Taking a GLP-1 For Weight Loss? These Healthy Habits Will Help

Ozempic, Wegovy, Mounjaro (oh my). While GLP-1 agonists like these were originally used to manage type 2 diabetes or reduce the risk of heart attack or stroke, their popularity continues to rise since they were marketed as weight loss medications.

GLP-1 agonists work by triggering the pancreas to produce more insulin, which reduces blood sugar levels in those with type 2 diabetes by slowing digestion and causing someone to feel full for longer and less physically hungry. Additionally, they act on regions of the brain that process feelings of hunger, making someone less interested in eating—hence leading to weight loss.

Because of this effect on appetite, many people on these drugs also report a decrease in “food noise,” or intrusive, constant thoughts about food that disrupt day-to-day life and can make it challenging to be consistent with healthy eating behaviors.

Mary Claire Haver, MD, a board-certified OB-GYN and author of "The New Menopause," explains, "We do see they are decreasing the risk of cardiovascular disease and death from CD. We are also seeing improvement in insulin resistance and fat loss. They have been helpful for those who struggled in the past and diet and exercise didn't work.” 

While the effects of these medications can be life-changing—and even life-saving in some cases—there are still some health concerns to keep in mind. Below are some tips for nurturing your mental and physical health when taking GLP-1s. 

Go in With Realistic Expectations 

While being excited about the benefits of these medications can be motivating, it’s important to be aware of what to anticipate day-to-day. When discussing the use of the medication with your doctor, beware of what to anticipate in terms of dosing and the type of follow-up that will be involved. For example, it’s important to monitor labs to make sure that liver and kidney function are not negatively impacted. Additionally, make plans to deal with potential side effects if they do come up. 

Katelyn Miskevics, LMFT, a therapist at LifeStance Health, says, “With the recent popularity of weight loss drugs, people may think that they know what to expect based on the information they see on social media, but it's important to do your own research if considering these medications and talking with your doctor. Without this, someone might develop unrealistic expectations or find themselves comparing their journey to someone else’s.”

She also encourages being aware of mental health challenges that could come up. “Overall, significant weight loss can bring up emotions related to feeling vulnerable and exposed, along with pressure to maintain your weight, and also what may feel like an identity crisis while adjusting to a new appearance and how others may perceive you. While losing weight quickly - especially at the beginning of your journey - may offer a sense of instant gratification, but if that naturally starts to slow down over time, someone might begin to feel disappointed.” 

Molly Carmel, LCSW, a therapist and coach specializing in eating disorders and addictions, says, “I’ve personally seen a range of outcomes with GLP-1 medications." Carmel adds, “GLP-1 medications can be incredibly helpful, but it’s important to remember they’re not a magic fix. One common challenge is that people sometimes forget to focus on their overall health and nutrition while on the medication.”

Prioritize Your Mental Health 

Something that doesn’t get nearly enough airtime is that losing a lot of weight, especially in a short period of time, can have a huge impact on your mental health. Miskevics says, “There are a number of ways to support your mental health throughout this journey. First, do your research on the mechanism of how you will be losing weight, talk to your doctors and professionals, and set your personal intention as to why you want to lose weight."

"Once you begin, set realistic goals to hold yourself accountable, but have some flexibility and grace with yourself if things don’t work out exactly as you imagined," continues Miskevics. "I recommend daily journaling, ensuring you are eating healthy amounts of food and nutrients, and not fixate too much on the weight itself, but more how you feel along the way. Post-weight loss, celebrate your successes and your body for all it does for you, and don’t put too much pressure on yourself to maintain specific weight. Losing weight should be a journey that helps someone feel strong, healthy, and confident in their skin.”

While so much of the focus around these drugs in the media relates to weight loss and appearance, it’s important to remember that health is about so much more than the number on the scale. “Keep in mind,” says Miskevics, “that you will never be fully defined by your image or weight, but who you are as a person."

Optimize Nutrition

Success on a GLP-1 is not just about eating less. Yes, eating less can lead to weight loss and related benefits, but because muscle loss is a common concern on GLP-1s—as this can negatively impact metabolic health and make it easier to regain weight when you come off of the medication—nutrition and exercise play an important role in preserving muscle mass. Negative effects on bone health and malnutrition are also complications to be aware of.  

Lauren Harris-Pincus, MS, RDN, the founder of NutritionStarringYOU.com and author of "The Everything Easy Pre-Diabetes Cookbook," encourages considering lifestyle changes to support having the best experience possible on the medication. “GLP-1 agonist medications are only one tool in a much larger toolbox when it comes to treating overweight and obesity. Diet and lifestyle interventions are critical for success and to promote optimal health for those taking the medication. Simply consuming fewer calories and smaller portions of foods that are not nutrient-rich may lead to nutrient deficiencies and sacrifice muscle and bone health.”

She explains that good nutrition habits are essential for success when taking a GLP-1 medication. “The key is to minimize side effects and maximize the nutrition content of the foods you eat while maintaining a caloric deficit for weight loss. We need to make sure people meet their needs for protein, fiber, fluid, vitamins, and minerals which can be challenging with a significantly reduced appetite.” 

