I’m a dietitian, and lately, I’ve seen a lot of interest in pharmacological approaches to weight loss from my patient population. Most patients fall into one of two categories — patients interested in offsetting weight gain they may have encountered after discontinuing one of these medications and patients who want these drugs’ benefits but can’t take them due to side effects or cost.
How GLP-1 agonists like Ozempic and Wegovy work to boost weight loss
The latest drugs consumers use to lose weight are called GLP-1 agonists. These medications, like Saxenda, Trulicity and Ozempic, were developed for individuals with diabetes but are now being utilized, many off-label, for their impact on weight loss. Right now, the only GLP-1 agonist approved for weight loss is Wegovy, the sister drug of Ozempic. These drugs act to suppress appetite, slow the rate at which the stomach empties and control blood sugar. Common side effects of the medication can include nausea, diarrhea, vomiting, and constipation. When you get off the drug, the fullness you felt that kept you from eating subsides. You start feeling those usual hunger pangs again, and consequently, you may start eating more to satisfy that hunger. An increase in your consumption can lead to the regaining of weight that was lost. A 2022 study found that most individuals gain weight back a year after stopping the medication.
5 ways to maintain weight after Ozempic or Wegovy
The question I am receiving from my patients is this — how do I keep the weight off and avoid putting it back on? The answer involves a proper transition from pharmacological intervention to lifestyle changes. Here’s what I advise my patients to do for a better chance at keeping weight off.
1. Moderate your carbohydrates.
The benefits seen in some of the new drugs related to weight loss include a reduction of appetite and better blood sugar control. Both may occur when modifying carbohydrates to 130g or less per day (considered a moderate carbohydrate approach). A 2017 randomized control trial found low carbohydrate approaches were more effective than low-fat diets in increasing satiety. Additionally, lower-carbohydrate strategies are effective in the management of diabetes and weight loss as well. In a sense, this dietary pattern may mimic many of the benefits seen in the pharmacological approaches without the addition of extreme restriction. Look at your dietary pattern and find your carbohydrate sources, then assess where you can find healthy reductions or alternatives. For example, if you are used to eating pretzels for a snack, consider swapping them for almonds. If your go-to breakfast is a pastry, consider switching to plain Greek yogurt with berries. If your lunch is typically a sandwich, consider swapping the bun for a cauliflower bun or low-carb tortilla. Instead of a pasta dish at dinner, think wild salmon and a side of quinoa and broccoli.
2. Make a plan to move more.
Regular physical activity is effective for the prevention of chronic conditions, better bone health and improving mental health. Physical activity after weight loss may also help in keeping that weight off. A 2017 analysis suggests that weight loss maintenance may be enhanced with moderate to vigorous activity for at least 150 minutes per week. If exercise was not a priority before, you could make it one now by starting small. Start by walking in the evenings, or take even more of a baby steps approach by simply parking further from destinations, taking stairs over elevators or using a standing desk over a sitting desk. Once your physician is on board and you’re feeling up to it, increase your intensity and time and add other activities, such as resistance training.
3. Make sleep a priority.
The latest weight loss drugs, at their core, result in a reduced consumption of food. Once off the drug, your sleep habits will play a role in keeping weight off. Skimping on sleep has been associated with weight gain and adverse blood sugar control. Lack of sleep has also been associated with an increase in hunger. Making sleep a priority is just as crucial as other lifestyle changes to keep weight gain at bay. These changes may include setting the proper temperature (experts recommend the room be between 60-67 degrees Fahrenheit, taking light sources out of the room (consider some good quality blackout shades), and turning off electronics a few hours before bed. Studies also show that keeping your sleeping hours consistent may also help you with weight management. That means, go to bed and wake up, at the time weekdays and weekends.
4. Find foods that fill you up.
There’s a reason why it’s easy to stop eating broccoli but difficult to stop eating pizza. Studies show that consumption of hyper-palatable foods can override messages in the brain that tell you you're full — as a result, you keep eating. On the opposite side of this are foods that create fullness, such as foods high in fiber (think fruits, vegetables, and whole intact grains), lean sources of protein, and healthy fats. All of these foods are associated with an increase in satiety, or fullness and satisfaction. Consuming more of these foods (and less of the junk food) may help you eat less overall. A diet that contains these full factor components is the Mediterranean diet. Studies show that the Mediterranean diet can be an effective way to lose weight and manage blood sugar.
More about Ozempic and Wegovy
- How does the drug in Ozempic and Wegovy help you lose weight?
- Is the compounded version of Ozempic safe for weight loss?
- How to eat healthy if you're losing weight with Ozempic or Wegovy
- What it feels like to take Ozempic and Wegovy: Patients share experiences with popular drug
- Is it safe to take the anti-obesity drug Wegovy long-term? Doctors weigh in
5. Focus on health, not on weight.
With all the focus on losing weight, it can be easy to forget what’s really important — your health. Physical and mental health are the key factors to living not just longer, but better. Being thin or on the lower end of the BMI chart is not a foolproof marker of good health. Prioritize numbers, like blood sugar, cholesterol and liver enzymes over the number on the scale.
Drugs that are currently being utilized for weight loss may make sense for many individuals, such as those with chronic health conditions. For everyone else who may not be able to stay on, or even start these drugs, it’s about finding alternatives. There is no one size fits all approach — find a long term dietary pattern that keeps you full, happy and satisfied.