When it comes to nutrition and weight loss, it is imperative that we recognize that one size does not fit all. Individualized nutrition plans are critical because what works for one person may not be effective—or even safe—for another.
Weight loss medications, for example, can be a valuable tool for some people, helping them achieve and maintain a healthier weight when traditional methods have failed. However, for others, these medications may pose risks that outweigh the benefits. The key is to understand that these interventions must be tailored to each person's unique needs and medical profile.
In our quest to simplify nutrition advice, we often fall into the trap of labeling dietary interventions as either "good" or "bad." This binary thinking overlooks the complexity and individuality of human metabolism and health. The same diet or medication can have vastly different effects depending on a person's genetics, lifestyle, and existing health conditions. Thus, it is vital to approach weight loss with an appreciation for nuance and a commitment to ongoing learning and adaptation.
The purpose of this article is to delve into our current understanding of weight loss medications, focusing specifically on GLP-1 receptor agonists. We will explore their benefits, risks, and appropriate usage, providing a comprehensive (and hopefully unbiased) overview of these medications.
Understanding Weight Loss Medications
Weight loss medications are designed to aid people in achieving and maintaining a healthier weight, particularly when lifestyle changes alone are insufficient. These medications fall into several categories, each with distinct mechanisms of action and therapeutic targets. Some of the most common categories of weight loss medications include:
Appetite Suppressants: These medications work by influencing the brain's hunger signals, reducing appetite and helping individuals feel full sooner. Common examples include phentermine and diethylpropion.
Fat Absorption Inhibitors: These drugs prevent the absorption of fat from the diet, thus reducing caloric intake. Orlistat is a well-known fat absorption inhibitor that works by blocking the enzyme lipase, which is necessary for the digestion of fat.
GLP-1 Receptor Agonists: These medications mimic the action of the glucagon-like peptide-1 (GLP-1) hormone, which helps regulate appetite and glucose metabolism. For the purpose of this article, we will focus on the peptide semaglutide, a prominent GLP-1 receptor agonist.
How GLP-1 Receptor Agonists Work
GLP-1 receptor agonists have gained significant attention in recent years for their efficacy in weight loss and glucose regulation. The peptide, Semaglutide, in particular, has emerged as a leading medication in this category. Semaglutide is mostly known by its brand names, Wegovy and Ozempic, and it works by mimicking the GLP-1 hormone, which is naturally produced in the gut.
GLP-1 receptor agonists, including semaglutide, function by:
Reducing Appetite: By acting on appetite centers in the brain, these medications help reduce hunger, cravings and caloric intake.
Slowing Gastric Emptying: They slow the rate at which food leaves the stomach, promoting a feeling of fullness and reducing overall food consumption.
Enhancing Insulin Secretion: These medications help improve insulin sensitivity and glucose control, which is particularly beneficial for people with type 2 diabetes as well as other metabolic conditions.
Other common names for GLP-1 receptor agonists include:
Semaglutide (Wegovy, Ozempic)
Liraglutide (Saxenda, Victoza)
Exenatide (Byetta, Bydureon)
Dulaglutide (Trulicity)
Semaglutide has shown promising results in clinical trials, demonstrating significant weight loss in people with obesity or overweight, with or without type 2 diabetes. Its dual benefits of weight loss and improved glycemic control make it a valuable tool for some people.
Health Benefits Beyond Weight Loss
GLP-1 receptor agonists, such as semaglutide, can offer health benefits that extend beyond weight loss, particularly in regard to metabolic and cardiovascular health.
1) Improvement in Blood Sugar Control and Reduction in the Risk of Type 2 Diabetes
One of the most significant benefits of GLP-1 receptor agonists is their ability to enhance blood sugar control. By increasing insulin secretion in response to meals and decreasing glucagon release, these medications help stabilize blood glucose levels. This is particularly beneficial for people with type 2 diabetes or prediabetes, as it can lead to better glycemic control and potentially reduce the need for additional diabetes medications. Additionally, by aiding in weight loss and improving insulin sensitivity, GLP-1 receptor agonists may lower the risk of developing type 2 diabetes in those who are at high risk.
2) Positive Effects on Cardiovascular Health and Blood Pressure
Studies have shown that these medications can lower blood pressure and reduce the risk of major cardiovascular events, such as heart attack and stroke, in people with type 2 diabetes. The mechanisms behind these benefits include improved blood vessel function, reduced inflammation, and favorable effects on lipid profiles (i.e. lowering LDL cholesterol and increasing HDL cholesterol). These cardiovascular benefits are particularly important given the high prevalence of heart disease among people with obesity and type 2 diabetes.
