I'm A Weight Loss Nurse Who Prescribes GLP-1s: What The Ozempic Conversation Is Missing
It’s hard to make it through the week without hearing someone talking about Ozempic or Wegovy for managing blood sugar and achieving weight loss. In some ways, this is great—we are finally having conversations about the previously taboo topics of weight management and obesity. On the other hand, it feels like people on these medications are dropping pounds in a way that might not be sustainable in the long run.
This is a sensitive topic, and there are many perspectives on the benefits and harms of these medications. As a functional nurse practitioner specializing in weight management, here is my take on when GLP-1s can be useful and how the medical community can leverage them in the healthiest way possible.
Some important context on GLP-1s
Medications like Ozempic or Wegovy are in a class called GLP-1, or glucagon-like peptide-1, medications. The active ingredient in Ozempic is semaglutide. Semaglutide is an incretin, a hormone produced in the gut that helps signal to your brain that you are full. Semaglutide also helps regulate the transit time in your gut; if food passes more slowly through your body, then you feel full for longer.
One myth that has been circulating around the internet is that Wegovy is more effective than Ozempic. In reality, they are the exact same. They are equally effective for weight loss at the same dosage. The thing is, until recently, Ozempic was typically prescribed at a lower dose when used for diabetes management. Wegovy, on the other hand, is prescribed with the intention of maximizing the dose to achieve optimal weight loss.
Ongoing research is also looking into new medications. One is CagriSema, which is a combination of cagrilintide and semaglutide. Cagrilintide emulates amylin3, a hormone that impacts satiety. The second is Retatrutide which is a GLP-1, gastric inhibitory polypeptide 4(GIP), and glucagon agonist. It’s similar to Mounjaro but adds a glucagon agonist, which may help people burn more calories in addition to suppressing their appetite.
A big misunderstanding about this growing class of medications is that you can take them for a while and just get off of them. Ultimately, they are more of a chronic medication and work most effectively if taken consistently, similar to an anxiety or blood pressure medication (funny how we don’t judge these!). This is important to take into account before starting these medications.
How I use them in my practice
I believe these medications certainly have a place in the weight management world. However, they must be paired with foundational nutrition, exercise, sleep, stress management, community, and mental health knowledge.
I've been practicing medicine with a focus on weight management for over seven years. I've also struggled with weight myself, so I understand what my patients are going through. I do prescribe GLP-1 medications to certain patients. However, I don't do so on their first visit. I don't withhold it, but I do make sure we have an appropriate plan of action to ensure that patients are able to not only lose weight but, more importantly, maintain it.
There is no such thing as a magic injection or pill for sustainable weight loss.
To help clients achieve long-term weight loss (that may or may not involve long-term use of medications), I always start by reviewing the importance of nutrition, exercise, mindset, stress management, community, quality sleep, and even clean water before prescribing medications.
If we choose to use a GLP-1 agonist or GIP, I always start low and slow and let the patient stay at the lowest dose as long as possible. Oftentimes, you’ll see practices going up to the highest dose right away. While this ensures quick weight loss (both muscle and fat), I find that going slow helps clients be more likely to maintain muscle mass6 as they implement new habits. This helps set them up for long-term success and even allows them to wean off medication or take it once a month in some cases.
It's also important to note that these medications are not for everybody. In my practice, I consider each client's personal history when planning a weight loss regimen. For example, I just recently saw a mom who is one year post-partum with diastasis recti. I referred her to physical therapy to get her into the right routine before making other changes. I'm not telling her to “go to the gym” and calling it a day. Her foundations are critical.
I always tell my patients that at the end of the day, they have full autonomy over their bodies. If you have obesity but are healthy and happy, you shouldn’t feel pressure to use these medications to lose weight. At the same time, those who are struggling and are suffering from health conditions secondary to obesity should not feel shame for using medication.
Very real side effects & complications we need to consider
One of the potential complications of using these medications for weight loss is the loss of lean muscle mass8. Lean muscle can be hard to regain once lost, especially as people age, potentially putting weight loss drug users at greater risk of sarcopenia9 (age-related muscle wasting). Even more concerning is the potential for loss of bone mass, which is infinitely harder to regain. According to DEXA body composition scans, up to 40% of the weight lost10 on semaglutide can be composed of lean mass (muscle, organs, and bone).
These are all reasons why it's essential to pair these medications with a holistic weight management plan. There must be a focus on maintaining lean muscle, building strength, and developing healthy eating patterns in order to feel your best.
Ozempic is also known to increase resting heart rate (an important measure of cardiovascular health) by 2-3 beats a minute, which may feel uncomfortable to some people.
Also, to be clear: these medications are for people who have obesity or type 2 diabetes. There is also some emerging research on the use of GLP-1’s for PCOS11 and heart disease. 12If you are trying to lose 10-15 lbs, the risks involved in taking these medications (particularly on bone and muscle loss) likely outweigh the benefits and ultimately could be detrimental to your metabolic health. Using these medications also requires the oversight of a qualified provider who has knowledge of this class of medications.
Despite what you've heard about Ozempic or Wegovy, there is no such thing as a magic injection or pill for sustainable weight loss. Behavior change is hard, and in order to achieve sustainable weight loss, you need to have a comprehensive plan that combines exercise, nutrition, and, in some cases, medicine. That's why I only prescribe GLP-1s in tandem with a program that is designed to set up patients for long-term health.
Editor's note: At mindbodygreen, we believe that weight loss medications should only be used after lifestyle modifications have been exhausted.
Emily Doctor, DNP is a weight management expert with over a decade of experience. She received her doctorate and masters degrees from Columbia University. Emily has worked as a nurse practitioner and clinical professor at top New York and Texas institutions, including New York Presbyterian-Columbia, NYU Langone and Memorial Hermann-Texas Medical Center. Her emphasis is always on root cause, nutrition, exercise, lifestyle, stress management and mindfulness.