Weight loss with Ozempic or Wegovy comes with a logical, but potentially jarring change in eating habits.
Both medications contain semaglutide, which mimics a hormone that tells the brain you’ve had a meal. Patients taking the drugs feel less hunger and they can experience side effects such as nausea, affecting how much food they can tolerate.
Jeannine DellaVecchia says she would sometimes force herself to eat when she was taking Ozempic because she would have “absolutely no appetite,” was “completely nauseous” and “vomiting all the time.”
“Some days, I would have omelets just to try to get something into me,” DellaVecchia, 40, who works for a hospital in Philadelphia, Pennsylvania, tells TODAY.com.
“You don’t feel like eating… it just wasn’t good for me.”
DellaVecchia was prescribed the Type 2 diabetes treatment Ozempic to treat symptoms related to insulin resistance caused by congenital adrenal hyperplasia and polycystic ovary syndrome. Weight loss wasn’t a priority although she says she was intrigued that the drug might also help her slim down.
It did just that, with DellaVecchia losing 30 pounds between August 2022 and February 2023, when she stopped taking the drug because she couldn’t tolerate the side effects, she says. DellaVecchia is currently still at her lowest weight of 152 pounds and trying to maintain the weight loss with a healthy diet and the help of her registered dietitian, Emily Rubin.
“I have seen patients with chronic nausea and vomiting on (semaglutide), which can cause dehydration and malnutrition if you can’t get enough calories or fluids daily,” Rubin, director of clinical dietetics in the division of gastroenterology and hepatology at Thomas Jefferson University Hospital in Philadelphia, tells TODAY.com.
How to eat while taking Ozempic and Wegovy
Wegovy, which is approved for weight loss by the U.S. Food and Drug administration, should be used in addition to a reduced calorie diet and increased physical activity, the agency notes. Ozempic is not approved for weight loss by the FDA, though many people are using it off-label for that purpose.
Patients trying to lose weight with either drug should work with a dietitian for a guided meal plan, but in general, they should aim to eat 1,200 to 1,800 calories a day depending on their initial weight, Rubin says. A rule of thumb is that eating 500 fewer calories a day than usual will lead to a weight loss of about 1 pound a week, she adds.
Eat a lot of different vegetables and healthy proteins as the foundation of your diet, advises Dr. Louis Aronne, an obesity medicine physician and director of the Comprehensive Weight Control Center at Weill Cornell Medicine and NewYork-Presbyterian.
“We’ve done studies showing that if you eat vegetables and protein first, and then have carbs towards the end of the meal, it actually is beneficial to your blood sugar, probably for your weight as well,” Aronne, who is a scientific adviser for Novo Nordisk, the company that makes Ozempic and Wegovy, tells TODAY.com.
“The cornerstone of the diet has to be real food… healthy food.”
The most ideal situation would be to commit to eating healthier food as semaglutide is reducing hunger and cravings for unhealthy options, says Dr. Zhaoping Li, professor of medicine and chief of the division of clinical nutrition at the University of California, Los Angeles.
"You can have the chance to make the right decisions — to eat good food," Li tells TODAY.com. "There’s nothing better than you not only losing weight, but also overall eating much healthier food."
For those on the drug, Rubin recommends increasing your intake of lean protein such as chicken, turkey, fish, eggs, beans, soy and low-fat dairy. If you have no appetite or nausea, try low-calorie protein drinks, she adds.
She advises a minimum of 60 grams (about 2 ounces) of protein per day, preferably spread out over meals and snacks. Protein preserves muscle mass and provides amino acids needed for growth and development, says dietitian Kristin Kirkpatrick.
Vegetables and fruits, which are full of vitamins, minerals and fiber, are essential for a healthy weight-loss program, Rubin notes. She also recommends one to two daily servings of healthy fats such as avocados, nuts and seeds.
Choose a small amount of whole grains — a half-cup serving per meal — such as whole-wheat pasta, whole-wheat tortillas, quinoa or sweet potato, Rubin advises. These are complex carbs that are high in fiber.
How to manage nausea while taking Ozempic and Wegovy
The most common side effects of Ozempic and Wegovy include nausea, diarrhea, vomiting, stomach pain and constipation, according to Novo Nordisk.
Rubin advised patients to talk to their doctor about any bothersome symptoms and discuss the best dose of each drug to minimize side effects.
Patients start with the lowest dose and gradually work their way up to higher doses, Aronne says. Doctors know how to manage the problem of nausea, he adds.
Some patients receive anti-nausea medications, but Li cautioned against taking another drug. Most anti-nausea medicines carry significant side effects, she notes.
"We call (nausea) a side effect, but truly that is how the drug could work — by making you feel you don’t want to eat," Li says.
Generally, if the dose is raised slowly and doctors advise patients to not eat past the point of fullness and to notice which foods may exacerbate their symptoms and eat less of those, the side effects are well tolerated, says Dr. Ania Jastreboff, director of weight management and obesity prevention at the Yale Stress Center in New Haven, Connecticut. She serves on the scientific advisory board for Novo Nordisk.
For example, DellaVecchia likes hoagies, but if she would try to eat one, it would make her sick, she says. A better option was yogurt with almonds, peanuts and some cinnamon, which she found delicious and filling.
Another Ozempic patient previously told TODAY.com that greasy food in general was "really hard" for her to eat after starting the medication.
Li points out that's not a bad thing.
"If they feel nauseated with high-fat food, that’s actually great, right? We don’t want saturated fat. We don’t want too much oil. That’s good," Li says.
"There are also people who feel sweets are not as enjoyable as they used to be. I would say, OK, great with that as well. If you’re not really enjoying your typical American diet — that can be either ultra-processed carbs or high-fat diet — that’s a great thing."
If a patient still experiences a lot of side effects after changing the foods they eat or how much they eat, it may be time to back down on the dose of semaglutide, Li says.
Rubin offered these tips to reduce nausea:
- Stay hydrated by drinking eight cups of fluids such as water or calorie-free electrolyte beverages per day.
- Drink ginger or peppermint tea.
- Try ginger chews or capsules.
- Eat smaller, more frequent meals.
- Don’t eat or cook strong-smelling food.
- Avoid hot, fried or greasy food.
- Don’t eat too quickly and don’t have a large drink with meals.
- Don’t lie down soon after eating.
- Don’t wear tight clothes around your waist.
Novo Nordisk had these additional tips:
- Eat bland, low-fat foods, like crackers, toast and rice.
- Eat foods that contain water, like soups and gelatin.
- Go outside for fresh air.
DellaVecchia says as soon as she stopped taking Ozempic, the hunger came back. She's been able to maintain her weight loss so far.