Two dietitians' very different experiences on GLP-1 medications

Experiences often vary while taking GLP-1s. Watching others on social media has made many question their own results. “Should I be losing 5, 10, or 20 lbs a month?!” We talked with two of our Registered Dietitians, Cristina and Summer, who are both taking the same GLP-1 medication, but have two unique experiences.

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‍When did you make the decision to start a GLP-1? Why?

• Cristina: I decided to begin a GLP-1 in April 2022. At the time, I worked as a dietitian in a bariatric surgery and medical weight loss clinic. As a dietitian, I always felt a little embarrassed about my weight. I had lost weight several times in my life, but I was never able to keep it off over time due to my appetite and intense cravings. One day in the clinic, a patient who had just begun Wegovy said to me “I never knew what being full felt like until I started this medication. It is life-changing.” Later that day another patient said something to the same effect. Although I had all the tools at my fingertips, I never considered medication for myself until this point. That day I talked to our clinician about starting a GLP-1 for myself. 
• Summer: I’ve struggled with my weight - more specifically a very large insatiable appetite - my entire life. I had lost and gained weight many times over from the age of 16 and went to school to become a Dietitian in an effort to find some solutions to my nutrition struggles. While I was mostly successful in losing 100 lbs from my heaviest and maintaining this for a long time, I would always get “stuck” at a weight just above the overweight range. Despite all my best efforts doing all the things, I was frustrated. I built an online relationship with Dr. Spencer Nadolsky years ago, discussing nutrition on Twitter, and always trusted his insights. So, when he shared about Sequence, GLP-1’s and his patient’s experiences on the medication, something clicked! I started Mounjaro off-label for obesity in September of 2022 and have since lost 45 lbs over about 6 months to achieve a normal BMI for the first time in my adult life. I was a member of Sequence for about a month before I asked Dr. Spencer if they were hiring Dietitians - and here we are now! 

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What does it feel like to be on a GLP-1?

• Cristina: It feels freeing and like I am in control of my choices. For me, I don’t get overwhelming feelings of fullness after a small portion, but I am full after an appropriate portion, and I am able to stop eating without wanting more. I portion my plate appropriately and I typically don’t eat until the next meal. Prior to a GLP-1, I would be hungry every 2 hours and never fully satisfied after a meal. On top of that, my cravings are much more controlled. At times, before using a GLP-1, I would have such strong cravings that I would run out after dinner to satisfy it. Now, I rarely crave higher fat or more indulgent foods, but when I do, I am able to have a small portion and move on. I often find myself craving things like fresh mediterranean cuisine and greek salads. 
• Summer: The experience of starting a GLP-1 medication has been absolutely life-changing. I don’t think I even realized how much my thoughts and obsessions with food consumed my brain! It makes so much sense to me in retrospect looking at past weight loss attempts that would always be sidetracked by an unrelenting hunger, even if the meal plan was filling! Now, when I eat reasonably balanced meals throughout the day, I actually feel full and satisfied. I do still have what now feels like a normal appetite and feel like I am able to eat according to my best intentions without being sidetracked by cravings, snacks, or any desire to binge. I can push food away at a restaurant without cleaning the plate. I no longer reach to finish my kids' chicken tenders. I no longer feel called to pull into fast food drive-thrus. Even when eating foods that would previously be an issue - like cookies for example - I am much more satisfied with just one. 

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Have you had side effects?

• Cristina: I was very worried about side effects, so I increased slowly. However, I had minimal side effects that included very mild nausea 1-2 days after my injections and mild constipation in the first 3 months of starting the medication. I dealt with the nausea by having a high protein breakfast and a cold sandwich for lunch. The constipation resolved on its own, but I did focus on increasing my fluid and fiber intake.
• Summer: The first month or so I would say that I had some constipation, but I have since been able to manage this with a nightly routine of Magnesium Gummies and a packet of Miralax every third day or so. I do also remember in the beginning feeling some nausea when I would try to eat very high fat foods or drink a protein shake too quickly, but that has since gone away. 

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Did you lose weight right away?

