You may have heard about the slimming injections that are rumored to be behind countless celebrity weight-loss transformations. The once-a-week injections known as glucagon-like peptide-1 (GLP-1) receptor agonists, which have been historically used to treat Type 2 Diabetes until recently, have become the darlings of the weight-loss industry. The injectables, known as Ozempic and Wegovy (semaglutide), Saxenda (liraglutide) and Mounjaro (tirzepitide) have taken off like hotcakes and for those with qualifying BMIs (30 or 27 with another weight-related concern) they’ve been a saving grace for those in a lifelong battle with the scale, sometimes even delivering the same amount of weight loss as bariatric surgery. Here’s what to know before getting started.
The main trigger for weight loss is appetite suppression
“When we look at these new classes of hormones, they’re really affecting more gut hormones,” says Chicago, IL bariatric and lifestyle specialist Neha Shah, MD. “So, these gut hormones are actually the hormones that talk to the brain and say ‘I’m hungry,’ and ‘I’m full,’ or how much insulin to secrete. So, what we’ve found is twofold: One, that the fullness and craving effect is much different with medications like this because you’re looking at the root cause, like for sweet cravings. Patients will tell me something all the time, like it’s such a feeling of fullness that for some people they’ve may have never felt before in their lives.”
You can get a prescription from a Telehealth provider
While it’s recommended to see a healthcare professional who can evaluate your health and eliminate any concern for serious risks, there are Telehealth options available such as Sequence, Push or Alpha medical who can diagnose your condition and prescribe weight loss medications such as these. “There has been a huge amount of Telehealth providers that are prescribing this medication,” says Dr. Shah who feels a Telehealth visit can’t replace the work you do with a specialist that is monitoring your case. “Like with any medication, if you don’t have support, accountability and dietary changes, then these medications are not going to be fully effective. You may not feel that a dietician can tell you something new, but you might benefit from learning from a metabolic workup. We have to rule out a thyroid condition, find out who really has diabetes, who has a vitamin deficiency, who is anemic. You don’t always get that level of analysis and support with Telehealth.”
You can’t ignore the side effects
The main side effects—which are more severe for some than others—include nausea, vomiting, gas, abdominal pain, bloating, constipation and bouts of fatigue, but they’re temporary. The biggest concern to note is the risk of thyroid cancer. “It’s not recommended for people with a personal or family history of thyroid cancer because the medication may cause thyroid tumors in some,” notes Dr. Shah.
Where you inject can help with side effects
There are three recommended places you can inject the medication into every week: the upper arms, the inner thighs or the stomach (about 4 inches away from your belly button). If you’re experiencing side effects often and for prolonged periods of time when injecting in the stomach, Dr. Shah says switch to your inner thigh which may help decrease nausea and upset stomach, but may delay slightly the onset of appetite suppression.
Your dosage will continue to increase
The first month is a loading dose to get your body used to the medicine and you will stay on that dose for four weeks. The following month you will increase to a higher dose and continue increasing every month to ensure the medication continues to work effectively. For instance, on Mounjaro, the loading dose is 2.5mg, followed by 5mg, 7.5mg, 10mg, 12.5mg and 15mg doses. However, if a dose is working and weight loss is sustained, it’s not necessary to increase it. “Generally at lower dosages, people have less severe side effects,” says Metamora, IL family medicine and obesity expert Jennah LaHood Siwak, MD, who goes by @weightdoc on TikTok. “If a dose is working for you then why increase? Also, keep in mind that the goal with GLP medications is that you may need to be on this medication long-term. If we increase you too quickly, there’s no where else to go from there.”
You’ll feel better eating a high-protein diet
To avoid many of the stomach-upsetting side effects associated with these injections, experts say your best bet is to increase your protein intake and decrease sugar, fat and carbs. “Protein helps preserve lean muscle mass,” says Dr. Siwak. “More muscle mass increases your metabolism. So, more protein, more muscle mass, faster metabolism equals more calories that you’re going to burn per day without gaining weight. There’s also something called the DIT or diet induced thermogenesis. This refers to the thermic effect of food or how much energy it takes or how many calories it takes to process that food. DIT is higher for protein than it is for carbs or fat so it is going to take your body more energy digesting protein compared to carbs or fat. Another thing that protein does is it makes you feel more full.”
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