I first started writing about the increasingly popular GLP-1 receptor agonist medications (GLP-1s for short) about two years ago.
Much of what I wrote back then was informed by my time working alongside Dr. Spencer Nadolsky and a team of nutrition coaches when we were part of his online nutrition coaching program, Big Rocks.
I remain grateful for that time and those experiences to help shape the way I viewed the medications and how I view them now.
Much like I would embrace and support a client who elected to have bariatric surgery, the same applies to those who choose to take a GLP-1 to assist with fat loss.
Normally, someone must have a BMI higher than 35 to qualify for weight loss surgery if another condition is present such as diabetes or high blood pressure. If BMI is over 40, the associated condition does not need to be present.
By comparison, you can have a BMI lower than 35 to qualify for a GLP-1 but you may be limited in how you receive the medication: 27 BMI or higher with an associated condition and 30 or higher without.
This also opens up the conversation into the source of the medication.
Currently, if you wanted access to a GLP-1, you could talk to your doctor and get a prescription for the pharmaceutical grade options or there are a host of avenues if you want a compounded version of the same medication. The latter appears to be a way to receive a GLP-1 regardless of your current BMI.
That being said, the FDA is currently trying to crackdown on the compounded versions and it remains to be seen how much longer they will be available on the market.
As is the case for nutritional supplements, if there is no third party to verify what’s in the medication, you have no guarantee that what you’re taking actually has the appropriate ingredients (or hasn’t been spiked with something else altogether).
Historically, the compounded options have been more cost-effective for those looking to use them and the FDA’s actions may present issues for those who need the medications but can no longer afford them.
Arguably, the most popular form of GLP-1 on the market is semaglutide (also known as Ozempic, Wegovy and Rybelsus), however, tirzepatide (Mounjaro and Zepbound) appear to have better results with fewer negative side effects.
It’s important to note that there are more GLP-1s coming down the pipeline too. Cagrisema and retatrutide are two medications that are going to be hitting the market over the next year or two and it stands to reason that as new medications hit the market, they will likely be more powerful/effective with fewer side effects and it will bring the cost of older medications down.
As with any medication, it’s hard to know how an individual will react until they start taking it. Some people are hyper-responders and start seeing positive results at low dosages and others are slow responders and may not start seeing results until dosages are much higher.
While some degree of gastrointestinal discomfort is most commonly associated with the GLP-1s, some tips to reduce those symptoms are to eat smaller, more frequent meals, drinking enough water, and having some protein with each meal.
Headlines might scare you into thinking you might get “Ozempic face” or “Ozempic butt” but what people tend to miss is that the same aesthetic changes might also take place if someone were simply dieting aggressively and losing the same amount of weight without regard for maintenance and preservation of lean muscle mass.
On that note, it’s my strong suggestion that ANYONE who is taking a GLP-1 should also be strength training to preserve their lean muscle mass and getting in enough protein to support that goal. Unfortunately, too many people are taking the medications just to get the scale to move and they aren’t prioritizing building a stronger body and nourishing themselves with the right amounts and types of food.
While I’ve mentioned this in previous writings, I’ll mention it again here for convenience’s sake. The basic mechanism behind the GLP-1 making them so effective is that they delay gastric emptying. Phrased differently, you register fullness sooner. This sends a signal to the brain that you can stop eating when you might have normally finished the plate. As long as this process equates to an energy deficit for the day/week, the scale will respond in kind.
Some other interesting things can happen on the medications as well. I’ve worked with individuals who’ve lost or reduced many of their food/alcohol cravings. One client of mine noted that once they started the medications they no longer wanted to drink. And for those who struggle with constant “food noise”, they also report a reduction in those pervasive feelings.
All of which can help an individual adhere to a food plan allowing an energy deficit to be achieved with less effort.
So, what happens when you get off of the medications?
Well, MOST people will regain MOST of the weight they lost.
Why?
Because once the medication is out of your system, your rate of digestion goes back to normal and if there’s no “governor” to tell you when to stop eating, your hunger will then go right back to where it was prior to starting the meds.
The reality is, some people will remain sensitive to and aware of the portions and sizes they were successful with and manage their diets without the GLP-1s, but most will not.
Which is why, many responsible practitioners will tell their patients that there is a great likelihood they will remain on some dosage/type of the medication indefinitely.
I heard a coach recently make the comment that the people who are usually most critical of the usage of GLP-1s are the people who will probably never need them. While I’m sure there are exceptions to that statement, it’s also hard to argue with.
I’ve maintained a fairly simple view of this: If you knew someone had struggled with moderate to severe depression for most of their lives and the best way to give them quality of life was to find the right type and dosage of a antidepressant, you’d support that choice. I find GLP-1s to be much the same. If you knew someone had struggled with not just fat loss, but maintenance of weight lost, relentless food noise, and perhaps other conditions which could be reversed like Type II diabetes, high blood pressure, etc. and this medication allows them to live a life of higher quality, support that decision.
We all (myself included) have a very different relationship with food, with our bodies, with the gym, with what we believe our bodies “should” look and perform like and I think each person should be supported in mostly equal measure as long as it appears what they’re doing is safe.
GLP-1s aren’t going anywhere and I would imagine the next 5-10 years will be very eye-opening in terms of what’s available and what’s possible to help someone succeed with fat loss.
At the end of the day, I’ll encourage again that whether you take a GLP-1 or not, make sure you’re lifting weights, make sure you’re getting stronger, make sure you’re consuming enough protein, and make sure that somewhere in the process that you love yourself enough and respect yourself enough to make the best decisions you can.
(Photo courtesy of Haberdoedas)
