Should you get on the Ozempic bandwagon?

Holiday weight gain hits home for many come January. These days, folks making resolutions to slim down and get fit have an increasingly popular option to consider: GLP-1s.

Use of GLP-1s, traditionally prescribed to diabetic individuals, has risen among non-diabetic people who are hoping to reach their weight loss goals.

In a Q&A with Tania Rivera, registered dietitian and associate clinical professor at the Robert Stempel College of Public Health & Social Work, she shares how having a registered dietitian on your weight loss team can help assess whether GLP-1s are right for you and guide you toward a path of sustainable health.

What are GLP-1s and how do they work?

GLP-1s, short for glucagon-like peptide-1, are hormones naturally produced in the body by the small intestine. GLP-1s manage glucose levels in the bloodstream and slow the stomach’s emptying process, which causes a feeling of fullness and triggers insulin release from the pancreas.

Popular medications, such as Ozempic, Mounjaro and Wegovy, are known as GLP-1 agonists as they mimic the natural GLP-1s produced in the body. When people are on these medications, their appetite changes and they eat a lot less.

GLP-1s have traditionally been used by diabetic individuals. However, use of these medications has risen among non-diabetic people hoping to shed a few pounds. Who is the ideal candidate for GLP-1s?

A person with a BMI over 35 and those who would like to lose more than 20 pounds is the ideal non-diabetic candidates for GLP-1s with the support of a registered dietitian. For those who want to lose less than 20 pounds, it is best for them to first work with a registered dietitian before opting for the GLP-1 route.

What we’re seeing is a growing number of people without diabetes or obesity use these drugs just for minor weight loss. These medications will need to be taken forever unless someone is willing to work with a registered dietitian along the way to change their habits and eventually get off of them.

In what ways can a registered dietitian help?

People often wrongly believe that dietitians are simply going to take away all their favorite foods. In fact, what we do is address the root cause of the weight gain, such as emotional eating, limited exercise and the consumption of ultra processed foods. Behavior change is key in this situation.

Dietitians work with clients on behavioral changes little by little. We set goals and help establish small incremental changes that can lead to big changes later, and that’s what sustains overall behavioral modification.

Someone who's already on a GLP-1 can greatly benefit from working with a registered dietitian. GLP-1s reduce food noise — a constant, obsessive chatter in the mind about food — leading individuals to eat less. This reducation in food noise creates a perfect atmosphere for the individual and the dietitian to effectively make behavior modifications and lifestyle changes. The key is to use these medications in conjunction with behavioral changes.

How long should a person on GLP-1s work with a registered dietitian?

What we've seen so far is that in about 11 months, individuals on GLP-1s experience a period of decent weight loss that then kind of tapers off. That's when people become disappointed. These medications are forever unless someone is willing to work with a registered dietitian along the way to wean themselves off. My suggestion for somebody that really needs to be on a GLP-1 would be to work with a dietitian for those 11 months. As soon as the medication results start to taper off, that individual should be ready to start decreasing their use of the medication.

What are some healthy eating habits that we should incorporate into our daily diet?

Whether you’re on a GLP-1 or not, eating a healthy, balanced diet is critical for sustainable health.

Fiber is your best friend because it’s dense. We want nutrient-dense food. I recommend a daily intake of 25-35 grams of fiber. I usually recommend a high-fiber cereal in the morning with yogurt to start your day off.

And I recommend a daily minimum of about .45 grams of protein per pound of body weight for the average person. [Simply multiple your weight in pounds by 0.45 to arrive at the total grams of protein you should aim for per day.] Getting enough protein is important to maintain muscle, especially as we age. Protein sources include lean meats, legumes and tofu. If some people aren’t meeting their protein needs, I suggest a protein smoothie. 

What are some lifestyle changes that we should adopt?

The best exercise that is easiest to implement is walking. I really encourage exercising a minimum of three times per week, at least an hour at a time. I like the idea of circuit training because it includes cardio and weights.

There are also little things we can do in our day. Taking the stairs, parking further away and taking breaks to walk around if you’re in a sedentary job. These small bouts of exercise do add up.

I also advise practicing mindful eating. I have a hunger and fullness scale, and it's like from zero to ten. I always tell people to track their hunger and fullness every hour. It should be in the middle zone. You should never be super hungry or super full. I tell people to stop and assess their hunger midway through the meal. You might not be hungry anymore. You're just eating it because it's there or you bought it. The mindful attention to hunger and fullness is another key ingredient in making a good weight loss plan.