By Dr. Jamie Long
Love it or hate it, Ozempic and other GLP-1 RA medications like it (e.g., Wegovy, Mounjaro, Zepbound, etc.) are celebrated by many as one of the most groundbreaking medicines of this century. Despite the first GLP-1 RA medication (Exentide) gaining FDA approval nearly two decades ago, Ozempic and other drugs like it have become especially popular over the past few years. Many of us know someone taking it and likely with some success. As more and more people begin taking GLP-1 medications to improve health conditions such as diabetes and to lose weight, you may be asking yourself if one of these medicines is right for you.
If you’re considering a GLP-1 medication, below are some questions to ask yourself. My hope is that the questions below will help the decision making process be as thoughtful as possible. Although there are many benefits to the medicine, it doesn’t come without risks, possible side effects, and significant changes requiring your attention.
1. If you have a history of an eating disorder, have you been in recovery for an extended amount of time?
With any pursuit of intentional weight loss, comes a risk for disordered eating patterns. When there is hyper-focus on losing weight and overhauling a nutrition plan, some people can find themselves becoming overly rigid, obsessive, and restrictive. If you have a history of disordered eating patterns, it may be beneficial to have some time in recovery under your belt. If you are currently struggling with disordered eating patterns that include a strong drive for thinness and urges to restrict food intake, this medication may be contraindicated for you. I recommend discussing this decision honestly and openly with your healthcare provider.
At the same time, many individuals report that the medication has helped them with some types of disordered eating. It’s true that Ozempic and other GLP-1s are reported to reduce “food noise,” food cravings, and binge eating. And still, I recommend that you work on your relationship with food with the help of a specialized clinician (e.g., eating disorder therapist).
Food noise: Thinking about food, eating or calories in a manner that makes it difficult to concentrate on other things (e.g., working, following a conversation, etc.).
2. Are you committed to feeding yourself even when not hungry?
A very common treatment effect of GLP-1 medications is a reduction in appetite. Some individuals even report food aversion — that is, feeling repulsed by some food items. It’s possible that you could find yourself not wanting to eat or even forgetting to feed yourself. Not surprisingly, even if you have zero appetite, your body still needs fuel to operate its most basic functions. It’s not a good idea to skip meals or an entire day of nourishment. If you’re not committed to eating despite feeling nauseous, you could seriously harm yourself.
Instead, make a commitment to nourish your body and pay attention to a variety of hunger cues. Know that you may not get a traditional hunger pang signaling it’s time to eat. So, pay attention to signs of fatigue, headaches, nausea, difficulty concentrating, etc — as these too can be clues that your body needs calories. You may need to supplement meals with protein shakes, snacks, and extra fluids. It’s easy to become dehydrated and under nourished while on the drug.
3. Are you comfortable monitoring your caloric intake and weight?
If you are someone who isn’t comfortable counting calories or weighing yourself, taking a GLP-1 may be premature for you. I recommend working on increasing your ability to tolerate facing the number on the scale and your calorie consumption (in a neutral, matter-of-fact manner) before beginning a GLP-1 medication.
As mentioned above, a common treatment effect of GLP-1s is a suppressed appetite. If you only eat when you’re hungry, there’s a good chance that you will consume an insufficient amount of calories and nutrients to meet your energy needs. In order to attend to this possibility, it is important to track your food intake at least some of the time to ensure that you’re meeting your minimum energy goals (minimum calories required are often identified via a BMR calculation; consult your provider).
I don’t believe it’s necessary to track calories/food intake every day, but it is important to track food intake at least on a temporary basis until you become accustomed to this new way of eating. Then, tracking intake every now and again, in order to recalibrate your judgment so to speak, will help reduce the likelihood that you’re under eating.
Similarly, tracking your weight (either weekly or monthly, but not more often than that) can help you identify and correct weight loss trends that are in excess of what’s recommended (0.5-2 lbs/week is generally considered safe). Losing more than 2 pounds per week, can trigger numerous medical complications such as dehydration, electrolyte imbalances, gallstones, muscle loss, bone loss, and hair loss just to name a few). If rapid weight loss is caught early, you can increase your food intake or lower your medication dose so that you can resume a safe treatment plan.
4. Are you willing to reject the diet mentality?
Many people have been immersed in diet culture for years even though numerous studies show that diets fail (i.e., most dieters regain more weight than they lost, within five years). Some people fear the GLP-1 craze is just another get-skinny-at-all-costs diet industry scam.
However, GLP-1 medications are not a diet, and you don’t need to diet while on one. True, the drug manufacturers (and perhaps your prescriber) recommend reduced caloric intake and exercise while on the medication, but going on a restrictive diet is not going to serve you in the long-term.
While on the medication, this is the time to heal your relationship with food, not start another unsustainable, miserable diet! Make a commitment to engage in workable, flexible, long-lasting health promoting behaviors. This may mean that your nutrition and meal habits change, but it doesn’t mean you should go on a restrictive weight loss diet program.
5. Are you willing to work on your relationship with food, exercise, mind, and body?
Ozempic, Wegovy, Mounjaro, Zepbound and medications like it are not miracle drugs, meaning they won’t do all the work for you. They are not a cure-all medicine that will remedy the complex biological and psychological challenges that impede one’s relationship with food and body. True, these drugs are a tool that eases some of the hardships surrounding metabolic health. And still, individuals taking the medicine will need to put in effort to nourish themselves, exercise, and do the things that all humans have to do to influence their well-being. Allow the medications to be a means of assistance, and be willing to do the hard work to improve your health, holistically.
