Navigate Weight Loss Meds With an Intuitive Eating Dietitian

Recently, I have been having more conversations with my clients about GLP-1 medications or the trendy “weight loss meds.” I thought it would be helpful to provide some clarification on these medications from a non-diet, intuitive eating dietitian.

What are GLP-1s (weight loss meds)?

GLP-1 agonist medications, also called GLP-1 receptor agonists, include medications such as semaglutide (Ozempic, Wegovy), tirzepatide (Zepbound, Mounjaro), dulaglutide (Trulicity), and liraglutide (Saxenda). 

These medications work by mimicking the effects of the glucagon peptide-1 (GLP-1) hormone in the body. GLP-1 is a naturally occurring hormone that reduces appetite, slows gastric (stomach) emptying, and decreases blood glucose levels.

GLP-1s were originally developed and approved for use in treating Type II Diabetes. Later, they began to be studied on how well they induced weight loss. 

What does the research say?

In managing diabetes…

GLP-1 receptor agonists are effective at reducing A1C by 1-2 percentage points. This is similar to another diabetes medication called Metformin. 

GLP-1 receptor agonists also reduce risk of MACE (major adverse cardiovascular events). This is another important factor to consider in their effectiveness and helpfulness for patients with diabetes, who are at an increased risk of MACE. (1)

In weight loss…

GLP-1 receptor agonists are prescribed at a higher dosage when prescribed for weight loss than they are for treating diabetes. For example, Liraglutide is approved for “chronic weight management” at 3mg / dose, while it is used in diabetes management at up to 1.8mg / dose. Semaglutide is used at 2.4mg / dose as a weight management drug as opposed to up to 2mg / dose as a diabetes medication. 

GLP-1s have been shown to induce a clinically significant amount of weight loss. Specifically, semaglutide was studied over 68 weeks, and participants taking 2.4mg once per week experienced an average of 9% weight loss compared to those on placebo.(2) Once weekly Tirzepatide elicited 10-12% weight loss in another study. (3)

Clinical studies also show us that once a GLP-1 (in this study it was semaglutide/Ozempic) was stopped, weight was regained.(4)

Side Effects of GLP-1s

Many side effects have been observed in patients taking GLP-1s. They include nausea, vomiting, constipation and diarrhea. In most patients, the side effects will subside after 2-4 months of consistent use. However, for some patients, the side effects are so unpleasant that they and their provider decide to discontinue use of the medication, or to try some changes. The provider may try switching the patient to a different GLP-1, or they might be able to split the dosage up into two smaller doses. 

The side effects of the medication will also likely impact the body’s hunger and fullness cues. We might expect to see a reduced appetite and slower digestion, resulting in feeling full more quickly. Overall, we anticipate seeing some type of change in how the person is experiencing their hunger and fullness cues from the body.

These medications have only been studied for up to 2 years so we don’t know all of the potential long-term side effect. As of now, we know that some of the risks include pancreatitis, gallbladder problems, intestinal blockages and the possibility of thyroid tumors. 

Can I take a GLP-1 medication and do Intuitive Eating? 

Whether you are already on your intuitive eating journey or have yet to begin, here are some important things to consider if you are on or considering GLP-1 medications: 

• Decreased Hunger/Fullness Cues

One principle of Intuitive Eating is honoring hunger. When the appetite is suppressed due to medication, this can be difficult to do. Knowing when to eat and what it feels like to be hungry may change. It may become helpful to use timed reminders to ensure adequate nutritional intake in the absence of hunger signals. 

• Eating for Satisfaction:

Another principle of intuitive eating is to engage the satisfaction factor of food. On GLP-1s, the amount of satisfaction coming from food may change due to side effects like nausea. Food may lose some of the pleasure that it used to provide, based on taste changes, food preferences, and other medication side effects. 

• Making Peace with Food:

One of the main tenets of intuitive eating is making peace with food. It is already difficult to keep a non-diet mentality given the diet-obsessed culture we live in. Adding in use of GLP-1s can complicate things even more. It may be difficult to maintain a neutral, non-dieting mindset around food, especially depending on how your weight responds to the medication. 

If you’ve done a lot of work around quitting chronic dieting or finally making peace with your body, this medication might shake things up. It’s something to consider before starting.

Advice from a non-diet, intuitive eating dietitian

Explore your thoughts and feelings in advance

Deciding to try a GLP-1 is a decision that you should make thoughtfully and carefully in partnership with your healthcare provider or team. If you are already working with a therapist or dietitian, I recommend talking through this decision and exploring the thoughts and feelings it brings up. 

Set other goals/markers for what success looks like 

Be thinking about what benefits you are looking for this medication to provide you, separate from weight changes. Are you hoping that you have less intense cravings? Are you hoping that helps curb binge eating episodes? Do you anticipate that you will think about food less and have more brain space for other things?

Keep working on your other health-promoting habits 

Enjoyable body movement, adequate sleep, stress management and hydration are a few other healthy habits I would encourage you to continue to pursue. We want to establish these medications as just one small piece of the puzzle of your healthy lifestyle, not as the single “quick fix.”

Work with a dietitian

If you and your doctor decide to try GLP-1s, it may be helpful to partner with a registered dietitian to help manage any side effects and ensure adequate nutrition. An RD trained in eating disorders can help you navigate the emotions and thoughts that come up if your body undergoes changes. 

Bottom line

There are clear risks of untreated type II diabetes. In most cases, to use GLP-1s to manage diabetes and help control blood glucose levels over the long term is a clearly indicated choice based on the risks of untreated diabetes compared to the possible risks/side effects of GLP-1s. 

However, here in the weight-neutral world, we believe that the “risks” of being at a higher weight are less clear. The medications can have some unpleasant side effects that could lower quality of life. A changing body might mess with the body acceptance and respect that you have been cultivating. The effects of the medication will likely only last as long as you take the medication, so you have to consider whether you are prepared to stay on GLP-1s long-term. If you have any history of disordered eating or eating disorders, you should definitely discuss this with the provider before starting GLP-1s. An eating disorder is a very serious and life-threatening condition. Triggering a relapse could be detrimental to health. This should be strongly considered before starting a GLP-1. 

The decision making process is complex, and the best way to work through it is alongside a trusted healthcare provider and ideally, with a dietitian. I would love to connect with you and discuss working together. Reach out to me here to book a free discovery call.

Resources:

1. El Sayed, Nuha A., et al. “10. Cardiovascular Disease and Risk Management: Standards of Care in Diabetes—2023.” Diabetes Care 46.Supplement_1 (2023): S158-S190.
2. Davies M, Færch L, Jeppesen OK, Pakseresht A, Pedersen SD, Perreault L, Rosenstock J, Shimomura I, Viljoen A, Wadden TA, Lingvay I; STEP 2 Study Group. Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021 Mar 13;397(10278):971-984. doi: 10.1016/S0140-6736(21)00213-0. Epub 2021 Mar 2. PMID: 33667417. 
3. Bhagavathula, Akshaya Srikanth, Kota Vidyasagar, and Wubshet Tesfaye. “Efficacy and safety of tirzepatide in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized phase II/III trials.” Pharmaceuticals 14.10 (2021): 991.
4. Wilding, J. P., Batterham, R. L., Davies, M. J., Van Gaal, L., Kandler, K., Konakli, K., Lingvay, I., McGowan, B., Oral, T. K., Rosenstock, J., Wadden, T. A., Wharton, S., Yokote, K., & Kraus, W. E. (2022). Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension. Diabetes, Obesity and Metabolism, 24(8), 1553–1564. https://doi.org/10.1111/dom.14725