Diet Quality and Micronutrient Intake among United States Adults Eligible for GLP-1 Receptor Agonist Antiobesity Medications: A Nationally Representative Analysis.

BACKGROUND

Glucagon-like peptide-1 receptor agonist antiobesity medications (GLP-1 RA AOMs) are increasingly prescribed for obesity management; however, baseline dietary quality and nutritional risk among treatment-eligible populations remain poorly characterized.

OBJECTIVES

We aimed to compare diet quality and micronutrient adequacy among United States adults meeting GLP-1 RA AOM eligibility criteria and examine whether differences persist after accounting for sociodemographic, behavioral, and clinical factors.

METHODS

We conducted a cross-sectional analysis of adults aged ≥20 y from the National Health and Nutrition Examination Survey 2005-2020. GLP-1 RA AOM eligibility was defined according to prescribing criteria [body mass index (BMI) ≥30 kg/m2 or BMI ≥27 kg/m2 with ≥1 obesity-related comorbidity]. Diet quality was assessed using Healthy Eating Index-2025 (HEI-2015) from 24-h dietary recalls. Micronutrient inadequacy was evaluated relative to estimated average requirements and adequate intake benchmarks. Survey-weighted linear regression models adjusted for demographic, socioeconomic, behavioral, and clinical covariates. Stratified analyses examined BMI class and food security.

RESULTS

Among 16,143 adults (representing 97.7 million United States adults), 43.5% (95% confidence interval: 42.6%, 44.5%) met GLP-1 RA AOM eligibility criteria. Eligible adults had poorer diet quality than noneligible adults (HEI-2015: 49.2 compared with 51.7; P < 0.001), corresponding to an unadjusted difference of -2.50 points. Differences persisted after demographic (β = -2.19) and socioeconomic adjustment (β = -2.05) but were substantially attenuated and no longer statistically significant after additional adjustment for waist circumference (β = -0.42; P = 0.29), suggesting that central adiposity was strongly associated with the observed association between GLP-1 RA AOM eligibility and diet quality. Component analyses showed poorer scores for nutrient-dense foods, including fruits, vegetables, whole grains, and plant proteins. Higher waist circumference was independently associated with poorer diet quality (β = -1.47 HEI points per quartile). Micronutrient inadequacy was modestly higher among eligible adults for several nutrients, including vitamin C, vitamin A, magnesium, vitamin E, vitamin D, fiber, potassium, and vitamin K.

CONCLUSIONS

Adults eligible for GLP-1 RA AOM therapy demonstrate modest but consistent differences in baseline diet quality and micronutrient adequacy. These findings suggest that modest nutrition risk may co-occur with GLP-1 RA AOM eligibility and support consideration of nutrition assessment as part of comprehensive obesity care.