Disclaimer: This is not medical advice, you need to work with your provider because taking medications is very serious and for most people this is a lifelong medication.
Endocrinologists are referring us patients who are taking one of the weekly weight loss injections of Ozempic, Wegovy or Mounjaro. They all work by simultaneously slowing digestion, increasing insulin secretion by the pancreas, increasing insulin sensitivity, and mimicking the appetite-suppressing hormone GLP-1. Mounjaro is a little different since this medication also targets a second type of hormone receptor (GPI).
Zepbound (Mounjaro) has just been approved by the FDA for weight loss without a Type 2 Diabetes diagnosis. For insurance purposes, you have to have a BMI greater than 30 or a BMI over 27 with another medical condition such as Type 2 diabetes, high blood pressure, heart disease, etc.
Much of the commentary on these drugs is raising the question of whether they will be abused as a “quick fix” for quick weight loss as an “easy way out”. Our clients know that there is never any judgment or shame in our working relationship together. We are seeing that these medications can be extremely beneficial for patients who have exhausted all options including lifestyle changes and regular exercise but still have no improvements in their A1c, blood sugar, insulin levels, or inflammation in their body.
There are potential dangers and side effects of these drugs. Side effects of these medications include nausea/vomiting, dyspepsia, constipation, abdominal pain, and other GI issues. Not everyone experiences these side effects, but they are very real and should seriously be taken into consideration when deciding to start these meds. We can teach you how there are ways to mitigate the side effects, such as adequate hydration, sleep and adequate protein intake.
TIPS
1. Lack of adequate hydration may cause you to need an electrolyte packet to add to water every day since with eating less people are not drinking enough water.
2. Recommended to eat one hour after waking and then every 3-4 hours because you cannot physically intake the same amount of food because food does not move through you the same way that it did before. The concern we have with all of our clients is that undereating is almost guaranteed if you are not paying attention to your food intake. Most people when they start taking these meds can go all day without eating and that is so unhealthy and is not what these medications are meant to do. You can still eat an appropriate amount of food and experience the benefits with these medications.
3. Patients taking these medications are prioritizing the wrong kind of food intake. While on these meds it is tough to tolerate super high fat, fried foods and alcohol consumption. You must focus on the nutrition value of food because you cannot eat the same amount in a sitting anymore.
4. We see significant muscle loss with patients on these weight loss meds so it is crucial to ensure you are focusing on your protein intake and eating enough because muscle loss happens so much faster while taking these medications. Do not use these drugs as a magic pill to starve yourself and under-eat.
Jackie RD was working with a 30-year-old woman with insulin-resistant polycystic ovary syndrome (PCOS) experiencing extreme amounts of pain, major swelling in her hands and horrible joint pain. We want to see a fasting insulin level of less than 4 while this patient’s fasting insulin level was at 30. She had been diagnosed with insulin resistant PCOS since she was 13 years old and had tried all of the possible lifestyle changes in the book. Nothing was helping! This is unfortunately very commonly seen in patients with insulin resistant PCOS.
This patient was not solely concerned about her weight; she was more focused on improving her fasting insulin lab levels, to get rid of her excruciating pain and swelling. As a dietitian, we are not able to prescribe medications but since all her prior steps were exhausted we decided to recommend a weight loss medication because we wanted to encourage what is best for the people that we counsel. We did ensure she was aware of the side effects and the importance of preventing undereating and adequate hydration while on Mounjaro to help avoid those side effects. This patient could not even bend her toes and guess what!? After starting Mounjaro, she can now bend her toes! Her insulin levels started to come down and weight started to come off while her joint pain was subsiding. This patient eventually dropped back down to the 2.5 mg Mounjaro dose for maintenance to ensure the least amount of side effects.
If you feel you have exhausted every option for weight loss, consider talking to your doctor and we can work together.
Nutritional counseling is usually covered by health insurance including ABMG, Aetna, Blue Cross, Blue Shield, Cigna, CCHP, Hill, Sutter, UHC, UMR and others. We are happy to call on your behalf and see what your policy covers or nutrition. Please visit www.LindaRD.com to learn more about our services. Email lifeweight1@yahoo.com or call at 925-855-0150 to discuss your nutritional concerns and see how we can help you.