MedCity Influencers, BioPharma

Are Registered Dietitians the Key To Optimizing Weight Loss With GLP-1s?

Prescriptions for GLP-1s are soaring, but fewer than a third of people prescribed the costly drugs will continue taking them one year later without personalized support. Without the expert guidance of a registered dietitian, you risk not achieving the significant clinical benefits these drugs offer and forfeiting the potential for sustainable, transformative health outcomes.

Enormously popular weight loss medications like Wegovy, Saxenda, and the new Zepbound are full of promise. Promoting an average of 18% weight loss in clinical trials, GLP-1(glucagon-like peptide 1) agonists help control blood sugar and may even lower the risk of heart disease. But as amazing as these wonder drugs are, they can’t make up for a poor diet — and they don’t come without risk.

Many of us have heard the scary reports of GLP-1-induced stomach paralysis and pancreatitis. Though those occurrences are rare, more common side effects like loss of appetite, nausea, and diarrhea can cause discomfort and even malnutrition if not managed well. With pricey GLP-1 prescriptions skyrocketing at a rate of over 250% and yet, one-year adherence to the drugs at only 27%, we risk one of the biggest healthcare wastage crises of our time. If people are going to go on these drugs, we must do more to help them succeed.

The best way to avoid GLP-1 cost losses is to set people up for success with proper support from registered dietitians. Dietitians can prevent malnutrition, help patients handle side effects, manage expectations for weight loss goals, and design well-balanced eating plans to help people lose weight in a healthy, sustainable way.

In order to optimize results, we have to understand how these drugs work. GLP-1s reduce appetite and feelings of hunger, increase feelings of fullness after eating, and even reduce cravings for fatty, energy-dense foods. These factors make it easier for someone to quiet the “food noise”  in their head (constantly thinking about what to eat next), and focus on more productive thinking patterns and behaviors to create a healthier lifestyle. But sometimes that lack of “food noise” goes too far and contributes to a complete loss of appetite that leads to malnutrition.

Prevent malnutrition

Though it may seem counterintuitive, malnutrition is fairly common in those with obesity, and taking GLP-1s can exacerbate that risk. Malnutrition from chronically low food intake, or even common side effects like nausea and vomiting, can lead to serious complications. It may start with hair loss, fatigue, low energy levels, poor concentration, inability to regulate body temperature, and reduced ability to perform everyday tasks. But those can escalate to vitamin and mineral deficiencies, a compromised metabolic state, and an increased risk of infection.

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A Deep-dive Into Specialty Pharma

A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.

Dietitians can help prevent malnutrition by designing healthy eating plans and encouraging people to undergo regular health check-ups and lab tests to monitor nutrient levels and overall health. They’re also skilled at picking up on physical signs of malnutrition and quickly intervene if any deficiencies or imbalances are suspected.

Help manage side effects 

Over 50% of people taking GLP-1s feel nausea, 19% experience vomiting, and 21% get diarrhea. (However, these side effects tend to improve over time.) Persistent nausea, vomiting, and diarrhea can make it hard to tolerate food, causing dehydration and too much weight loss over a short period. Many people go off the drugs because they just can’t tolerate the side effects.

Dietitians, however, can help people manage those side effects by carefully timing meals, measuring portion sizes, and suggesting nutrient-dense foods that are easier to tolerate. They also provide moral support to people dealing with those uncomfortable side effects and major lifestyle changes.

Set reasonable weight loss goals

Unrealistic expectations for fast weight loss don’t help anyone. Dietitians can help manage expectations and keep people within healthy ranges of 0.5%- 1.0% per week of initial weight. For someone who weighs 200 pounds, that’s one to two pounds per week. Also, a reasonable goal of 5% weight loss at 12 weeks is associated with improved health biomarkers like lipid levels, blood pressure, and A1C.

While big weight loss averages of 20% are exciting, we can lose sight of the end goal of better overall health. Maintaining a well-balanced diet with a reasonable calorie restriction when on GLP-1s is essential for physical health and weight loss success.

Design well-balanced eating plans 

Practicing medical nutritional therapy, dietitians can design personalized nutrition plans to meet unique health needs and support weight loss goals. They’ll take a patient’s food tolerances and cultural food preferences into account, tailoring eating plans that work for a patient’s changing needs as medications are titrated.

Dietitians also provide behavioral counseling and support to help people develop healthy eating habits and make sustainable lifestyle changes. This support is critical for long-term success in managing weight and avoiding malnutrition.

It’s not worth the risk

Registered dietitians play a pivotal role in guaranteeing that those taking GLP-1s effectively manage side effects and get the essential nutrients required for optimal health. By implementing tailor-made nutrition strategies, diligent monitoring, comprehensive education, and intensive behavioral support, dietitians empower individuals to not only reach their clinical weight loss goals but sustain them, too.

Finally, to ensure that the substantial investment in GLP-1 medications yields their full potential, keep this in mind: Without the expert guidance of a registered dietitian, you risk not achieving the significant clinical benefits these drugs offer and forfeiting the potential for sustainable, transformative health outcomes.

Photo: fcafotodigital, Getty Images

Gretchen Zimmermann is VP of Clinical Strategy at Vida Health.

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