Considering a weight loss injection such as Ozempic or Wegovy? As yourself these five questions first. By Claire Turnbull.
Having worked in the world of health and nutrition for over 25 years, I’ve seen all sorts of trends come and go. New food rules, lists of what to eat and avoid, miracle supplements that promise the world.
But something that has hit us hard and fast and doesn’t look like it’s going anywhere anytime soon is the rise of weight loss injections.
You've probably heard of the most common ones: Ozempic, Wegovy, Saxenda and Mounjaro. They’re all over social media, talked about on podcasts, and endorsed by high-profile celebrities like Oprah Winfrey and Serena Williams.
For some people, especially those carrying significant extra bodyweight, these medications can be incredibly helpful. They can support significant weight loss, improve blood sugar control, and reduce the risk or severity of conditions like type 2 diabetes, heart disease, and joint problems.
But they're not the quick, easy fix for weight loss I find many people think they are. There are some real pros and cons that must be, and unfortunately are often not, considered.
The rampant 'skinny pen' in the UK
This was certainly the case when I went to the UK recently and saw how far and wide these weight loss injections have spread. While lots of people are using them to assist with the management of obesity alongside chronic health conditions, I was gobsmacked by the number of people, including friends of mine, accessing injections online to lose a few kilos before a holiday or to manage an ordinary midlife increase in dress size.
The "skinny pen", as I heard people calling it, seemed to be so normalised and easily accessed that few people were stopping and thinking about the potential long-term consequences of being on the drug or what life would be like if they stop taking it.
In New Zealand, things aren’t quite so wild.
Yet.
But interest is swiftly rising as more people start taking these drugs, and we still have the opportunity to try and carefully manage how they are used.
Access to GLP-1 drugs in NZ
At the moment here, only a couple of GLP-1 drugs (dulaglutide and liraglutide) are funded, and this is only for people meeting specific criteria who have Type 2 diabetes. For those wanting to use GLP-1 drugs outside of this, they are accessible if you are able to pay yourself, typically costing around $300 to $600+ per month, depending on the medication, dose, and provider.
The World Health Organisation (WHO), however, has recently made conditional recommendations that GLP-1 drugs be used for the management of obesity, and there are currently submissions sitting with Pharmac in New Zealand requesting funding for this purpose. So, access may soon widen.
With interest peaking, new versions of these drugs in development, and production ramping up globally. This is set to become huge business. Clinics are popping up throughout New Zealand, and many medical practices are already highlighting their ability to prescribe GLP-1 drugs for those able to pay.
Some of these practices do thorough screening, have in-depth conversations about the pros and cons, and insist on people working with a dietitian or nutritionist, psychologist, and committing to strength training as part of the process.
Others, however, appear to offer a short chat and a prescription, with inadequate lifestyle guidance and ongoing support. This really concerns me, because without the right wrap-around care, you can end up in a much worse situation than when you started, especially if you suddenly cease taking the medication due to either side effects or cost.
If you are considering these medications, here are a few things to think about first.
1. Do I understand how the drugs work?
GLP-1s are powerful medications that work by mimicking hormones in your body that regulate appetite, blood sugar, and digestion. They reduce hunger, slow how quickly food leaves your stomach, and help you feel fuller for longer.
For people who feel like they constantly think about food, they are often said to reduce "food noise".
They do, however, only work for as long as you take them. When you stop, your appetite will come back and weight regain is very common.
2. Am I across the potential side effects and risks?
In the media we often see the upsides and celebrity transformations, but there are risks attached to these drugs that it's important to consider.
Firstly, the issue of body composition. When you lose weight on these drugs, it’s not just body fat that goes, you also lose muscle, and potentially bone mass too.
Research suggests that around a third of the weight loss can come from lean mass, which is significant.
The impact of this cannot be underestimated. Muscle is critical not only for strength, but for long-term joint health and metabolism.
Muscle is metabolically active tissue, meaning it burns energy even at rest. If you lose a lot of muscle and then come off the medication without changing your habits, you can end up in a worse position, regaining weight with a higher body fat percentage and lower metabolism than before.