• Cristina: I maintained my current weight with small fluctuations for the first three months after starting medication. I also did not notice much of a difference in my appetite until I reached a higher dose in my fourth month, which is when my weight loss became more consistent at about 1-1.5 lbs lost per week.
• Summer: I did yes, pretty quickly actually. I had to make a strong effort to make sure I was eating enough. I did also find that the medication gave me so much mental space that I felt more energetic and alert, and so I channeled that energy into more exercise as well! My weight loss would stall occasionally for a week or so along this journey which was usually my cue that it was time to increase my dosing. I’m thrilled with my rate of weight loss (which averaged about 1-2lbs per week) - it’s the first time in my life I've been able to lose weight consistently over months without “falling off the wagon”. 

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Are you still hungry?

• Cristina: Yes, I still have regular hunger cues and know when I have not eaten enough or need to eat. The first 1-2 days after an injection, I do not feel hungry for breakfast, but I still eat breakfast to set myself up for success later in the day. Other mornings I wake up with my stomach growling and ready to eat. My hunger is now much more manageable and is more easily satisfied.
• Summer: It depends. In the 1-2 days after my weekly injection, I would say that my appetite is at its lowest, although I am still able to eat my three balanced meals per day. On days where I’m more active or stressed or closer to my monthly cycle, I am more hungry as well - which is honestly normal for humans and not something that I let cause me concern. I do make sure I never skip breakfast, which definitely helps me avoid feeling snacky later in the day. 

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Do you still have cravings?

• Cristina: Yup! I regularly have cravings, but they easily pass and are no longer extreme. Previously, I was unable to get cravings out of my mind and had a difficult time controlling my portions of my favorite foods. Pizza was my favorite- but now, I can have 1-2 small slices of pizza with a salad and be completely satisfied.
• Summer: Absolutely! I love delicious food! And sometimes I get an idea that something sounds good so I will make a plan to fit it into my weekly menu. I’m less likely to act immediately on my cravings in a way that feels out of control because I know I can make any and all foods fit in a balanced and moderated way at any time. I also find that I am satisfied with a small portion of a treat for fun food whereas before I would eat much much more in one sitting. 

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Did you change your diet?

• Cristina: Overall, the components of my diet did not change much, but that is because I was already cooking balanced meals and snacks. What did change was my portion sizes, satisfaction with the portion I served myself, not having seconds, reduced evening snacking and number of cravings that were given into which led to a reduction in calories for weight loss.
• Summer: Obviously I’m eating fewer total calories than I was before to achieve weight loss - but the main structure of my main meals and foods have generally stayed the same. Eating lower fat, I think,  would be the biggest change. I would say that I am also eating somewhat smaller portions, prioritizing protein, and eating a lot of vegetables much more consistently. I’m having much fewer “eff it” days. I am not consuming any unplanned snacks. I find myself happy with less frequent and smaller restaurant meals and much less alcohol too, especially on weekends.

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Has your weight loss stalled?

• Cristina: Yes, I have experienced stalls a few times over the last year. Often it was from busyness in my life related to traveling and socializing that increased dining out and alcohol intake. When I hit a stall, I focus on the basics of protein and fluids and reduce dining out.
• Summer: Yes but they are usually short-lived if I just stick to my good basic habits. I try really hard not to get too focused on the number on the scale, especially during a stall. I like to reflect on non-scale victories and how I’m feeling to help me know If I’m engaging in the health behaviors I know I need. 

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Do you plan to continue your medication long-term? 

• Cristina: Hopefully! As long as my insurance covers the medication and I am able to afford it, I would like to continue medication long-term for maintenance and disease prevention later in life.
• Summer: I hope so! Of course, this requires continued affordability but I find my medication to be so important for both my physical and mental health that I hope to be on it for the rest of my life

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Maybe their experiences aren’t so different after all! When looking at the big picture, both Summer and Cristina have had great success utilizing a GLP-1 for weight management. While their journeys there may have been different, they both experienced a reduction in hunger and cravings along with major improvements in their physical and mental health. They would agree that this medication has changed their lives for the better and that it’s important to look at the big picture as opposed to comparing your journey to someone else’s. 

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