Feb. 8, 2024 — New and efficient weight reduction medication have been a recreation changer for folks with weight problems or who’re obese with a associated well being situation. However sufferers taking these medication mustn’t neglect food regimen and train, consultants say. 

In approving GLP-1 medicines resembling Wegovy and Zepbound, the FDA has specified that sufferers taking these medicines must also preserve correct vitamin and get common train. 

Many sufferers obtain prescriptions for these GLP-1 medication with out being suggested to change their life. One purpose is that the first care medical doctors who typically prescribe the medicines aren’t essentially educated in weight problems medication and lack the time to coach sufferers, mentioned Katherine Saunders, MD, an weight problems knowledgeable at Weill Cornell Drugs and a co-founder of Intellihealth, a software program and medical providers firm specializing in weight problems care.

Saunders says she has seen GLP-1 medication being prescribed “with none construction.” 

“That’s problematic,” she mentioned. “We are able to’t prescribe these medicines in a vacuum, with out schooling or help. We have now to search out out what every affected person’s state of affairs is. What’s their baseline food regimen and baseline train, what are they keen to do?”

She careworn that weight problems is a diverse and “advanced persistent illness that requires customized therapy. The reply will not be a one-size-fits-all strategy. So it’s essential to do a complete analysis and to design tailor-made therapy plans.”

Gary Foster, PhD, chief science officer of the favored weight reduction program WeightWatchers, agreed that GLP-1 medication alone will not be sufficient for individuals who have to lose a major quantity of weight. 

“Whereas these medicines help people with organic challenges in shedding pounds, they can not substitute wholesome consuming, elevated bodily exercise, or a shift in mindset –crucial elements for enhancing psychological and bodily well-being and attaining long-term weight administration,”  he mentioned. 

WeightWatchers’s new GLP-1 Program “is particularly designed to fulfill the distinctive wants of these taking a GLP-1 remedy to help important behaviors resembling consuming enough protein, choosing vegatables and fruits, sustaining hydration, and establishing a daily exercise routine.”

Many Companies Leap In 

Apart from WeightWatchers and Saunders’s agency, Intellihealth, many different organizations provide prescriptions for GLP-1 medication within the context of a weight reduction program. Amongst these are the Mayo Clinic, Noom, Transcarent, and Teladoc — all of which use telehealth platforms.

The Mayo Clinic not too long ago employed Amwell, a nationwide telemedicine agency, to offer GLP-1 prescriptions to qualifying members of its food regimen clinic. If a clinic member meets FDA {qualifications} — a physique mass index over 30 for overweight sufferers or a BMI over 27 for obese folks with at the very least one weight-related persistent situation — they will go immediately from the Mayo Weight loss plan Clinic web site to Amwell and make an appointment with an Amwell physician to get a prescription. Mayo continues to provide these members dietary and other forms of help.

Mayo additionally gives help for Weight loss plan Clinic members who have already got GLP-1 prescriptions, mentioned Tara Schmidt, lead registered dietitian for Mayo Clinic Weight loss plan. The clinic’s base program consists of six completely different meal plans, a meals tracker, a bar code scanner, and an train routine. Mayo has added a seventh meal plan designed for people who find themselves taking GLP-1 medication. 

“It’s larger in protein, and we made positive to deal with issues like managing unwanted effects and offering ample vitamin,” Schmidt mentioned. “This can be a volume-restricted food regimen with delayed gastric emptying. So as an alternative of our traditional 12-week program, the GLP-1 program lasts for twenty-four weeks. We’ve added 12 weeks of content material associated to those medicines.”

Vitamin must be calibrated to each the direct and the unwanted effects of those weight reduction medication, she defined. 

“There are a number of gastrointestinal unwanted effects with GLP-1s as a result of they delay the speed of gastric emptying, or the speed at which meals leaves the abdomen. Many individuals expertise nausea, vomiting, diarrhea, and/or constipation. To ensure they get sufficient vitamin and sufficient hydration and protein, we remind folks that they should drink incessantly and that they could tolerate softer or blended or liquid meals initially higher than they’d a stable meal. In the event that they don’t keep hydrated, they’re prone to have complications and fatigue.”

Common Train Is Important 

It is also key to begin or preserve an train program when taking GLP-1s, she careworn.  When individuals are on any form of food regimen and lose a number of weight, a part of that misplaced weight consists of lean muscle mass. “So we encourage members to do energy coaching — common bodily exercise, together with energy coaching — to retain that muscle mass,” Schmidt mentioned. 

Saunders agreed that folks want train to protect muscle mass and total well being. She estimates that GLP-1 customers can lose a few third of their muscle mass over time until they train recurrently.

And in the event you lose muscle, “it can make it a lot more durable to maintain all that weight off, and the metabolic results of dropping muscle can have implications for bone well being and metabolic well being. When folks become old, it may possibly have an effect on stability and make them weaker.”

WeightWatchers emphasizes the psychological facet of weight reduction.  

“These [GLP-1] medicines successfully lower urge for food and scale back meals ‘noise,’ which we outline as fixed, intrusive ideas about meals, leading to substantial weight reduction. This implies we now have to make sure correct vitamin to assist with getting sufficient vitamins to optimize well being and well-being,” mentioned Michelle Cardel, PhD, the agency’s head of worldwide medical analysis and vitamin. 

Beginning and Stopping Medicines

Regardless of the issue of shedding pounds by food regimen and train alone, the Mayo Weight loss plan Clinic advises individuals who aren’t but on medicines to strive way of life modification first. 

“GLP-1 medication are a stepping stone, similar to bariatric surgical procedure. Begin with way of life, and do you have to want further instruments or help, we now have different choices,” mentioned Schmidt.

Spencer Nadolsky, DO, medical director of WeightWatchers, stresses that the corporate’s clinicians suggest GLP-1 medicines solely to individuals who meet the FDA standards. They might obtain these prescriptions after being screened for BMI eligibility and contraindications for GLP-1 medication. After that, a WeightWatchers physician might decide {that a} specific remedy can be useful to the affected person, he mentioned. 

Specialists estimate that roughly half of the individuals who begin utilizing GLP-1 medication discontinue them inside a 12 months, both due to their unwanted effects or due to the fee. After they cease taking the drug, they often regain a lot of the burden they misplaced. But when they’re in a food regimen program, it may possibly assist them preserve their weight down even after they cease the remedy, Schmidt mentioned. 

“Their ideas of meals are prone to return, they usually received’t have that physiologic [i.e., drug] help anymore. What can support in any type of weight reduction — or on this case, prevention of weight regain — is to do issues like self-monitoring, ensuring that you simply keep on a calorie-restricted food regimen, and sustaining self-awareness. While you step on the size and see a little bit little bit of weight reduction, you’re extra prone to do the identical factor tomorrow.”

Nonetheless, each Schmidt and Saunders mentioned that individuals who can profit from GLP-1 medication ought to keep on them for a very long time. 

“We’d by no means count on somebody to take a drugs for blood stress or diabetes and cease the remedy as soon as their numbers are managed,” Saunders factors out. “We’d say, ‘The remedy is working, carry on taking it.’”

Even after a WeightWatchers member achieves their purpose weight and transitions to a upkeep dose of their weight reduction remedy, “they will select to [continue] with the GLP-1 program. It is because this system is structured to advertise well being at any stage of the burden loss journey,” Nadolsky mentioned. “Remaining on this system throughout upkeep ensures ongoing emphasis on important habits, together with ample protein consumption, incorporating vegatables and fruits, sustaining hydration, and prioritizing every day exercise — all essential elements for total well being.”

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