weaver CM, Zeisel SH. Impact of frequency of multi-vitamin/multi-mineral supplement intake on nutritional adequacy and nutrient deficiencies in U.S. adults. Nutrients. 2017; 9(8): 849.
43.
Frankenfeld CL, Wallace TC. Multivitamins and nutritional adequacy in middle-aged to older Americans by obesity status. J Diet Suppl. 2020; 17(6): 684-697.
44.
Blackburn GL, Bistrian BR, Hoag C. Hair loss with rapid weight loss. Arch Dermatol. 1977 Feb; 113(2): 234.
45.
Zhang W, Fan M, Wang C, Mahawar K, Parmar C, Chen W, Yang W; Global Bariatric Research Collaborative. Hair loss after metabolic and bariatric surgery: a systematic review and meta-analysis. Obes Surg. 2021 Jun; 31(6): 2649-2659.
46.
Tran MM, Mirza FN, Lee AC, Goldbach HS, Libby TJ, Wisco OJ. Dermatologic findings associated with semaglutide use: a scoping review. J Am Acad Dermatol. 2024 Jul; 91(1): 166-168.
47.
Desai DD, Sikora M, Nohria A, Bordone L, Caplan AS, Shapiro J, Lo Sicco KI. GLP-1 agonists and hair loss: a call for further investigation. Int J Dermatol. 2024 Sep; 63(9); 1128-1130.
48.
Finner AM. Nutrition and hair: deficiencies and supplements. Dermatol Clin. 2013 Jan; 31(1): 167-172.
49.
Rushton DH. Nutritional factors and hair loss. Clin Exp Dermatol. 2002 Jul; 27(5): 396-404.
50.
Wilding JPH, Batterham RL, Calanna S, Davies M, Van Gaal LF, Lingvay I, McGowan BM, Rosenstock J, Tran MTD, Wadden TA, Wharton S, Yokote K, Zeuthen N, Kushner RF; STEP 1 Study Group. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021; 384(11): 989-1002.
51.
Jastreboff AM, Aronne LJ, Ahmad NN, Wharton S, Connery L, Alves B, Kiyosue A, Zhang S, Liu B, Bunck MC, Stefanski A; SURMOUNT-1 Investigators. Tirzepatide once weekly for the treatment of obesity. N Engl J Med. 2022; 387(3): 205-216.
52.
Bettge K, Kahle M, Abd El Aziz MS, Meier JJ, Nauck MA. Occurrence of nausea, vomiting and diarrhoea reported as adverse events in clinical trials studying glucagon-like peptide-1 receptor agonists: a systematic analysis of published clinical trials. Diabetes Obes Metab. 2017; 19(3): 336-347.
53.
Gorgojo-Martínez JJ, Mezquita-Raya P, Carretero-Gómez J, Castro A, Cebrián-Cuenca A, de Torres-Sánchez A, García-de-Lucas MD, Núńez J, Obaya JC, Soler MJ, Górriz JL, Rubio-Herrera MÁ. Clinical recommendations to manage gastrointestinal adverse events in patients treated with Glp-1 receptor agonists: a multidisciplinary expert consensus. J Clin Med. 2022 Dec; 12(1): 145.
54.
Fitch A, Ingersoll AB. Patient initiation and maintenance of GLP-1 RAs for treatment of obesity: a narrative review and practical considerations for primary care providers. Postgrad Med. 2021; 133: 310-319.
55.
Wharton S, Calanna S, Davies M, Dicker D, Goldman B, Lingvay I, Mosenzon O, Rubino DM, Thomsen M, Wadden TA, Pedersen SD. Gastrointestinal tolerability of once- weekly semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss. Diabetes Obes Metab. 2022; 24: 94-105.
56.
Ahuja NK. Nutritional approaches to chronic nausea and vomiting. Pract Gastroenterol 2017; 168: 42-50.
57.
Grimm M, Han J, Weaver C, Griffin P, Schulteis CT, Dong H, Malloy J. Efficacy, safety, and tolerability of exenatide once weekly in patients with type 2 diabetes mellitus: an integrated analysis of the DURATION trials. Postgrad Med. 2013; 125: 47-57.
58.
Davies MJ, Bergenstal R, Bode B, Kushner RF, Lewin A, Skjøth TV, Andreasen AH, Jensen CB, DeFronzo RA; NN8022-1922 Study Group. Efficacy of liraglutide for weight loss among patients with type 2 diabetes: the SCALE diabetes randomized clinical trial. JAMA 2015; 314: 687-699.
59.
De Bruyn G. Diarrhea in adults (acute). Am Fam Physician. 2008 Aug; 78(4): 503-504.
60.
McFarland LV. Systematic review and meta-analysis of Saccharomyces boulardii in adult patients. World J Gastroenterol. 2010 May; 16(18): 2202-2222.
