Navigating Weight Loss with Obesity Medications

Obesity medications — commonly known as GLP-1s (glucagon-like peptide 1 receptor agonists) and GIPs (gastric inhibitory polypeptide receptors ) — have become increasingly common in recent years. This is partly due to their effectiveness in treating multiple health conditions including Type 2 diabetes, obesity, chronic kidney disease, coronary heart disease and obstructive sleep apnea.

Who’s Eligible for Obesity Medications?

People must meet certain criteria to take obesity medications. Individuals may qualify if they have a minimum body mass index (BMI) of 27 with at least one of the following qualifying health conditions:

• Type 2 diabetes
• Prediabetes
• Hypertension
• High cholesterol
• Obstructive sleep apnea
• Cardiovascular disease

Alternatively, individuals with a BMI of 30 or greater with no additional health conditions may also be eligible for these medications. Age is another consideration. Semaglutide has been approved for patients ages 12 and older, whereas tirzepatide is approved for patients 18 and older.

Insurance companies vary on which medications are covered. Most state Medicaid plans’ coverage also vary. Some programs may require trying another medication before GLPs or GIPs can be approved. Currently, Medicare Part D will only cover these medications for a diagnosis of Type 2 diabetes.

Nutrition-Related Side Effects

The side effects from starting these medications or when increasing doses is a reason some patients decide to stop treatment. Side effects may include:

• Constipation
• Nausea
• Acid reflux or heartburn
• Diarrhea
• Low blood sugar (if taking insulin or other oral hypoglycemics)
• Muscle loss
• Increased risk of osteoporosis and osteopenia

Additionally, these medications may not be appropriate for certain individuals, for example, those with a history of pancreatitis, certain types of cancer, gastroparesis, severe inflammatory bowel disorder (IBD), Type 1 diabetes or eating disorders. Research is limited on the effect of obesity medications when pregnant or breastfeeding. These medications also have been shown to interfere with birth control, antibiotics, antidepressants and blood thinners.

A registered dietitian nutritionist (RDN) can help individuals manage these side effects, allowing patients to stay on medication longer and tolerate higher doses.

Food Choices with Weight Management Medications

Certain foods can be more difficult to tolerate when taking GLPs and GIPs. For example, foods high in fat may be more difficult to digest, especially on the day of injection. Focus on nutrient-dense food choices and limit or avoid alcohol and foods that are greasy or fried, spicy or high in added sugars.

For individuals on these medications, protein will always be a priority. Protein helps stabilize blood sugar, regulate appetite and preserve lean body mass. Recommendations for protein vary based on body weight and treatment goals. Adequate hydration also is important. An RDN can recommend appropriate foods and supplements to help you meet your needs.

Setting Expectations about GLPs and GIPs

Expectations should be discussed early in treatment. Patients with Type 2 diabetes often do not lose as much weight as those without Type 2 diabetes. This may discourage some individuals from taking their medication, regardless of glucose improvement. Cost, medication shortages or uncontrolled side effects also may cause individuals to stop taking GLP or GIPs.

Lifelong behavior and lifestyle changes are needed for long-term success. Routine meals with adequate calories, protein and fiber, and appropriate intake of vitamins and minerals, is recommended. Physical activity is important, too. Individuals should aim for 150 to 250 minutes of aerobic exercise per week with two to three days of full-body strength training.

How an RDN Can Help

An RDN may review a person's lab values and overall nutritional status by performing a Nutrition Focused Physical Exam (NFPE). The NFPE can help determine risks from fat and muscle loss and any potential nutrient deficiencies. Potential for muscle loss is a side effect that needs to be addressed early on.

Working with an RDN can help decrease chances of muscle loss and nutrient deficiencies. An RDN also can provide education and tips to help manage negative side effects of the medication.