营养：肥胖管理药物的基石

Nutrition as the Keystonefor Obesity Management Medication The consumer health market opportunity behind the rise of obesityprescription medicines VOLKER SPITZER, Vice President, Global R&D/RWE Services & Thought Leadership, IQVIA Consumer HealthSARAH RICKWOOD, Vice President, EMEA Thought Leadership at IQVIA Table of contents Introduction1Nutrient intake and deficiency prevalence in GLP-1 RA users2Dose- and duration-dependent effects4Mechanisms underlying nutrient deficiencies5Clinical consequences of deficiencies6Mitigation strategies for nutritional health8The role of the nutrition and medical nutrition industry11Conclusion14About the authors15References16 Introduction 2025 is a pivotal year for anti-obesity medications(AOMs), bridging the explosive growth of 2024 andthe next wave of launches expected in 2026. Themarket, already surpassing $30Bn at list price levelsin 2024, will see shifting dynamics across innovation,reimbursement, supply, and clinical understanding.1 vomiting, or diarrhea3can further impair nutrientabsorption, compounding the risk of deficiencies. While the current clinical evidence and product approvalsfocus largely on GLP-1 RAs, it is important to recognizethat current pipeline AOMs include a broader range ofmechanisms of action beyond GLPs. Key events include redefinition of clinical obesity by TheLancet Commission, multiple high-stakes phase 2/3 trialreadouts, easing of supply shortages, and early real-world evidence accumulation. As competition intensifies,innovators must differentiate on efficacy, tolerability,and persistence—while digital health support andphysician education become critical levers. 2025 willmark the transition from peak hype to a more structured,evidence-driven and competitive AOM market.1 Many of these investigational agents also aim to reduceappetite or caloric intake through central or peripheralpathways.1If appetite suppression and reduced foodintake are central features across these novel therapies,it is reasonable to hypothesize that similar risks ofnutritional deficiencies could emerge once thesemedications are approved and widely used. Althoughthis remains to be tested, it highlights the need forproactive research to evaluate nutrient adequacy andlong-term metabolic consequences across all classes ofobesity related drugs, not just GLP-1-based treatments. Currently available AOMs are Glucagon-like peptide-1receptor agonists (GLP-1 RAs) and associated agents—including injectables like semaglutide (Ozempic®/Wegovy®), liraglutide (Victoza®/Saxenda®), and theinjectable gastric inhibitory polypeptide (GIP)/GLP-1receptor agonist tirzepatide (Zepbound/Mounjaro). Overall, rapid and significant weight loss inducedby GLP-1 RAs and potentially other AOMs can leadto nutrient shortfalls if not properly managed, as thedrugs’ powerful appetite-suppressing effects maylead to an inadequate intake of essential micro- andmacronutrients. Although true deficiencies typicallytake time to manifest, proactive nutritional strategiesare vital to address these potential risks (see Figure 1).4 They induce weight loss by suppressing appetite andslowing gastric emptying. Patients on GLP-1 RAs oftensignificantly reduce their food intake. For example,subjects taking oral semaglutide consumed about1,218 fewer kilocalories per day compared to thosetaking placebo, following a standard breakfast.2While this calorie reduction drives weight loss, it alsoraises concerns about nutritional adequacy. Simply put,eating less means fewer nutrients consumed, unlesspatients make a conscious effort to choose nutrient-dense foods. Common side effects like nausea, This whitepaper examines the potential impact of anti-obesity medications (AOMs) on nutrient deficiencies andoutlines strategies to mitigate these risks-both in thecontext of currently approved GLP-1 receptor agonistsand, hypothetically, with future therapies that also reducecaloric intake through similar or other mechanisms. 2025 will mark the transition from peak hypeto a more structured, evidence-driven andcompetitive AOM market.1 nutritional counseling, patients may simply eat less ofthe same unbalanced diet, perpetuating micronutrientdeficiencies to a similar extent as general calorierestriction. It is therefore unsurprising that observeddeficiency prevalence in GLP-1 RA users is high whenmeasured against dietary guidelines, even if directplacebo-controlled comparisons of nutrient status arestill limited. Nutrient intake and deficiencyprevalence in GLP-1 RA users Several recent studies indicate that patients usingGLP-1 RAs often fail to meet recommended dietaryintakes for multiple nutrients. In a 2025 cross-sectional study of 69 GLP-1 RA users(primarily semaglutide and dulaglutide/tirzepatide),dietary records revealed widespread micronutrientshortfalls.4On average, participants consumed belowthe Dietary Reference Intake (DRI) for fiber, calcium,iron, magnesium, potassium, choline, and vitamins A,C, D, E, and K. Over 90%