3) Reduced Joint Pressure and Easier Adoption of Healthier Habits
Weight loss with GLP-1 receptor agonists can alleviate the physical burden on the body's joints, particularly in weight-bearing areas such as the knees and hips. This reduction in joint pressure can make it easier for people to engage in physical activities, leading to increased levels of exercise and physical fitness, as well as enjoyment in these activities.
4) Other Potential Health Benefits
Improved Liver Health: Weight loss and better blood sugar control can reduce the risk of non-alcoholic fatty liver disease (NAFLD) and improve liver function.
Enhanced Sleep Quality: Weight loss can lead to improvements in sleep apnea and other sleep disorders, contributing to better overall sleep quality and daytime alertness.
Reduction in Inflammation: GLP-1 receptor agonists have anti-inflammatory effects, which can reduce the risk of chronic inflammatory conditions associated with obesity, such as certain cancers and autoimmune diseases. The anti-inflammatory effects extend to the brain and even joints, easing neuroinflammation and chronic pain.
Potential Side Effects of GLP-1 Receptor Agonists
The side effects of GLP-1 receptor agonists have garnered a lot of attention lately. And unfortunately, some of that fear is misguided. While there are side effects associated with these medications, they're typically related to the dose being too high, weight loss being too rapid, or pre-existing conditions that weren't carefully attended to first.
With the right dosing, you should not experience side effects. A thoughtful provider will slowly increase the dose over time while educating you on dietary and lifestyle interventions to maximize results, reduce the risk of side effects, and optimize your health.
Common side effects include:
Gastrointestinal Issues - The most frequently reported side effects of GLP-1 receptor agonists are gastrointestinal in nature. Nausea and constipation are the most common side effects though vomiting, diarrhea, and abdominal pain have been noted. It's our advice to work on healing the gut and optimizing digestion prior to utilizing this medication.
Headache - Hydrating appropriately and adopting strategies to maintain balanced blood sugar can help reduce the frequency of headaches.
Fatigue - Losing weight, whether medication-related or not, can lead to fatigue. Again, adopting healthy habits, especially around sleep hygiene and quality nutritional intake can mitigate these effects.
Loss of Muscle Mass - Rapid weight loss tends to result in a loss of muscle mass (whether or not medication is involved). Healthy muscle is essential for maintaining a healthy weight, but it’s also important for healthy aging and longevity. Since these medications reduce appetite, it's important to be intentional about consuming adequate protein and engaging in resistance training to protect against loss of muscle mass.
In addition to the above side effects, some more serious risks should be carefully considered and discussed with your doctor before beginning these medications. These include:
Gastroparesis: One of the primary concerns of GLP-1 receptor agonists is the risk of gastroparesis or delayed gastric emptying. While yes, this is a concern, it's not nearly as common as it's been made out to be. Plus, it's transient and resolves when people go off the medication.
Pancreatitis: GLP-1 receptor agonists have been associated with an increased risk of pancreatitis, an inflammation of the pancreas. Symptoms include severe abdominal pain, nausea, and vomiting. If you suspect pancreatitis, seek immediate medical attention. But, when you rapidly lose weight, especially in the presence of poor health habits, the pancreas can take a hit. Appropriate dosing, while improving health habits can significantly reduce the risk of pancreatitis.
Thyroid Tumors: Some studies have shown an increased risk of thyroid tumors with GLP-1 receptor agonists. However, these studies were conducted on rats and have not been replicated in humans. While more research is needed, people with a personal or family history of medullary thyroid carcinoma or multiple endocrine neoplasia syndrome type 2 should avoid these medications.
Kidney Issues: There have been reports of acute kidney injury and worsening of chronic kidney disease in some people taking GLP-1 receptor agonists. However, people who reported these effects experienced severe diarrhea and vomiting which is often worse in people with underlying gastrointestinal concerns, rather than specific to the medication.
Hypoglycemia: When used in combination with other glucose-lowering medications, GLP-1 receptor agonists can increase the risk of hypoglycemia (low blood sugar). Symptoms include dizziness, sweating, confusion, and rapid heartbeat. A qualified nutrition provider can help you nourish your body well while taking these medications to avoid this side effect.
Overall, the side effects we hear about in the media are often coming from folks taking extremely high doses and/or who have not appropriately addressed underlying concerns or adopted health habits to support their goals. The side effects we've seen in practice are minimal and entirely manageable with thoughtful lifestyle and dietary interventions.
