The Importance of Having a Dietitian on Your Side When Taking Weight Loss Medication

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There is a lot of buzz around the new drugs in town for weight loss. These medications belong to a class of drugs called GLP-1 receptor agonists (GLP-1 RA) used to treat diabetes; medications under this class include Victoza, Trulicity, Ozempic/semaglutide, Rybelsus, Wegovy and Mounjaro. Their method of action is to increase insulin release with food, slow gastric emptying, promote fullness, and suppress glucagon. 

As an RD, I am seeing patients having success with weight loss, diabetes management, improvement in insulin levels, reduced cholesterol levels, reduced blood pressure and improvements in confidence using GLP-1 RA. While these medications can help patients progress towards their health goals, it is important to be mindful of their impact on the body. Medication can be a great tool, but working with an RD to improve dietary/lifestyle behaviors in tandem with taking these medications can be really beneficial long term. 

Nutrition concerns I am seeing with these patients include:

  1. Suppressed hunger can help with reduction of calories to aid in weight loss; however, it can also lead to behaviors like skipping meals, causing inadequate nourishment and malnutrition. Missing out on important nutrients can impact our whole system: gastrointestinal tract/constipation, fatigue/energy level, bone density, strength, immunity, hair loss, sleep, and more.
  2. While losing weight rapidly might sound great, it is hard on the body. It causes metabolism to slow down, increases muscle and bone mass breakdown, makes weight harder to keep off, increases risk of gallstone formation, and leads to electrolyte imbalances and dehydration. Weight loss of no more than 0.5-2 pounds per week is much gentler on the body.

Special Considerations:

  1. If patients are breaking down their lean muscle mass stores, this will decrease the calories burned on a daily basis and slow down metabolism. Long term, this is going to make it challenging to maintain this weight loss.We know with age, muscle mass is harder to build and can impact balance/mobility. We want these patients to preserve as much lean muscle mass as possible.
  2. Long term, we do not know the impact of these medications on body dysmorphia or eating disorders due to limited studies available. Drastic changes in weight, appearance, dietary behaviors, or appetite while on the medication or when coming off the medication have the potential to greatly influence these conditions.

In short, these medications can be very helpful with progress towards health goals – specifically for folks whose weight puts them at health risks and those for whom lifestyle changes alone have not been successful. Working with an RD can help modify dietary and lifestyle behaviors alongside medication use to have long term success, muscle preservation, and create a positive relationship with food.