In this article I would like to provide some answers to questions you may have about: 

1. What to know if you are considering a GLP-1 weight loss medication. 
2. What to know if you are already taking a GLP-1 weight loss medication.
3. What to know if you want to stop taking a GLP-1 weight loss medication.

Before we start, please understand the information in this article is for general knowledge and is not meant to replace your doctor’s advice.

If you are considering starting one of the GLP-1 weight loss medications, you may have many questions going through your mind.

Questions such as . . .

Are these medications safe?

Can I afford it?

Will I have to take it forever?

Are there long term side effects? 

We can get the answers to some of those questions, but we may not know all the answers. 

For the purposes of this article, the medications I am talking about are FDA approved GLP1 medications Wegovy (semaglutide), and Zepbound (tirzepatide),

These come in pill or shot form. And there will be more coming so the choices will only get more complex.  

How do these medications work?

Our body naturally makes GLP-1 and GIP hormones to regulate things like blood sugar levels and appetite. Hormones in general are like messengers travelling to different parts of our body to help control different function. Think of it like text messages or signals that go out in the body and tell our cells to do something. 

Wegovy or semaglutide is a GLP-1 (glucagon-like peptide-1) and Zepbound or tirzepatide is a GLP-1 and GIP (glucose dependent insulinotropic peptide). 

The GLP-1 and GIP hormones are produced in the intestines when we eat, especially when we eat carbohydrates and fat. These and other gut hormones help support digestion, nutrient absorption, hunger, fullness, and hydration. 

These weight loss medications are made to make the same thing happen in our body that should normally happen to control hunger, fullness and cravings. But with the medication it’s a much stronger dose than our body gives us. It’s like taking an espresso shot dose compared to a cup of coffee dose. Plus, they last a lot longer in our body. For the shots it’s about a week versus just a few minutes. The stronger effect of the medication is part of what causes side effects.  

How do I know if it’s safe for me to take these weight loss medications?

If you are considering starting Wegovy or Zepbound talk to your primary care provider first about whether this medication is right for YOU. There are certain situations and health conditions where it’s not a good idea to take these types of medication. You may also need some labs done if you haven’t had them checked in several months. 

Also, if you are on medication already and want to wean off, make sure you work with your health care provider. You want to have a good plan for weaning off or staying on a low dose. Each person’s situation is different and depends on your health goals.

What are the side effects of these weight loss medications?

Common side effects are nausea, vomiting, constipation, diarrhea and acid reflux, getting full faster or loss of appetite. This is due to the main action of these medications to slow down digestion. There are other possible side effects and not everyone gets side effects. 

As far as the risk of long term side effects, all I can tell you is that GLP-1 medications have been around for many years for diabetes and personally I have not seen long term complications. That being said, if the medications are not used responsibly and someone loses too much weight too quickly or becomes malnourished or side effects are ignored, such as digestive problems, there could definitely be long term side effects. 

If you are already taking Wegovy or Zepbound, here are several nutrition considerations to be aware of.

Digestion Changes

If you have any digestive problems, I recommend trying to improve how your digestive system is working BEFORE you start the medication. There are very specific nutrition therapies that can help with constipation, diarrhea, and nausea.

Vomiting is often resolved by eating small amounts and avoiding heavy, greasy foods. You may need to eat more often if you can only eat very small portions at once.  

Dosing

This should depend on your situation, not a preset schedule. Dose increases can also trigger or worsen side effects. Be sure to communicate side effects with your provider. 

Just because the usual dosing schedule is to increase each month, that may not always be best. If you are having bothersome side effects we should correct those before moving on. Your doctor may want you to stay on a lower dose until the side effects get better. 

Nutrient Loss

Avoid becoming malnourished. Another reason to work with your provider and dietitian is to monitor for nutrient deficiencies. There are at least 11 different vitamins or minerals your body could get low in when you drastically cut back on food intake. 

Your dietitian can help you decide what foods or supplements you might need. Sometimes we need to get creative with your plan when your appetite has decreased and you can’t eat much. 

Wellness, Not Just Weight

Don’t sacrifice health for weight loss. Muscle and bone loss are also a risk. This especially is common if you can’t eat much or can’t exercise. To avoid losing muscle try to get protein throughout the day, not just all at one meal.  

Exercising your muscles is necessary to stay strong, among the many other reasons. And remember to focus on wellness, not just weight loss. It’s not about the scale, it’s about being healthier. 

When you start losing weight you will likely notice your clothes fitting better before you see the scale move. Stepping on the scale too often will usually not help you lose weight faster. A better measure of success would be getting your body composition checked. That way you can see if you are keeping muscle and losing fat. 

Slow and steady wins the race when it comes to weight loss. 

Good Hydration

Hydration is more than just drinking enough water.  Your body actually needs to be able to absorb that water. I help clients look at what’s in their drinks, including artificial sweeteners, hidden sugars, electrolytes and caffeine.

There’s so many products out there nowadays including protein shakes, sugar-free drinks, protein water, vitamin water, electrolyte drinks and more. You may need help making the best choice for your situation. 

Get a Personalized Plan

There is no one specific diet to follow while taking these weight loss medications. Your nutrition and eating plan should be personalized with the help of a registered dietitian. 

Your plan should consider many factors. These include your symptoms, side effects, other health conditions and medications. Lifestyle factors also play a role, like how well you sleep, your stress level, and food preferences. 

People think dietitians are going to judge all the bad things they eat or take away their favorite foods. My approach, as a dietitian, is not to tell you what to eat. I will give you information and suggestions. Ultimately though it’s your choice to decide what strategies work best for you. Problem solving is actually the main thing I help my clients with. For example, if you are struggling with constipation, I have a “toolbox” full of tools to choose from and I help you decide which ones you would like to try to get things moving – ideally without more medication.

Follow up with your Health Care Provider

Be smart when you take these medications and work with your health care team. My preference would be monthly visits with your doctor or dietitian when starting a weight loss medication. Not seeing your doctor for months is not a good idea. That may be more appropriate once you are on a maintenance dose but when doses are changing there will almost always be side effects or concerns that come up.  

For nutrition needs you may require adjustments in food, hydration, or supplements and that’s where your dietitian can help. I generally see my clients monthly until they are in a weight maintenance phase. 

Your insurance may also require visits to your doctor or dietitian to get the medication covered. And some also have requirements to continue covering the weight loss medications. You may need to call them and ask if there are any requirements for approval.

The first question is Why are you stopping?  The answer to that question directs us how to proceed with a plan. 

The best plan should help you: 

• minimize weight regain
• minimize hunger and cravings that often return
• make sure any weight regain is not just fat but more lean muscle with strong bones and adequate hydration
• wean off slowly and not just stop “cold turkey” 
• monitor blood sugar changes if that has been a concern for you 
• monitor digestive changes. If you work with me I have a  digestive assessment we can do. 
• make sure you are getting adequate nutrients. Your body needs the same nutrients off the medication as when you are taking the med.  We want to get your own GLP-1 hormone to work as well as possible.
• avoid the dieting mindset. The tendency is to just try to eat less to avoid gaining weight but often that will backfire. 
• establish an appropriate exercise plan, ideally from an exercise specialist, that matches your personal health and lifestyle needs. 

The new weight loss medications can make it much easier to lose weight and have helped many people. Just don’t lose focus on wellness in the process!

I hope this article has helped you realize the importance of nutrition, no matter what your stage of weight wellness!

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