In age of GLP-1 agonists, food choices still matter for health

Jennifer Lubell , Contributing News Writer

For patients who have struggled to lose excess weight through lifestyle changes alone, GLP-1 receptor agonists marketed as Wegovy, Ozempic and Mounjaro have emerged as a game-changing alternative for reducing morbidity and mortality.

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“There's a very understandable excitement about the newer class of high-potency weight-loss drugs. An agent that can achieve 15% to 20% weight loss truly opens a world of possibilities for so many,” said AMA member Stephen Devries, MD, a preventive cardiologist and executive director of the educational nonprofit Gaples Institute in Chicago.

However, it’s important not to lose sight of the continued value of a high-quality diet.

“With the availability of these new, highly effective drugs, the question is: Do food choices still matter? And the answer is a resounding yes,” said Dr. Devries, who is also an adjunct professor of nutrition at Harvard T.H. Chan School of Public Health.

In a podcast distributed by the AMA Ed Hub, an online platform with high-quality CME/MOC from many trusted sources to support lifelong learning of physicians and other medical professionals, Dr. Devries discussed why weight loss alone doesn’t ensure optimal diet-related health outcomes.  

Patients taking new weight-loss medications and seeing dramatic results may assume their food choices aren’t as consequential as they used to be, said Dr. Devries.

GLP-1 agonists are highly effective therapies for weight loss, he said. But diet quality “remains a vital concern for everyone, including those on the newer weight-loss meds.”

A U.S. Burden of Disease Collaborators study examined 17 risk factors that contribute to death. It found that poor quality diet was the top risk factor of death and requires increased attention.

Other studies have pointed to the benefits of a healthy diet, and the role it plays in reducing morbidity and cardiovascular disease—including among patients whose weight is considered healthy.

One Swedish study examined the link between adherence to a Mediterranean-style diet and mortality, following 79,000 individuals stratified by body mass index (BMI) for 17 years. The Mediterranean-style diet emphasizes eating vegetables, fruit, legumes, nuts, whole grains, and small amounts of dairy, while reducing intake of red and processed meat.

Even among participants with a BMI between 20 and 25, those who consumed the lowest-quality diet had a 60% higher risk of overall mortality and a 76% greater risk of death from cardiovascular disease, compared with those most adherent to a healthy, Mediterranean-style diet.

Dr. Devries also emphasized that “even the healthiest diet didn't remove the additional risk of cardiovascular mortality associated with obesity. The ideal situation is to have both a healthy body weight and a healthy diet.”

Another study followed 30,000 participants for 16 years. Researchers used an alternative healthy-eating index to measure diet quality, studying this in tandem with BMI and the association with cardiovascular disease.

“After adjusting for covariates in those with normal weight, a healthy diet reduced the risk of incidence of cardiovascular disease by 21%, compared to those who consumed the least healthy diet,” said Dr. Devries.

For physicians who prescribe weight-loss medications, Dr. Devries stressed that “at every body weight, diet quality still matters.”

Physicians should position a high-quality diet as a long-term goal, even for patients who reach their weight-loss targets.

“Patients need to know that the foods they consume are as important to their health as the ones they're avoiding,” he advised. This may be especially important for patients who experience side effects from the newer agents, such as nausea or disinterest in foods.

While “we don't know if or how there will be an off-ramp … if there's a chance of getting people off the meds and maintaining weight loss, it will be important that they've established and maintained a healthy pattern of eating during the time they've been on the medications,” Dr. Devries said. “Even for patients who do stay on the meds indefinitely, a high-quality diet will be crucial for optimal health and longevity," he added.

The podcast episode is part of the “Medicine with a Fork” nutrition-focused series from the Gaples Institute that previews a more comprehensive, self-paced CME course, "Nutrition Science for Health and Longevity: What Every Physician Needs to Know."