February 8, 2024 – New and effective weight reduction medications have made a game-changer for people struggling to reduce weight obesity or who’re obese and have an associated health condition. But patients taking these medications shouldn't neglect weight-reduction plan and exercise, experts say.
In the approval of GLP-1 drugs comparable to Wegovy and Zepbound the FDA has specified that patients taking these medications also needs to eat right and exercise commonly.
Many patients receive prescriptions for these GLP-1 medications without being advised to make lifestyle changes. One reason is that the first care physicians who often prescribe the drugs aren't necessarily trained in obesity medicine and don't have the time to teach patients, said Katherine Saunders, MD, obesity expert at Weill Cornell Medicine and co-founder of Intellihealth . a software and clinical services company specializing within the treatment of obesity.
Saunders says she's seen GLP-1 drugs being prescribed “without any structure.”
“That’s problematic,” she said. “We cannot prescribe these medications in a vacuum, without education or support. We have to find out what each patient's situation is. What is his basic diet and basic exercise, what are they willing to do?”
She emphasized that obesity is a various and “complex chronic disease that requires individualized treatment. The answer is not a one-size-fits-all approach. Therefore, it is important to conduct a comprehensive assessment and design tailored treatment plans.”
Gary Foster, PhD, chief scientific officer of the favored weight-loss program WeightWatchers, agreed that GLP-1 drugs alone usually are not enough for individuals who must lose a major amount of weight.
“While these medications help people with biological problems lose weight, they cannot replace a healthy diet, increased physical activity or a change in mindset – critical components for improving mental and physical well-being and achieving long-term weight control,” he said .
WeightWatchers' recent GLP-1 program “is specifically designed to meet the unique needs of those taking a GLP-1 medication to support essential behaviors such as consuming adequate protein, choosing fruits and vegetables, maintaining… “To support hydration and the establishment of a regular activity routine.”
Many companies are stepping in
In addition to WeightWatchers and Saunders' company Intellihealth, many other organizations offer recipes for GLP-1 medications as part of a weight loss program. These include Mayo Clinic, Noom, Transcarent and Teladoc, all of which use telehealth platforms.
Mayo Clinic recently hired Amwell, a national telemedicine company, to provide GLP-1 prescriptions to qualified members of its diet clinic. If a clinic member meets the FDA qualifications – a body mass index over 30 for obese patients or a BMI over 27 for overweight people with at least one weight-related chronic condition – they can go to Amwell directly from the Mayo Diet Clinic website and schedule Make an appointment with an Amwell doctor to receive a prescription. Mayo continues to provide nutritional and other types of support to these members.
Mayo also offers support for Diet Clinic members who already have GLP-1 prescriptions, said Tara Schmidt, senior registered dietitian for Mayo Clinic Diet. The clinic's basic program includes six different meal plans, a food tracker, a barcode scanner and an exercise program. Mayo has added a seventh eating plan for people taking GLP-1 medications.
“It has a higher protein content and we made sure to consider things like managing side effects and providing adequate nutrition,” Schmidt said. “This is a volume-restricted diet with delayed gastric emptying. So instead of our usual 12 week program, the GLP-1 program lasts 24 weeks. We added 12 weeks of content about these medications.”
Diet must be tailored to both the direct and side effects of these weight loss medications, she explained.
“There are many gastrointestinal side effects of GLP-1 because it slows the rate of gastric emptying, or the rate at which food leaves the stomach. Many people experience nausea, vomiting, diarrhea and/or constipation. To ensure they get enough food, fluids and protein, we remind people that they need to drink frequently and that they may initially tolerate softer, mixed or liquid meals better than a solid meal. If they don’t drink enough fluids, they are likely to experience headaches and fatigue.”
Regular exercise is essential
It's also important to start or maintain an exercise program while taking GLP-1, she emphasized. When people go on any type of diet and lose a lot of weight, some of that lost weight is lean muscle mass. “That's why we encourage our members to do strength training – regular physical activity, including strength training – to keep up that muscle mass,” Schmidt said.
Saunders agreed that people need exercise to maintain muscle mass and overall health. She estimates that GLP-1 users can lose about a third of their muscle mass over time if they don't exercise regularly.
And when you lose muscle, “it becomes rather more difficult to keep up weight, and the metabolic effects of muscle loss can impact bone health and metabolic health. As people age, this may affect balance and make them weaker.”
WeightWatchers emphasizes the psychological aspect of weight loss.
“This [GLP-1] Medications effectively suppress appetite and reduce “food noise,” which we define as constant, intrusive thoughts about food, leading to significant weight reduction. “This means we must pay attention to proper nutrition to obtain sufficient nutrients to optimize health and well-being,” said Michelle Cardel, PhD, head of worldwide clinical research and nutrition for the corporate.
Starting and stopping medications
Despite the issue of reducing weight through weight-reduction plan and exercise alone, the Mayo Diet Clinic advises individuals who usually are not already taking medications to first try making lifestyle changes.
“GLP-1 drugs are a stepping stone, just like bariatric surgery. Start with lifestyle. If you need additional tools or support, we have other options,” said Schmidt.
Spencer Nadolsky, DO, medical director of WeightWatchers, emphasizes that the corporate's doctors only recommend GLP-1 drugs to individuals who meet FDA criteria. You can get these prescriptions after being screened for BMI suitability and contraindications to GLP-1 medications. After that, a WeightWatchers doctor can determine that a selected medication can be helpful for the patient, he said.
Experts estimate that about half of people that start taking GLP-1 drugs stop taking them inside a yr, either due to uncomfortable side effects or the price. After stopping the medication, they sometimes regain much of the load they lost. But in the event that they take part in a weight-reduction plan program, it could actually help them keep their weight down even after stopping the medication, Schmidt said.
“Your thoughts about food will probably return, and they won't be as physiological [i.e., drug] Help more. What can be helpful in any form of weight loss – or in this case, preventing weight gain – is self-monitoring, ensuring a reduced calorie diet, and maintaining self-confidence. If you step on the scale and notice a slight weight loss, you are more likely to do the same thing tomorrow.”
Still, each Schmidt and Saunders said individuals who can profit from GLP-1 drugs should take them long-term.
“We would never expect someone to take a medication for blood pressure or diabetes and stop the medication once their numbers are under control,” Saunders emphasizes. “We would say, 'The medication is working, keep taking it.'”
Even after a WeightWatchers member reaches their goal weight and switches to a maintenance dose of their weight-loss medications, “they may choose to do so [continue] with the GLP-1 program. “That's because the program is structured to promote health at every stage of weight loss,” Nadolsky said. “Maintaining the program during the maintenance phase ensures continued emphasis on essential habits, including ample protein intake, incorporating fruits and vegetables, maintaining hydration, and prioritizing daily activity – all important components for overall health.”