Secondly, because these drugs impact your digestive system, people can experience nausea, vomiting, diarrhoea and constipation, especially when starting or increasing doses.
As nutrition professionals, our concern goes beyond discomfort. We are also thinking about what these drugs may be doing long-term to gut health and the microbiome, an area where research is still emerging.
Next up, because appetite is reduced, people can end up under-eating, which can lead to fatigue, low energy, and poor nutritional intake. These drugs make a large calorie deficit easy, but that doesn’t mean it’s nutritionally adequate.
If you’re not getting enough protein, fibre, omega-3 fatty acids, vitamins, and minerals, you will start to feel terrible and your health can suffer, even if your jeans are smaller. Supporting people to eat well despite low appetite and getting supplementation right is a key part of doing this safely.
There are also less talked about risks, including dehydration, gallstones, inflammation of the pancreas and sudden loss of vision.
These medications are not suitable during pregnancy, and planning is needed if you are considering having a baby. They can also affect the absorption and effectiveness of some medications, including the oral contraceptive pill and other oral medications. Particularly when starting or increasing doses.
There is also a very high chance that you may need to stay on this long term and not just for 6 or 12 months, as appetite returns once you stop taking the medications. Currently, this comes at a high cost which must be factored in before starting this medication.
3. Am I able to prioritise protein and strength training?
To help counteract muscle loss, you’ll need to be prepared to eat small, protein-rich meals, even when you don’t feel like eating.
This is something we work closely on with clients and their prescribing doctors, because if doses are too high, this can become extremely challenging. Ironically, you may need more protein than you do now, with less appetite.
Strength training is absolutely essential. I cannot emphasise this enough. Some doctors will only continue prescriptions if patients can demonstrate they are protecting muscle mass through nutrition and exercise, which is the responsible approach. Unfortunately, this isn’t always the case, so don’t assume you’ll get this support unless you seek it out.
Alongside protein, fibre and fluids are also critical to support digestion, as well as ensuring adequate intake of vitamins and minerals.
4. Have I addressed my relationship with food?
While these medications can reduce your appetite, they won’t fix your relationship with food.
If you eat because you’re stressed, tired, bored, overwhelmed, or using food as a coping tool, those patterns may pause while your appetite is suppressed, but they won’t disappear.
If you come off the medication without addressing these issues, they will likely return.
5. Are these medications appropriate for someone like me?
The recommendations from the WHO and submissions to Pharmac highlight current thinking about who these drugs are designed to be used by. That is people with a body mass index (BMI) of 30kg/m2 or more, with at least one weight-related health condition; and those with insufficiently controlled Type 2 diabetes and/or cardiovascular disease, with a BMI of 27kg/m2 or more.
For those who meet these criteria, the benefits may outweigh the risks and long-term use may be required.
For those who don’t meet these criteria and are considering them for smaller amounts of weight loss, it is essential that they carefully weigh up the risks and benefits for their individual situation.
If factors such as lifestyle, stress, poor sleep, poor nutrition, and lack of movement play a big role in your weight, these drugs may help you lose weight, but they won’t fix the underlying drivers. And if you stop the drugs, you will likely end up back where you started, potentially with less muscle and more fat which puts you at higher risk of chronic illness and health issues.
If, however, you're willing to work on your lifestyle at the same time as taking these drugs, they may be a useful tool, not necessarily to use for life, but to help support change. That means prioritising your nutrition, getting adequate sleep, doing strength training, and taking the right supplements at the same time. This is what we do day in day out at Mission Nutrition and findWellness. Our aim is to work alongside doctors who prescribe these medications to support people, both physiologically and emotionally, so they are able to get the most out of them for better long-term health and wellbeing. So, if you need more support, we are here to help.
As with any wellbeing journey, it is about working out, along with registered, qualified health professionals, what is right for you and your personal situation to make sure you are making informed decisions. But it all starts, with asking the right questions.
Claire Turnbull is a registered nutritionist with an honours degree in dietetics, a wellbeing educator and author.
SHARE ME