GLP-1s like Ozempic and Mounjaro can improve long-term health, but they can’t be relied upon alone, Sophie Medlin, a dietitian who works with patients taking the drugs, told Business Insider.
For those who need to lose weight for medical reasons, the drugs can be life-changing by making it easier to eat in a calorie deficit. They do this by mimicking hormones that make us feel full, and slowing digestion.
However, in order for the change to be sustainable, it’s important to make and stick to healthy habits, including exercising regularly and eating a balanced diet featuring protein. This helps to maintain muscle mass and bone density. “Otherwise, you can end up in real trouble,” she said.
Medlin, who is based in London, said she has seen GLP-1 patients in their 40s and 50s with the muscle mass of the average 90-year-old, because they neglected their nutrition and exercise. Muscle mass and bone density are key for protecting our metabolic health and keeping us mobile as we age.
She shared three things she wishes people knew about taking GLP-1 medications.
You’ve heard you can lose up to 20% body weight on GLP-1s, but those patients likely worked with dietitians
GLP-1s are intended to be prescribed alongside a reduced-calorie diet and increased physical activity. Participants in the clinical trials testing how effective GLP-1s are for weight loss were supported by dietitians and received lifestyle counseling, Medlin said.
In contrast, she regularly sees patients who lost and regained weight after coming off GLP-1s before they worked with her, because they didn’t change their diet and lifestyle enough to maintain their weight.
Medlin said that most people who choose to stop taking GLP-1 do so either for financial reasons or because they’ve reached their goal weight.
“You have to use them in a way that helps you to change your habits and change your mindset around food. Otherwise, you’re going to feel like you’re stuck on them forever,” she said.
A dietitian can help you get the most out of GLP-1s, and “make sure that you keep the weight off once you’ve lost it,” Medlin said.
If you can’t eat on GLP-1s, your dose could be too high
Medlin said that GLP-1s should help reduce food noise — the persistent, intrusive thoughts about food and eating that some people say make it difficult to regulate their appetite — making portion control easier. They shouldn’t make eating feel “like an impossible task,” she said.
The sweet spot dose might be lower than what a provider is recommending, she said. The optimal dose should balance health benefits and effectiveness with side effects, according to the American Diabetes Association.
If you’re not losing weight as quickly as you’d hoped, or your progress seems to have plateaued, Medlin recommended looking at your diet before increasing your dose. That way, you’ll spend less on prescriptions and lower the risk of side effects.
“If you can look at your diet and go, ‘Well, actually, I could drink a bit less alcohol or I could reduce the calories that I’m taking in elsewhere,’ then you don’t need to increase the dose,” she said.
Protein is key
If you do find yourself battling a low appetite on the appropriate dose, however, Medlin said to first focus on eating a good source of protein, such as fish, chicken or tofu. “That’s going to really help you make sure that you’re not wasting muscle mass,” she said.
Muscle uses more energy that other types of tissues such as fat, so when someone loses muscle, their basal metabolic rate (BMR), or how quickly they burn calories at rest, drops. This makes it harder to lose weight and increases the risk of regaining weight if they stop taking the medication.
It’s also important to eat fiber, carbs, and healthy fats, too, for a balanced diet.
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