Home Kickstart Assess Evaluate Refer
Rapid weight loss can result in the loss of both fat and muscle and can also affect bone density. Carefully structured nutritional patterns and physical activity are needed to preserve muscle mass and bone density (Mozaffarian et al., 2025). As people modify their dietary patterns to lose weight, it is crucial to maintain sufficient intake of protein, calcium, vitamins, and other essential nutrients to avoid the development of deficiencies. For example, it is important for older adults to obtain adequate calcium and vitamin D to maintain bone health and slow the development of osteoporosis.
People with obesity often have dietary patterns that do not provide adequate intakes of these nutrients. Inadequate nutrient intake may be exacerbated while people are following reduced-calorie diets and reducing overall consumption, which may be particularly common following metabolic surgery or while using GLP-1s (Christensen et al., 2024; Fulgoni et al., 2024). People taking orlistat long-term may experience deficiencies of fat-soluble vitamins (Chapela et al., 2024).
Decreased protein intake can lead to muscle loss and sarcopenia, and negatively impact bone health (Chapela et al., 2024). Risks are increased in people with a history of weight cycling (repeated weight loss and regain), and those who lose weight without performing adequate physical activity (Christensen et al., 2024). Long-term reduced caloric intake may also be of particular concern (Fulgoni et al., 2024). Advanced age increases the risk for malnutrition. Furthermore, older adults may present with additional conditions that increase the risk for malnutrition, including poor dentition and comorbid chronic diseases. People facing food insecurity may also have difficulty accessing nutrient-dense foods (Almandoz et al., 2024).
Attention to dietary intake is needed to ensure people are developing dietary patterns that meet nutritional needs, including protein and micronutrients (Christensen et al., 2024). Dietary supplementation may assist with offsetting the impact of reduced caloric intake and help people ensure they achieve adequate nutritional intakes (Fulgoni et al., 2024). Ideally, nutritional deficiencies can be addressed with nutrient-dense foods (e.g., protein-rich foods) (Chapela et al., 2024). However, fortified foods, especially formulated products (e.g., protein shakes), and/or dietary supplements (e.g., multivitamin/mineral products) should be considered when nutritional needs are not being met from the diet (Fulgoni et al., 2024). Micronutrient supplementation, including vitamin D supplementation, in people with obesity may help improve health-related outcomes (Chapela et al., 2024).
Clinicians should educate patients who are reducing their caloric intake (regardless of the method) of the importance of adequate intakes of protein, dietary fiber, and micronutrients. Any preexisting deficiencies should be addressed. Further, body composition and muscle function should be monitored during weight loss (Christensen et al., 2024). Referral to a nutrition expert may be needed to address deficiencies (Chapela et al., 2024).
Overview | Goal Setting | Evaluate Treatment Guidelines | Physical Activity Interventions | Nutritional Interventions | Counseling and Behavioral Interventions | Evaluate Digital Health Options | Pharmacotherapy | Prepare People to Manage Common Medication Adverse Events| Recommend Dietary Supplementation When Appropriate | Evaluate Interventions for Sarcopenic Obesity | Evaluate for Metabolic Surgery Referral | Resources