Patients taking glucagon-like peptide 1 receptor agonists (GLP-1 RAs) can lose between 5% and 15% of their body weight, but even though weight loss is an important aspect of a healthy lifestyle, without a balanced diet and exercise, it can be easy to fall short of fitness goals.
When patients get on GLP-1 RAs, their appetites go down dramatically, and they lose weight, but they also lose muscle. Additionally, their lack of appetite can make it difficult to consume enough of the fruits, vegetables, and protein needed to meet dietary recommendations. That’s why it’s crucial for healthcare providers to counsel patients on how to stave off muscle loss and nutrient deficiencies.
Once on GLP-1 RAs, patients are much more open to making positive changes to their diet and lifestyle because they’re seeing results. The scale is finally ticking down, which provides a great opportunity for patients to be excited about making life-changing health improvements.
“Generally, people feel lighter, happier, and much more motivated once on these medications. They want to go to the gym and eat a healthy diet,” said Ziyad Al-Aly, MD, chief of research and development and GLP-1 RA expert at the Veterans Affairs St. Louis Healthcare System, St. Louis.
Educating Patients to Make Healthy Changes
Still, for many patients, education is key. It’s about finding ways to fit enough nutrients into their day. Reduced appetite can make it difficult to get enough protein, fruits, vegetables, and whole grains to avoid losing muscle mass and also get enough nutrients like iron, folate, B12, and calcium.
Clinicians should also be reminding patients of the importance of establishing a healthy diet when they’re losing weight, which is key to being able to sustain weight loss in the event they’re no longer able to take the medication or that the medication no longer works for them, said Tonya F. Turner, RDN, associate director for Clinical Services at the Medical University of South Carolina’s Weight Management Center, Charleston, South Carolina.
“Providers should be using these medications as a tool to help their patients get into good nutritional habits for the future,” said Turner.
Turner advises her patients “to be the best version of themselves” both in their weight loss and their nutrition, by using resistance training to reduce lean muscle loss and cardio to keep their hearts in good condition. Resistance is particularly important for helping to reduce the muscle loss that happens when they lose large amounts of weight.
It’s also important to note that most of the research around these weight loss medications coincides with appropriate lifestyle changes. In many cases, patients may not lose as much weight without exercise and a healthy diet, which can also be a motivating factor.
“The evidence doesn’t just apply to the drug but also includes lifestyle interventions,” said Silvana Pannain, MD, an endocrinologist and director of Chicago Weight, a multidisciplinary weight loss program at the University of Chicago Medicine, Chicago.
Keeping an Eye on Medication Dosage
It’s important for primary care physicians to keep a close eye on their patient’s medication dosage because if their appetite is too diminished, it’s much harder to eat a balanced diet, said Al-Aly. Patients should gradually go up on their dosage so they lose weight in a sustainable manner. While you can take a multivitamin as a means of safeguarding nutrition, it shouldn’t be a substitute for a healthy diet.
“You can put a band-aid on it and have them take supplements or drink protein shakes, but the better approach is to think about dosage if patients seem to be eating too few calories,” said Al-Aly. “This is a marathon, not a sprint.”
How to Fit in Healthy Changes When Appetite Is Diminished
For patients who find it difficult to fit in enough protein, fruits, and vegetables, Turner advises eating small mini meals throughout the day to sneak in nutrients and adding vegetables to soups or smoothies so that they’re easier to digest. Hydration should happen between meals because oftentimes, drinking water with meals is more likely to make you feel overly full.
Expense and location caused by food deserts can also make it difficult to have access to ample fruits and vegetables, which means having a plan in place ahead of time can help patients succeed. Talking to patients about where they grocery shop, for example, can be helpful, said Ivania Rizo, MD, director of Obesity Medicine at Boston Medical Center, Boston.
Another motivating factor, in addition to a patient’s weight loss, is that positive lifestyle changes are important to staving off some of the negative side effects that can go along with these medications.
For example, getting enough fiber in fruits, vegetables, and whole grains helps reduce the constipation that plagues some patients, said Turner. In addition, drinking water keeps food from sitting in the stomach and causing nausea and vomiting. Maintaining an active lifestyle is also key to helping the gastrointestinal system run smoothly. And drinking enough water throughout the day also helps reduce the risk for kidney stones, listed as a medication side effect.
Meeting Patients Where They Are
Regularly counseling patients on the importance of lifestyle choices has major impacts on their ability to see all the positive health outcomes beyond weight loss that go along with these medications. Lasting change is gradual, and patients aren’t always going to be perfect, “but small changes over time can make a big difference,” said Turner.
Physicians should recognize that many people have been traumatized over the years as a result of the diet culture that we live in, and it can take time to change that, said Rizo. For patients who have for years been on diets that directed them not to eat, the idea of skipping meals may seem like a good idea. Physicians need to meet patients where they are, understanding that change can take time.
“It’s about setting expectations from the start that this is not just about losing weight but also about optimizing their health,” said Rizo.