Long-Term Safety and Efficacy
GLP-1 receptor agonists, including semaglutide, have been shown to be safe and effective for long-term use in weight management. On average, participants lose about 5-10% of their body weight after 6 months, and with the right dietary and lifestyle adjustments, people can maintain this weight loss for the long haul.
However, like all weight loss interventions, the potential for weight regain exists if the medication is discontinued. Research shows that some individuals may regain a portion of the weight lost after stopping the treatment, highlighting the importance of combining medication with ongoing lifestyle changes for sustained benefits. Regular follow-ups and a comprehensive weight maintenance plan are crucial to maximize long-term success and minimize the risk of weight regain.
A Functional Nutrition Approach to Weight Loss
Before we dive into who these medications are and are not right for, we wanted to discuss our functional nutrition approach to weight loss. That’s because we do not recommend these medications unless you have considered all (lower risk) options and/or are willing to adopt the following strategies to healthily lose and maintain a healthy weight for your body.
Remember, weight loss medications are a piece of the puzzle, not the entire picture. They must be considered within a broader framework of holistic health and wellness.
Here are the steps we recommend integrating into your weight-loss journey, whether you choose to utilize medication or not.
Uncover the Root Cause: Effective weight management starts with addressing underlying factors contributing to weight gain or weight loss resistance. Poor dietary patterns, a sluggish thyroid, hormonal imbalance, nutrient deficiencies, dysregulated blood sugar, inflammation, impaired gut health, challenges in liver detox, and poor sleep quality and quantity can all affect metabolism and hinder your weight loss efforts. Simply adding a weight loss medication does not address these root causes, it merely masks them.
Optimize Nutrition: There is so much to discuss in this regard and we deeply believe that nutrition should be individualized. That being said, focusing on whole, unprocessed foods and avoiding refined sugars and carbohydrates is a great place to start for most people. Including a variety of colorful fruits and vegetables, healthy fats, and proteins at each meal helps balance blood sugar while maximizing macro and micronutrient intake. Eating nutrient-dense, balanced meals spaced evenly throughout the day helps maintain energy levels and reduce the likelihood of overeating.
Do NOT skip meals: Yes, your appetite will slow down on these medications, however it is crucial to stick with 3 meals a day around 4-6 hours apart to support your nutritional intake, energy levels, blood sugar balance. As your appetite slows, you may feel more comfortable with 4 smaller meals throughout the day - but give your body time to digest these foods optimally.
Hydrate: Just as your appetite slows, you may also forget to hydrate. Make a plan to keep this a priority. Keep a large water jug available at all times and even set reminders so you are consuming half your weight in ounces daily.
Prioritize Protein: Adequate protein intake is essential for supporting muscle mass, metabolism, and satiety. Aim for approximately 1 gram of protein per pound of ideal body weight to promote muscle protein synthesis and enhance the body's ability to burn calories effectively. Doubling down on protein is one of the most important things you can do to prevent muscle mass loss while on GLP-1 receptor agonists.
Fuel up on Fiber: Incorporating sufficient fiber into your diet helps prevent constipation and supports a healthy gut microbiome. Whole grains, fruits, vegetables, and legumes are excellent sources of dietary fiber that contribute to digestive health and overall well-being. We recommend aiming for at least 30 grams of fiber per day. Start small and incrementally increase your intake.
Adopt a Healthy Exercise Routine: Physical activity is crucial for maintaining muscle mass, enhancing metabolism, and supporting overall health. Incorporating both cardiovascular exercise and resistance training, such as weightlifting, helps burn calories, build and protect lean muscle, and improve body composition.
Set Boundaries and Expectations: Establish clear guidelines for your weight loss journey, including your tolerance for side effects, the timeframe for medication use, and expectations for weight loss goals. Regularly reassess these boundaries with your healthcare provider to ensure they align with your health objectives.
Create a Support System: Engage with a supportive network of friends, family, or a healthcare team who can encourage and motivate you throughout your weight loss journey. Accountability and emotional support can make a significant difference in long-term success (and happiness).
Plan for Long-Term Maintenance: Develop a sustainable exit strategy for when you eventually taper off weight loss medications. Use this time to really focus on adopting healthy behaviors, such as mindful eating, regular physical activity, and stress management techniques, that will help you maintain weight loss and overall health in the long run.
