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The GLP-1 weight loss medications
This page was designed for both people taking a GLP-1 and for those considering taking one.
If you have ever tried to lose weight, you will know how difficult it is to keep the weight off and you will most likely have regained weight after each attempt and possibly even got heavier over the years. This has nothing to do with a lack of willpower and it is certainly not a failing on your part. Almost everyone who tries to lose weight through dieting or a “healthy lifestyle” program (which essentially means eating less), regains the weight and overtime and ends up a little (or much) heavier.
Will the GLP-1 weight loss medications such as Wegovy change this?
The short answer is we don’t yet. What we do know though, is unless you take steps to understand your body cues of hunger and fullness to understand how much you need to eat, and unless you do the work to heal your relationship with food and body, you are going regain the weight you lose once you wean off the medication. Studies show people regain 2/3 of the weight within the first year off the drugs.
If any of the below points were you pre-GLP-1 medication, or are you now, then you must take steps to resolve these while you’re on the medication, otherwise these will all reappear once you stop taking them and you will likely regain all the weight you lost.
- Constantly thinking about food or questioning whether or not you should eat a particular food, or at all (aka food noise)
- Strong food cravings
- Feeling shame/guilt around certain food
- Feeling out of control around food
- Bingeing behaviour, or even just feeling you’ve eaten way too much
- Trying to be “good” during the day and eating less and then feeling famished in the evening (or after work)
- Hitting the wall at 3-4pm and needing a “sugar hit”
- Feeling “addicted” to sugar or carbs
- yoyo dieting and having tried every diet under the sun
Do I need to see a dietitian?
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If you are taking Wegovy, Ozempic or Mounjaro you will most likely be eating less, for some people this is considerably less, I have worked with people who are now eating very little. While nutritional deficiencies pose a very real risk, under-eating also causes your metabolism to slow down (just like when you’re on a diet) and your body is going to enter starvation mode.
The difference with being on a weight loss medication is that it over-rides your body’s normal biology and you don’t feel hunger where you ordinarily would and when you do eat, you can feel full with very little food. Under-eating when you’re dieting can mess up your ability to recognise hunger, but at some point during the day you will likely feel starving and when you eat, you may find yourself needing to eat much more than you think you should. This is your normal healthy biology fighting starvation and keeping you alive. GLP-1 medications over-ride this normal biology.
Why am I not as hungry and why do I feel full so quickly?
The GLP-1 medications delay gastric emptying and slow digestion which helps reduce hunger. This is also why they can cause lots of gastrointestinal issues. They also act on a part of the brain related to appetite and this changes your perception of hunger and fullness.
Am I losing mostly fat?
As you lose weight, you are losing both fat and muscle, the less you eat or the faster you lose weight, the more muscle wasting occurs and this has damaging implications for your metabolism long-term (in the same way dieting does). So it is imperative you ensure you’re eating enough to minimise this effect, and that you also engage in some resistance/weight training to help maintain muscle mass. Significant under-eating will make it difficult to exercise, or prevent muscle gain even if you are active.
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So how much should I be eating?
As yet, we don’t know what optimal nutrition on these medications looks like – but the world is conducting one huge experiment as millions go on them. There is general consensus that protein for muscle mass and dietary fibre for gut function are two key considerations. But it can very hard to eat enough of either of these when you’re just not hungry or don’t feel like eating. There is also risk of micronutrient deficiencies such as calcium, Vitamin B12 and iron.
Usual protein requirements are ~0.8g per kg of body weight, so an 80kg person needs around 64g of protein daily. This is easy to achieve on a normal dietary intake and you don’t need to focus on protein. But if your food intake has significantly reduced on Wegovy (or other GLP-1 medication) due to decreased appetite, then it can be challenging to get this. In addition, the recommendation to minimise the muscle wasting that occurs as part of your weight loss, is to have at least 1.2g per kg of body weight. For an 80kg person, this would be ~96g of protein daily and can be very difficult to achieve if your food intake is significantly reduced.
We can help you meet your protein needs and ensure you’re eating as well as you can within the context of eating less. We will check your total food and protein intake and provide strategies to help you increase your protein and other nutrients. Will will also advise on any blood tests to check for possible deficiencies.
Can I practice intuitive eating and take a weight loss medication?
Yes. We continue to use the the intuitive eating framework with our clients on GLP-1s, but with some adjustments around tuning into and trusting appetite cues. All the other principles of intuitive eating are just as necessary and vital to ensure you develop and nurture a healthier relationship with food and body once you come of the medication.