61.
Sanklecha M, Verma L, Pai U, Mishra S, Maqsood S, Bir- la A. Lactobacillus rhamnosus GG evaluation in acute diarrhea (LEAD): an observational study. Cureus. 2022 Apr; 14(4): e24594.
62.
Yabe D, Nakamura J, Kaneto H, Deenadayalan S, Navar- ria A, Gislum M, Inagaki N; PIONEER 10 Investigators. Safety and efficacy of oral semaglutide versus dulaglutide in Japanese patients with type 2 diabetes (PIONEER 10): an open-label, randomised, active-controlled, phase 3a trial. Lancet Diabetes Endocrinol. 2020; 8: 392-406.
63.
Yamada Y, Katagiri H, Hamamoto Y, Deenadayalan S, Navarria A, Nishijima K, Seino Y; PIONEER 9 Investigators. Dose-response, efficacy, and safety of oral semaglutide monotherapy in Japanese patients with type 2 diabetes (PIONEER 9): a 52-week, phase 2/3a, randomised, controlled trial. Lancet Diabetes Endocrinol. 2020; 8: 377-391.
64.
Wharton S, Davies M, Dicker D, Lingvay I, Mosenzon O, Rubino DM, Pedersen SD. Managing the gastrointestinal side effects of GLP-1 receptor agonists in obesity: recommendations for clinical practice. Postgrad Med. 2022 Jan; 134(1): 14-19.
65.
Andrews CN, Storr M. The pathophysiology of chronic constipation. Can J Gastroenterol. 2011 Oct; 25 (Suppl B): 16B-21B.
66.
Aronne LJ, Sattar N, Horn DB, Bays HE, Wharton S, Lin WY, Ahmad NN, Zhang S, Liao R, Bunck MC, Jouravskaya I, Murphy MA; SURMOUNT-4 Investigators. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024 Jan; 331(1): 38-48.
67.
Pi-Sunyer X, Astrup A, Fujioka K, Greenway F, Halpern A, Krempf M, Lau DC, le Roux CW, Violante Ortiz R, Jen- sen CB, Wilding JP; SCALE Obesity and Prediabetes NN8022-1839 Study Group. A randomized, controlled trial of 3.0 mg of liraglutide in weight management. N Engl J Med. 2015 Jul; 373(1): 11-22.
69.
Mechanick JI, Apovian C, Brethauer S, Garvey WT, Joffe AM, Kim J, Kushner RF, Lindquist R, Pessah- Pollack R, Seger J, Urman RD, Adams S, Cleek JB, Correa R, Kathleen Figaro M, Flanders K, Grams J, Hur- ley DL, Kothari S, Seger MV, Still CD. Clinical practice guidelines for the perioperative nutrition, metabolic, and nonsurgical support of patients undergoing bariatric procedures – 2019 update: cosponsored by American Association of Clinical Endocrinologists/American College of Endocrinology, The Obesity Society, American Society for Metabolic & Bariatric Surgery, Obesity Medicine Association, and American Society of Anesthesiologists. Surg Obes Relat Dis. 2020; 16(2): 175-247.
70.
Guillet C, Masgrau A, Mishellany-Dutour A, Blot A, Cail- le A, Lyon N, Pereira B, Slim K, Robert M, Disse E, Feu- gier N, Le Ruyet P, Louvet C, Miolanne M, Farigon N, Laville M, Boirie Y. Bariatric surgery affects obesity-related protein requirements. Clin Nutr ESPEN. 2020 Dec; 40: 392-400.
71.
Wadden TA, Chao AM, Moore M, Tronieri JS, Gilden A, Amaro A, Leonard S, Jakicic JM. The role of lifestyle modification with second-generation anti-obesity medications: comparisons, questions, and clinical opportunities. Curr Obes Rep. 2023 Dec; 12(4): 453-473.
72.
Cambi MPC, Baretta GAP. Bariatric diet guide: plate model template for bariatric surgery patients. Arq Bras Cir Dig. 2018; 31(2): e1375.
74.
Carter FA, Jansen A. Improving psychological treatment for obesity. Which eating behaviours should we target? Appetite. 2012 Jun; 58(3): 1063-1069.
75.
Tsegaye A, Kökönyei G, Baldacchino A, Urbán R, Demetrovics Z, Logemann HNA. The psychological basis of obesity. Mahmood TA, Arulkumaran S, Chervenak FA. Obesity and Obstetrics. Second Edition, Elsevier 2020; 37-44.
76.
Bays HE, Burridge K, Richards J, Fitch A. Obesity pillars roundtable: excessive weight reduction with highly effective anti-obesity medications (heAOMs). Obes Pillars. 2022 Oct; 4: 100039.
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