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Eat less and exercise more? With Ozempic, Wegovy, and Mounjaro, it’s about eating enough.

Angela Fitch
·
Apr 3, 2023
Picture of anti-obesity medication.

As an Obesity Medicine physician for over ten years and the Chief Medical Officer of knownwell, I am a strong advocate for comprehensive metabolic health programs for patients who are interested in such treatment. Prescribing across the full spectrum of anti-obesity medications, when appropriate, is often a helpful tool for patients who want to change their body size.

Anti-obesity medications

At knownwell, we believe that medication protocols need to be tailored to the individual, as the efficacy of each medication varies greatly from patient to patient. GLP-1 receptor agonists, newer co-agonists that act on GLP-1, and GIP medications (such as Ozempic, Wegovy, and Mounjaro) have become increasingly popular because they often help reduce appetite and promote feelings of fullness. When patients are strong responders to these medications, they can experience a dramatic reduction in appetite and the overall drive to eat and drink, which can lead to a decreased intake of nutrients, fluids and especially protein.

When these patients are not part of a comprehensive care model with providers who are staying close to their progress, it is easy for them to dramatically decrease their caloric intake and even go full days without eating. To make matters worse, most of these patients have been told their entire lives to simply “eat less,” so they tend to view long periods without eating as a helpful side effect. It is our responsibility as clinicians to ensure that these patients are supported in consuming the nutrition they need for overall wellbeing (which I call planned portions of plants and protein) when the sensation of hunger is suppressed.

To make matters worse, most of these patients have been told their entire lives to simply “eat less,” so they tend to view long periods without eating as a helpful side effect. It is our responsibility as clinicians to ensure that these patients are supported in consuming the nutrition they need for overall wellbeing

Why protein?

If a patient is not consuming enough protein, it can lead to several health risks. One of the most significant risks is muscle loss. When the body doesn't get enough protein, it may break down muscle tissue to obtain the amino acids needed for essential functions. Over time, this can lead to aloss of muscle mass, which can impact mobility, strength, and overall health.  Less muscle mass also means the body burns less calories at rest, which makes it harder to continue to lose weight or maintain a weight reduction.  

In addition to muscle loss, not getting enough protein can also lead to other health issues, including weakened immune function, slower wound healing, and an increased risk of fractures. Patients taking medication for obesity should be mindful of their protein intake and aim to consume enough protein to support their body's needs.

How much protein is enough?

So how much protein should a patient aim to consume? While individual protein needs may vary, the general current RDA recommendation is to aim for at least 0.8 grams of protein per kilogram of body weight. For example, a person weighing 100 kg (220 lbs) would need to consume at least 80 grams of protein per day. However, most obesity experts recommend higher amounts of protein, especially for patients who are physically active or trying to build muscle. We typically target for 1-1.5gof protein per kilogram of body weight, or an average range of 80-150g of protein per day.

To make this practical, I often recommend eating planned portions of protein every 3-4 hours, even when not “hungry.”  While this advice is counterintuitive, it is especially necessary in the early days on these medications when a patient’s body is adjusting to the treatment. Typically, this eating pattern becomes more natural over time as hunger cues readjust. I also encourage using protein supplements in the form of a protein shake, bar or soup, as these types of supplements can be easier to consume when a patient’s appetite is low.

Additional resources

A patient’s health and wellness is about a lot more than a number on a scale, and it’s imperative that we fully support patients on their path to wellness. If you are a clinician and need additional support in helping patients, consider these resources. And if you are a patient on a medication that is making it hard for you to consume enough food, please talk to your healthcare clinician or a registered dietitian. They can help you develop a personalized plan to support your health and weight management goals.

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