The appetite may decrease but what happens to the quality and adequacy of what the patient still eats? GLP-1 receptor agonists such as semaglutide and liraglutide, as well as dual GIP/GLP-1 therapies such as tirzepatide, can reduce appetite and food intake.
This is part of how they support weight loss, but it also creates important nutrition considerations. (PubMed)
🔹 1️⃣ Meal size can become much smaller: Patients may feel full earlier and eat less at meals. Recent evidence shows substantial reductions in energy intake during standardized meals with GLP-1-based therapy. (PubMed)
🔹 2️⃣ Less food does not automatically mean better nutrition: When overall intake falls significantly, patients may also consume less protein, fibre, vitamins and minerals. This is particularly important in people who already have poor dietary quality or nutritional vulnerabilities. (PubMed)
🔹 3️⃣ Protein deserves attention If total food intake falls, absolute protein intake may also fall even when protein remains a similar percentage of total calories. For some patients, particularly older adults or those already at risk of sarcopenia, this may have implications for maintaining muscle mass. (PubMed)
🔹 4️⃣ Gastrointestinal symptoms can further reduce intake Nausea, early satiety, constipation, diarrhoea and bloating can make eating even more difficult. Nutrition counselling can help patients manage symptoms while maintaining adequate intake. (PubMed)
🔹 5️⃣ Weight loss is not the only outcome to monitor A lower number on the scale does not tell us whether nutritional status is being maintained. Consider monitoring diet quality, protein intake, hydration, micronutrient risk, body composition and functional status when clinically appropriate. (PubMed)
🔹 6️⃣ This is where the dietitian becomes essential The goal should not simply be: “Eat less. ”It should be: “Eat less energy if clinically appropriate while making the food that remains as nutritionally valuable as possible.”
🩺 Clinical Pearl
GLP-1 therapy can reduce appetite, but nutrition assessment should determine what is being lost along with the calories.
Don't ask only: “How much weight has the patient lost? ”Also ask: “What are they eating now, and are they still meeting their nutritional needs?”
💬 Dietitians: When managing patients on GLP-1 therapy, what do you monitor most closely protein intake, GI symptoms, micronutrients or muscle mass?