6. Are you willing to work on de-centering body size and appearance?
Your body size and shape is actually the least interesting thing about you, although societal messages may try to suggest otherwise. As a culture, we have a lot of work to do around our fear of fatness and glorification of thinness. Being in a larger body is not a death sentence and a thin body doesn’t mean it’s healthy. Bodies come in all shapes and sizes and we desperately need to normalize this fact. If your health journey is only about being thin and you are relentlessly pursuing an “ideal” body, then there’s a fair chance that you’ll hurt yourself.
Rather than center weight loss as the most important benefit of the medication, shift your attention to non-scale victories that support a personally meaningful life. Did your A1c go down? Did some inflammation decrease? Are you living with less pain? Do you have more energy and mental bandwidth to be present in other areas of your life? These are just a couple of examples of weight neutral benefits. (Note: some research suggests that many health benefits of the drugs are independent of weight loss). Try to identify several benefits of taking this medicine that don’t revolve solely around weight loss.
7. Do you have the support of a trusted provider?
Where you obtain a prescription for the medicine is important. Not all prescribers are equally invested in your well-being, and a reliable physician to monitor your physical health is critically important. Additionally, a trustworthy mental health therapist as well as a dietician (preferably both with disordered eating specialties/training) may also be really helpful as you address your relationship with food, mind, and body.
8. Have you completed a thoughtful costs/benefits analysis?
Check out my costs/benefits analysis worksheet in the download section below. You’ll notice that the handout has four quadrants in which you’ll record various pros and cons for taking the medicine vs not taking the medicine. It’s important to clarify how taking the medication might change your life. It’s also equally important to consider how not taking the medication may cost you; what risks could occur if you do; and the benefits of not taking it at all. Spend some time identifying thoughtful answers to these questions.
9. Do you have medical conditions that could be improved by the medicine?
A significant reason why these medications are so popular is because of the weight loss it causes for most people. It’s understandable how losing weight may be really important to some folks. However, there are numerous other conditions that can be improved by the drugs. Take some time to consider if your medical health could be improved by a GLP-1; this may be an another way to de-center weight loss as the ultimate driving factor.
10. Are you informed of side effects, health risks, and contraindications?
It’s estimated that approximately half of the individuals who take GLP-1s will experience side effects. The most common ones are mild experiences of nausea, diarrhea, constipation, heartburn, headaches, etc. Some people don’t experience any side effects at all, whereas others experience them so severely that it prompts discontinuation of the medicine.
Also, there are contraindications and serious health risks associated with GLP-1s. The FDA issued a warning of for thyroid/medullary thyroid cancer (MTC) and individuals who have any history or family history should not take the medicine. There’s also a possible risk of gastroparesis, renal issues, glycemic events, and pancreatic & gallbladder issues. All of these risks are very low and not statistically suggestive of causality but still warrant serious consideration between you and your prescriber.
11. Are you willing to have flexible end-goals?
If your health journey is centered around accomplishing something really specific, and you relentlessly pursuing that goal, you could seriously hurt yourself. One way to harm your health is by having rigid goal weight.
There are a lot of GLP-1 content creators on social media and several of them share a target weight to which they aspire. One person that comes to mind shared that she was three pounds from her goal weight before hitting a weight loss “plateau.” Despite already losing nearly 100 pounds, she was vocal about her disappointment and was eager to lose those last three pounds. To me, she met her goal; to her, she was failing. Sometimes we can get so fixated on a detail that we miss the bigger picture. Remember, goals are okay; rigid benchmarks may bring you unnecessary grief.
12. Are you willing to practice patience and trust the process?
If you’re following other GLP-1 users’ journeys (either online or in real life), be mindful of unfair comparisons. Know that your experience is unique to you and doesn’t need to look like someone else’s in order for it to be valid. Keep in mind that other people may see results faster but that could be because they are engaging in unsafe behaviors (e.g., extreme food intake restriction).
It’s okay to set goals, but set them gently. Focus on improving your life by increasing health promoting behaviors and let the chips fall where they may in their own time. Forcing a certain result will likely require unhealthy, obsessive, and rigid behaviors.
13. Do you have resources to attain the medication, perhaps indefinitely?
Without insurance coverage, a year’s worth of injection pens can run anywhere between $6,500 to $16,000. For the average American household, these prices are in another stratosphere. Make a thoughtful decision about the financial investment to take GLP-1 medicines. Identify your financial limits and what you may need to give up in order to pay for them. Don’t forget to account for the likelihood that these drugs may be taken long term.
14. Do you have resources to access new clothing?
When it comes to clothing sizes, a rule of thumb is that for every 10 pounds lost or gained, a new dress size is required to fit your body. The average amount of weight loss for those taking GLP-1s is around 50 pounds; that’s five different clothing sizes! In other words, it’s possible that you’ll need five different wardrobes to accommodate weight changes. The average American spends $1,500 per year in clothing. If this is multiplied by five different sizes, that equals $7,500. Of course, you may be able to spend less than that, but a clothing budget is still something to think about.
No matter what you decide, the decision is yours to make. If you’d like support around taking a GLP-1 medication, I am here to help. Reach out to schedule a phone call with me and learn more about my GLP-1 counseling services.
Download The Decisional Balance Worksheet:
