Mindset: GLP-1 - we're doing it wrong.

Semaglutide, Ozempic, Mounjaro, oh my!

This May Surprise You

If you think this post will be shaming those taking a GLP-1 receptor agonist like Semaglutide, Ozempic, or Mounjaro (GLP-1 + GIP), you’re wrong.

Society encourages you to take a side.

1. You think these medications/peptides are a miracle.

2. You’re skeptical and may believe it’s a “lazy” way to lose weight.

A short-sighted, simplistic perspective hurts more people than it helps. Their use cannot be condensed to a viral “hot take.”

These medications should be used with consideration and caution, AND they can be incredibly helpful when used responsibly.

Even if you come to the conclusion that you’re against people using them, it’s mission-critical for society and practitioners to understand how to support people who are on them, which continues to grow by the hour.

But First, What?

Let’s quickly recap what I’m talking about.

When you eat a meal, especially one rich in fiber, protein and/or fat, your body naturally releases a hormone called GLP-1. This hormone communicates with multiple parts of your body, including your brain, pancreas, and GI tract. It has numerous actions including appetite regulation and lowering blood sugar.

However, your body’s natural production of GLP-1 and the satiety signals are short-lived (a few minutes), and some individuals are less sensitive to those signals.

A GLP-1 agonist is a medication (glucagon-like peptide 1) given orally (Rybelsus) or via subcutaneous injection (this is the most common/effective way to use it). It mimics the naturally occurring hormone in your body, amplifying the signal to your brain and gut that you’re full (amongst other things). The half-life is much longer than what your body naturally produces, so you feel full longer (days vs minutes).

GLP-1 agonists impact the body by:

• Reducing appetite due to slowing gastric emptying (food sticks around longer in your gut and the volume triggers fullness).

• Silencing “food noise” so you're thinking about food less often.

• Reducing cravings for highly processed food, sweets, and even alcohol (for some).

• Reducing calorie consumption.

• Improving blood sugar parameters.

• Supporting a significant amount of weight loss (up to 15-20% of body weight).

While there are different names for these medications, they’re ultimately the same (or very similar) branded differently depending on FDA’s approved use:

• Semaglutide, GLP-1 (Ozempic) - Type 2 Diabetes

• Semaglutide, GLP-1 (Wegovy) - Weight Loss

• Tirzepatide, GLP-1 + GIP (Mounjaro) - Type 2 Diabetes

• Tirzepatide, GLP-1 + GIP (Zepbound) - Weight Loss

*There are others, but these are the most popular versions right now.

What We’re Missing

In an effort to offer these medications to individuals quickly, per a patient’s request and/or a provider’s recommendation, we’re missing a massive piece of the puzzle.

• Weight loss doesn’t happen in a vacuum.

• Weight loss needs a team approach.

This isn’t being considered or happening in 99% of cases right now.

Here’s what I mean…

When an individual undergoes bariatric surgery (surgical weight loss), they’re offered a multidisciplinary team. The team includes providers like their surgeon, an endocrinologist specializing in obesity, a nutritionist/dietitian, a primary care physician, and a psychologist.

It’s understood that losing a significant amount of weight has implications for your health that require mental and physical support. You have time to process this change with your team for weeks or months before and after the surgery. You are told which supplements to take and advice on how to modify your diet. You talk with obesity specialists about what this change means to you and how others may treat you.

When the average person starts one of these meds, this doesn’t happen.

You may not be told:

• Lifestyle interventions to take before starting, to support your body as it loses weight

• How to support your calorie/protein intake so you don’t lose a significant % of muscle

• How to support your digestion to reduce side effects and when “common” becomes concerning

• What supplements to take to offset nutrient deficiencies

• The pros/cons of long-term use or when/how to come off of it

• That you can “micro-dose” or start at a dose lower than what’s recommended

• The benefits of being patient when you don’t see immediate results

• How your self-identity may change and how to navigate a new version of yourself

• How trauma plays a role in weight gain/loss

• How to deal with others’ criticism and judgment

Not having a team or this information sets someone up for a tough road. They may be forced to seek out information on their own (which may not be accurate), or work with a provider who doesn’t understand their concerns.

It’s Complicated

People are talking about the unknown long-term implications of using these medications, but aren’t considering the care that is needed in the short term to reduce/prevent known complications like muscle loss, isolation/guilt, and nutrient deficiencies from using this med without proper education and support.

Instead, some individuals quietly take these medications, for fear of judgment or shame. Some won’t tell their provider about concerning side effects for fear of losing access to their prescription. Some seek compounded versions from sketchy vendors because of cost or access.

This stems from societal shame, blame, lack of education/awareness, and politics.

The conversations shouldn’t be about whether or not GLP-1 receptor agonists are “good” or “bad.” A more productive conversation is about their use, because people will continue to use them regardless.

We need more education about who is a good candidate, what someone should do before taking them, and open-minded support for those using them. We need more educated practitioners who can approach patients with compassion and care.

There’s no doubt these medications CAN be game-changing for those with obesity or even conditions like PCOS that aren’t responding to other interventions.

But let’s not forget to encourage other interventions first.

Prioritizing movement, dialing in your nutrition, seeing a therapist, improving your gut health, and opening detoxification pathways are all hugely helpful before starting these medications, but we’re not talking about those. And that’s what I’m most concerned about.

So let’s talk.