While weight loss medications like GLP-1 receptor agonists can jumpstart your journey to a healthier weight, they should be integrated into a comprehensive approach that addresses underlying health issues, optimizes nutrition, promotes physical activity, and fosters long-term lifestyle changes.
Who Is It For?
We cannot emphasize enough that GLP-1 receptor agonists are not right for everyone. They can certainly be a useful tool for some people, but careful consideration of the pros and cons, your mental and emotional health, body image, history, etc. are essential for determining whether this medication is right for you.
So, who would be a potential candidate for these medications? In order to have GLP-1 receptor agonists covered by insurance, you typically need to meet specific eligibility criteria, which may vary by insurance provider. Common criteria include:
Body Mass Index (BMI): A BMI of 30 or higher (classified as obese) or those with a BMI of 27 or higher (classified as overweight) who also have at least one weight-related condition, such as type 2 diabetes, hypertension, or dyslipidemia.
Previous Weight Loss Attempts: Documentation of unsuccessful attempts at weight loss through diet and exercise alone.
Medical Necessity: A healthcare provider’s determination that the medication is medically necessary for the person’s health and weight management.
That being said, just because it is available, it does not mean it’s necessarily the best choice. From our perspective, the ideal candidates would have the following characteristics:
Commitment to diet, lifestyle, and behavioral modifications. We know these medications are most effective when people are willing to adopt healthier diet, lifestyle, and mindset practices. Consider the outlined steps above and your willingness to begin integrating them into your life. If you aren’t ready to make those changes, these medications aren’t going to give you the sustainable success that you’re looking for.
Specific medical conditions such as Type 2 Diabetes, Cardiovascular Disease, Metabolic Syndrome, or PCOS.
Other weight-related health risks such as sleep apnea or osteoarthritis.
Be at least 18 years of age.
Have no contraindications for using these medications.
Diligently tried other weight-loss strategies to no avail. We prefer to try these medications after people have explored other options.
By targeting those who can benefit the most—especially those with weight-related health conditions and a commitment to lifestyle changes—these medications can provide health improvements and support long-term weight loss success.
Who Is It Not For?
This is an incredibly nuanced topic and understanding who should avoid these medications is crucial for ensuring safe and effective treatment. Some of our most pressing concerns are the ones that can’t always be “diagnosed” and fall somewhere in the gray area. Be honest with yourself about where you’re really at, physically, mentally, and emotionally and consider the following factors:
If you have a history of or an active eating disorder. If you have a history of or a current eating disorder, these medications are likely not for you. These medications affect appetite and eating behaviors and can potentially exacerbate disordered eating patterns. Plus, they cannot fix the way you see your body. If you have a negative body image, these medications can’t fix that and it’s dangerous to think otherwise. If you’ve had a history of an eating disorder but are recovered and curious about these medications, we recommend you think long and hard about them. Discussing why you want to use them with a trusted friend, family member, or therapist can help you determine if the intention is healthy or not.
If you are looking for an “easy button”, these medications are not for you. You will regain back the weight you’ve lost, and sometimes more, if you do not change your diet and lifestyle to maintain a healthy weight.
If this is the first step in your weight loss journey. We know that unwanted weight gain is a symptom of dysfunction. These medications do not address the root cause of your unwanted weight gain and can leave you searching for answers on the other end. Addressing the root cause of weight gain and adopting dietary and lifestyle strategies first, is absolutely necessary before pursuing these medications. Only once you’ve exhausted all other low-risk interventions should medication be considered.
Other, more concrete contraindications for these medications include:
A personal or family history of thyroid cancer
Pregnancy and breastfeeding
Potential Drug Interactions - particularly those that affect gastrointestinal motility or those that require precise timing of absorption.
History of Pancreatitis
History of Gastrointestinal Disease - including gastroparesis or inflammatory bowel disease (IBD).
Final Thoughts
While weight loss medications like GLP-1 receptor agonists can be a helpful tool for achieving and maintaining a healthier weight, they are not the right choice for everyone. These medications should be carefully considered and used under medical supervision, as they can pose risks that may outweigh their benefits for some people.
Remember, weight loss medications are just one tool in your toolbox. It's crucial to consult with a healthcare provider to determine if they are appropriate for your unique situation, ensuring that any intervention is part of a holistic approach to health and wellness.
*Ready to get started? Check out our Medical Weight Loss Program HERE.
*Ready to lose weight, but Semaglutide isn't for you? Check out our Functional Weight Loss Program HERE.
*Have questions? Schedule a FREE 15-Minute Consultation to discuss with our Licensed Practitioners.
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