For last week’s practice question, we quizzed participants on the next steps after 12% weight loss. Over 85% of respondents chose the best answer. We want to clarify and share this important information, so you can pass it on to people living with diabetes and your colleagues, plus prepare for exam success!
Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer it by clicking here.
Question of the Week:
KC is a 62-year-old individual with type 2 diabetes who presents for follow-up after initiating a weight loss program 3 months ago. They report consuming approximately 1,000–1,100 kcal/day and have lost 12% of their body weight, with a current rate of weight loss averaging 5% in the last month.
Their diet excludes most grains and fruits, and they report occasional fatigue and constipation. Current medications include metformin, tirzepatide, and atorvastatin.
Based on current standards of care, what is the most appropriate response regarding nutrition and weight changes?
- Continue the current plan, KC is achieving intentional weight loss while enrolled in a weight loss program
- Titrate GLP-1 receptor agonist to optimize weight loss outcomes
- KC has achieved weight loss of more than 10%, consider ceasing weight loss efforts to prevent nutrition deficiencies.
- Initiate screening for micronutrient deficiencies and assess protein and fiber intake
Getting to the Best Answer
Answer 1 is incorrect. 1.82% chose this answer, “Continue the current plan, KC is achieving intentional weight loss while enrolled in a weight loss program.” Although KC is achieving clinically significant weight loss, they have multiple risk factors for nutrition deficiencies, including intake <1,200 kcal/day, rapid weight loss (>4% per month), age >50, and restriction of nutrient-dense food groups.1 These risk factors warrant further evaluation before continuation without modification.
Answer 2 is incorrect. 3.03% of you chose this answer, “Titrate GLP-1 receptor agonist to optimize weight loss outcomes.” While GLP-1 receptor agonists are effective for weight management, further intensification may not be appropriate in the setting of already rapid weight loss and inadequate intake. Additional assessment and individualization of outcome goals is recommended before intensification is initiated.
Answer 3 is incorrect. 9.7% chose this answer, “KC has achieved weight loss of more than 10%, consider ceasing weight loss efforts to prevent nutrition deficiencies.” While monitoring weight change is necessary, automatically discontinuing weight loss efforts may not be recommended. Instead, care should focus on optimizing nutritional adequacy, potentially incorporating supplementation, and adjusting the treatment plan to support safe, sustainable weight-loss goals while minimizing nutrition and medical risk.
Finally, Answer 4 is correct. 85.5% of respondents chose this: “Initiate screening for micronutrient deficiencies and assess protein and fiber intake” GREAT JOB! KC meets several high-risk criteria for nutrient deficiencies, including low caloric intake (<1200 calories per day), rapid weight loss (>4% per month), older age, and limited dietary variety. The current standards of care recommend screening for micronutrient deficiencies within these high risk groups. Screening is guided by clinical judgement but nutrients of concern include iron, calcium, magnesium, zinc, B1, B12, Vitamin C, and fat-soluble vitamins A, D, E, and K.1 It is also recommended to ensure adequate protein intake to preserve lean mass and ensure adequate fiber and fluid intake to address constipation in individuals consuming very low-calorie intake.
We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!
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