Nutritional management that preserves lean mass and nutritional adequacy, with or without pharmacotherapy.
We commonly see people who have lost and regained weight repeatedly and are seeking an approach other than a further cycle of the same.
We also see people commencing or already taking a GLP-1 medication whose dietary intake has reduced substantially, who are uncertain whether that intake remains nutritionally adequate, or who have noticed a decline in strength and energy.
Others have been advised to lose weight for a specific clinical reason — planned joint replacement surgery, fertility treatment, hepatic steatosis, obstructive sleep apnoea or hypertension — and require a plan directed at that objective.
Many have received conflicting advice, or have a history of restrictive dieting that has complicated their relationship with food.
Body weight is influenced by metabolic, endocrine, pharmacological and behavioural factors. The relevant clinical question is not how weight can be reduced most rapidly, but how fat mass can be reduced while preserving lean mass, nutritional adequacy and a sustainable relationship with food, since these determine whether a result is maintained.
Preservation of lean mass during weight loss. During rapid weight loss, including that achieved with GLP-1 medications, a substantial proportion of the mass lost is lean tissue. Protein intake above approximately 1.2g per kilogram per day, distributed across meals rather than concentrated in one, combined with resistance training, has the strongest supporting evidence. Jessica Coombe (AEP) provides the resistance training component.
Nutritional adequacy at reduced intake. Where appetite is markedly reduced, total intake may fall below requirements for protein, fibre, calcium, iron and vitamin B12 without producing obvious symptoms. Adequacy is assessed directly rather than assumed, and the plan adjusted so that requirements are met within the reduced intake.
Management of medication-related symptoms. Nausea, reflux and constipation are common with GLP-1 medications and are among the principal reasons for discontinuation. Meal size, timing and composition, together with fibre and fluid intake, produce measurable improvement in most cases.
Screening for disordered eating. A history of dietary restriction, repeated cycles of loss and regain, or distress associated with food alters what constitutes appropriate treatment. This is screened for at assessment, and where identified is addressed directly rather than by applying a further restrictive plan.
These medications are effective, and this page is not intended to discourage their use. What they do not determine is dietary composition. Appetite suppression makes weight loss more readily achieved and also makes inadequate protein intake, avoidable loss of lean mass and nutritional inadequacy more likely — the combination that leaves a person weaker rather than healthier at a lower body weight. Nutritional management and resistance training determine the composition of the weight lost, not merely its magnitude. We work with patients taking these medications, discontinuing them, or not using them at all.
Some lean mass is lost during any substantial weight loss, and it can represent a considerable proportion of the total. Adequate protein intake distributed across the day, together with regular resistance training, reduces this, which is why both are addressed.
More than general population recommendations. Evidence supports intake above approximately 1.2g per kilogram per day during active weight loss, distributed across meals. A specific target is determined at assessment.
Yes. These are common reasons for discontinuation, and meal size, timing and composition, together with fibre and fluid intake, produce measurable improvement in most cases.
Please raise this at assessment. It alters the approach: a restrictive plan would not be appropriate, and this would be addressed first, with referral for specialist support where indicated.
No referral is required to book. If you have a chronic condition, your general practitioner may be able to refer you under a chronic disease management plan for a Medicare rebate.
The Endocrine & Wellbeing Clinic
Phone: (02) 9870 3256
Locations: Balmain (inner west Sydney) and Telehealth Australia-wide
Affiliated with: Dietitians Australia, Endocrine Society of Australia
This page is not a substitute for individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