Pay Attention to Muscle Mass

We’re so conditioned to look at the number on the scale, but when it comes to healthy weight loss, it’s important not to lose too much muscle. While muscle weighs more than fat tissue, it’s more metabolically active, meaning it burns more calories at rest than fat does. So, the more muscle someone has, the higher their metabolism. Muscle loss is one of the main reasons why someone may find it so easy to regain weight loss on a calorie-restricted diet if they haven’t been conscious of incorporating habits to help retain muscle. 

Dr. Haver says, “When you lose weight through severe caloric restriction, about half of what you lose tends to be muscle mass.” To protect against muscle loss, Harris-Pincus recommends strength training and consuming adequate protein. “Currently, we don’t yet have official recommendations for protein needs specific to GLP-1s so we use information based on weight loss in general and bariatric surgery guidelines. I typically recommend 1.2 to 2 grams per kilogram of ideal body weight or about .7 to 1g per pound to help maintain muscle mass and hopefully gain some with the help of strength training exercises at least two times per week. For a baseline recommendation, I suggest 25 to 30 grams of protein per meal, especially breakfast.”

If you want to keep an eye on whether you’re losing mostly muscle or mostly fat, you can purchase a smart scale that tracks this information or use a scale in a gym or doctor’s office that measures body composition. This can help you spot when to make changes to your diet or exercise routine to better support muscle retention or offer you tangible insight into what’s working. 

Have a Plan for Managing Side Effects

While not everyone will experience the same side effects or to the same degree as others, it’s important to have a plan for how to manage them if they do come up. This helps reduce overwhelm and discomfort. 

Carmel adds that not everyone has a positive experience on GLP-1s. “I’ve also seen clients who were non-responders or who didn’t respond well and faced severe side effects like stomach paralysis or intense nausea, which made the medication unusable for them. There are also cases where I have seen people ignore the medication’s satiety signals and continue overeating. For those with a history of eating disorders or emotional struggles, I’ve observed new, obsessive behaviors related to weight and body image emerging.”

Harris-Pincus says, “The most common side effects include decreased appetite, nausea, constipation, diarrhea, and vomiting. In my experience, nausea is the most common and can be helped by limiting fat in meals, even the ‘good’ fats because they delay digestion even more. Constipation is also common and can be helped by meeting fiber goals of 25 to 38 grams per day along with hydrating sufficiently with approximately three quarts of fluid per day including water, coffee, tea, seltzer, and other unsweetened beverages.”

While this side effect is less frequently discussed, Dr. Haver shares, the mechanism that helps reduce food noise may also cause other changes in desires. “I’ve had a few patients who found that while on these medications, they lost interest in other pleasurable activities.” Don’t be afraid to talk about this with your healthcare provider and discuss the best approach to optimize your quality of life.  

Nurture Your Relationship With Food 

The journey of weight loss while taking a GLP-1 medication can be a great opportunity to improve your relationship with food. Miskevics explains, “GLP-1s may offer someone an opportunity to fast track their health goals, but I would encourage individuals taking them to also use that time as an opportunity to understand how their emotions correlate to their eating habits, and to see if they can develop a healthier dynamic with food. Try to focus a little bit less about the appearance aspect of losing weight, and challenge yourself to focus more on the positive changes felt: feeling more energized, better quality of life, creating a healthier mindset surrounding body image.”

Carmel adds, “There’s a saying: “If you want to know why you’re binging, stop binging.” When your appetite and impulses are better controlled, you might start to uncover underlying emotional issues. Addressing these through therapy, coaching, or support groups can really enhance the benefits of the medication and help if you decide to taper off - and decrease your desire to turn to food when you're having big emotions.” 

“With the reduction in food obsession,” says Carmel, “it’s a great time to adopt habits that support mental well-being, like meditation, journaling, and breathwork. The space created by the medication can be a wonderful opportunity for emotional healing and improving mental health.”

Don't Wait Until You're on Medication to Start Making Changes

If you’re planning to start a GLP-1 agonist medication in the near future, Dr. Haver recommends putting some healthy habits in place now. “Start looking at your protein intake. Start resistance training.” Walking really isn’t enough, she says. “If you’re sedentary, get a weighted vest, add hand weights. If you’re already working out, get more serious in the gym.

Exercises that allow you to maintain your muscle mass are critical.” She also encourages looking at other lifestyle factors. “How’s your sleep, how’s your stress reduction? These things are also critical for reaching and maintaining a healthy weight.” 

Bottom Line

Getting the support you need, making plans to manage side effects, and exploring the emotions that come up can help you have the best experience possible when using these medications on your weight loss journey. 

Carmel says, “I encourage my clients to view GLP-1s as a helpful tool and to allow them to work on building healthy habits like meal planning, getting enough protein, and strength training. The clients who succeed are the ones who use the medication to support these healthy habits, not as a means to eat what they want.”