GLP—1 Agonists & Weight Management - My Approach

By now, you have probably heard of GLP-1 agonists, like the popular semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). These medications have gone beyond their traditional role in managing type 2 diabetes and are revolutionizing the world of weight management.

How GLP-1 Agonists Work

GLP-1 agonists work by mimicking the naturally occurring hormone GLP-1 (glucagon-like peptide 1), which regulates appetite and insulin. These medicines enhance feelings of fullness and slow down how fast food leaves the stomach, helping patients eat less and feel satisfied longer. Additionally, these medications have a direct effect on the brain's appetite-regulating pathways, which further help curb hunger and cravings. Most often, these medications are self-administered in a weekly injection, typically into the skin of the abdomen.

GLP-1 agonists promote weight loss by reducing caloric intake.

Research On GLP-1 Agonists and Weight Loss

Research on GLP-1 agonists for weight loss has shown very compelling results. A 2021 study of non-diabetic adults published in the New England Journal of Medicine showed that the use of weekly semaglutide in addition to lifestyle changes resulted in an average reduction in body weight of 14.9% in the semaglutide group as compared with 2.4% with placebo. A 2024 study highlighted in The Lancet examined the long-term impact of liraglutide (another GLP-1 agonist) on weight management and found that those treated with liraglutide maintained a significant reduction in body weight over a 12-month period, compared to those who received a placebo. This supports the notion that GLP-1 agonists can not only help reduce weight but also assist in maintaining these reductions long-term.

Simply put, these medications are a game-changer for the treatment of overweight and obesity.

What About Side Effects?

The most common side effects of GLP-1 agonists are gastrointestinal (nausea, vomiting, diarrhea, constipation, and more), but they typically lessen as one’s body gets used to the medication. Some patients experience dizziness and/or rapid heart rate, which may be due to dehydration. There is also the potential for more rare and serious risks like pancreatitis, gallbladder disease, kidney issues, and more. Those with a history of thyroid cancer may not be candidates for this type of medication.

My research shows that GLP-1 agonists are generally well-tolerated. Gastrointestinal side effects tend to lessen over time, and more serious side effects are possible, although rare.

GLP-1 Agonists in My Practice

With the epidemic of overweight and obesity in our country, I cannot ignore the compelling data on GLP-1 agonists and weight loss, and I have begun using these medications with my patients. That being said, I have one concern that stands out when using these medications:

RISK OF MALNUTRITION

Those using GLP-1 agonists lose weight by reducing their calorie intake, pure and simple. There is no alternative mechanism of action that burns fat directly. Reducing calorie intake too severely can lead to a variety of problems, including:

・Nutrient Deficiencies

・Altered Metabolism

・Hair Loss

・Bone Loss

・Muscle Wasting

・Hormone Imbalances

・Fatigue

・Weakened Immune System

・and more…

As an Integrative and Functional Medicine physician, nutrition is an integral part of my practice. So often, when trying to lose weight, we focus on what we shouldn’t be eating - but for optimal health and well-being, it is essential to focus on what foods our bodies need to thrive. For example, we need:

・Adequate protein for tissue repair, muscle mass, and bone health.

・Essential nutrients for thyroid health, energy production, and immune system support.

・Antioxidants to combat oxidative stress and reduce accelerated aging.

・Essential fatty acids to maintain healthy cell membranes and brain function.

To reduce the risk of malnutrition and support safe and healthy weight loss in my patients using GLP-1 agonists, I focus these four principles:

START LOW- GO SLOW

Like many other medications, I like to “start low and go slow” with GLP=1 agonists. This is especially helpful in minimizing side effects. I have found that many patients respond favorably to low doses and have no need for a higher dose. They achieve steady weight loss at a healthy pace.

Starting with lower doses helps to minimize side effects and save money!

WORK WITH A HEALTH COACH

Combining the use of GLP-1 agonists with a Health Coach Program focused on diet and lifestyle change has various benefits. We use these programs to help patients develop meal structures and schedules that work for their lifestyle and ensure adequate nutrient intake. Weekly check-ins help monitor progress and side effects and allow for precision in medication dosing. Perhaps most importantly, a health coach program dives into the WHY behind each patient’s journey—identifying roadblocks to a healthier lifestyle and outlining plans for success.

A health coach program can help support safe and healthy weight loss by focusing on proper nutrition, monitoring progress more closely, and emphasizing the importance of lasting behavior change.

FOCUS ON PROTEIN

When using these medications, it is essential to focus on adequate protein intake to avoid muscle wasting. Patients are encouraged to consume protein from a variety of healthy sources. We emphasize planning, measuring, and tracking protein intake.

Read my prior blog to learn more about how much protein you need in a day.

USE NUTRITIONAL TESTING

Knowing your nutrient needs should not be a guessing game! Comprehensive nutritional testing allows us to directly measure a variety of vitamins and minerals, essential fatty acids, amino acids (the building blocks of protein), antioxidants, and more. Repeat testing after a significant weight loss allows us to identify areas of need and adjust dietary intake and nutritional supplements with precision.

Learn more about Comprehensive Nutritional Testing commonly used in my practice.

Are you interested in learning more about a healthy, individualized approach to weight loss? As a board-certified Integrative & Functional Medicine physician, I can help! I specialize in optimal health and wellness, focusing on hormone balance, thyroid optimization, gut health, customized nutritional supplements, cardiometabolic health, and more.

Contact us to schedule an appointment or learn more.