Some Thoughts On GLP-1 Medication From a Registered Dietitian
Oof, I had to take a long walk this past week because I am feeling a bit overwhelmed by the GLP1-s (including Wegovy, Mounjaro, Zepbound, and, of course, Ozempic).
“The shot” is something on everyone’s minds thanks to our society’s (and by extension, the medical profession’s) obsession with weight and profiting off people’s insecurities. What was once a treatment for some has become seemingly ubiquitous, at least in perception, based on ads I see daily. Practically everyone knows someone using a GLP-1.
For the record, I am open and curious about patients' experiences with them. Some experience so much relief, mentally. Part of me thinks it helps them put thoughts about weight and food in the background so they can think about anything else. Although we could do that without GLP-1s, it takes longer and more energy on their part. Some patients just don't have the time or energy. Sometimes, putting all the food/weight/hunger pressure in the background helps them progress with their nutrition therapy. However, others who don't know how to stay nourished while on them and/or deal with the side effects are struggling – and that’s one of the things that troubles me the most.
What I am having an issue with the most, though, is providers (MDs, but also telehealth companies, which is troublesome to me on another level) prescribing them as a sort of catch-all rather than truly assessing whether they’re the right choice for the patient (or even what the patient wants). Many patients, recently, have said their providers bring it up before the patient does, without any questioning. That feels off to me. Especially not knowing about the patient's life, mental health, life situation, or any context. So I am struggling. But I see my role as helping them stay as nourished as possible, regardless of whether the patient is taking GLP1s or not. At the end of the day, I am a sounding board.
It’s okay to be curious about GLP-1s, but some things to keep in mind while on them are:
Remembering to balance your plate using the Plate Method (especially the Diabetes Plate Method).
Eating regularly throughout the day – you absolutely cannot take these drugs without eating.
Getting enough protein. A typical amount is 20-30 grams per meal, 5-15 grams per snack.
Taking multivitamin + additional supplements if needed (Vitamin D, Ferritin, B12, etc. Ask your doctor to test for these nutrients). If you want more information, I have also written about supplements in the past.
Monitoring your bowel habits, especially if you experience constipation (going less frequently and/or hard-to-pass stools). Ask your doctor for an OTC laxative to have on hand (but only if you have no prior history of eating disorder laxative use). Try to determine if you need something to help soften your stool or just help stimulate the bowel movement. You can try prune juice first: 4 oz. of prune juice or 3-4 prunes a day, and increase to 6-12 a day as needed. Also, try a Squatty Potty to help position your body correctly when using the bathroom.
Please tell your doctor if you are experiencing negative side effects. They may be able to adjust the dosage or switch to another medication.
Do not try to lose weight as fast as possible, it’s not sustainable. If weight loss velocity is too quick and or you are experiencing negative side effects, please tell your doctor and consider not increasing the dosage.
At the end of the day, this is the patient's decision along with (hopefully) their trusted doctor. Be clear on what you want from this drug. It is okay to want to lose weight, but do so with the right support and stay as nourished as possible so as not to lose muscle mass and keep your energy levels, mood/stress, and sleep in check. It's also okay to wait and not try GLP1s first. You could see if working with a dietitian (and therapist?) for 6-12 months first is getting you to where you want to be.
One more thing, you never know what someone's relationship to food, their body, their body image, so just be kind (and mind your own business)!
If you want to know more, feel free to book an appointment with me. I also offer free, 15-minute consultations.