The Ozempic Era - Part One
Avoiding malnutrition during and after treatment.
Preface
I wrote this article for one reason; to help people undergoing prescription weight loss treatment have the healthiest experiences and most successful outcomes. I want you to lose weight in a healthy manner, while avoiding an all too common side effect; malnutrition.
These treatments are rapidly increasing in popularity, but they aren’t without their pitfalls. However, these pitfalls that can be avoided rather easily and I’m going to explain how.
This article will make you aware of and teach you things that your doctor most likely won’t; but they should. Let’s do this!
What is Weight Loss Dieting?
The most basic goals of dieting are weight loss, weight maintenance, and weight gain. The most basic strategies for these goals are maintaining a caloric deficit (weight loss), eating at caloric maintenance (weight maintenance), and maintaining a caloric surplus (weight gain).
Putting two and two together, it’s reasonable to say that weight loss drugs are taken by those needing help in maintaining a caloric deficit, so let’s focus on that one.
In my opinion, the most challenging part of maintaining a caloric deficit is the hunger that naturally comes with it.
While in a conservative caloric deficit, hunger will present itself from time to time throughout each day. This is normal, and it’s not a bad thing when weight loss is the goal, but it’s still a feeling we’re inherently programmed to avoid.
Some people can embrace these temporary periods of hunger and view them as confirmation that they’re in a caloric deficit. Personally, when I’m maintaining a deficit, and hunger strikes, I view it as a confirmation that I’m actively burning fat in that moment. Is that 100% true? Not necessarily, but it’s my way of turning an inherently unfavorable feeling into a positive and it works very well for me.
Truthfully, a conservative caloric deficit, producing mild hunger from time to time, is the foundation of a healthy muscle-retaining weight loss approach.
I also feel obligated to mention that it’s unhealthy and a sign of under-eating if you’re hungry all the time.
Here’s the other side of the coin; just like some people build and possess the discipline and willpower to maintain a caloric deficit on their own, for a multitude of reasons, some people don’t. Up until now, these people commonly sought out hit-or-miss natural appetite suppressants, stimulant-filled so-called fat-burning pills, and the latest over-hyped miracle diet.
Unfortunately, herbal suppressants don’t work very well, fat-burning pills only work when the person taking them is in a caloric deficit (the state they struggle to maintain in the first place), and miracle diets also only work when the user is in a caloric deficit (again, they struggle to maintain this on their own). With these three common fixes coming up short, are these people simply out of luck?
A New Era in Dieting
There used to be no magic pill for weight loss, but this is no longer the case.
Enter the era of Ozempic, Wegovy, and other weight loss drugs that actually work.
Explaining the primary appetite control and glucose (blood sugar) regulation mechanisms through which these drugs work would require a whole book. Don’t worry, I’m not interested in boring you with technical mumbo jumbo. Instead, here’s the cliff notes version for Ozempic, which is hugely popular today:
Ozempic’s active ingredient is semaglutide, which mimics a naturally occurring hormone known as glucagon-like peptide-1, or GLP-1.
GLP-1 interacts with the brain and reduces hunger, causes the sensation of feeling full, and promotes satiety. The result; decreased calorie consumption made easy.
Ozempic slows the digestion process, resulting in feeling fuller for a longer period of time. Naturally, this decreases how often a person eats, reducing total daily calorie consumption.
Ozempic improves pancreatic insulin secretion, promoting more stable blood sugar levels. The result is a decrease in cravings for those hyper-palatable high-sugar/high-fat/high-calorie foods. Of course, this decreases calorie consumption overall.
Do you notice the common result of each mechanism? If you said ‘decreases calorie consumption,’ you’re correct. This decrease results in a calorie deficit, which results in weight loss.
In even more of a summary, let’s say the cliff notes of the cliff notes, drugs like Ozempic decrease the feeling of hunger, literally make you eat less often through slowed digestion, and blunt cravings for high-calorie junk foods. You become an adherence superhuman.
The Adherence Spectrum
Alright, I need to talk about this ‘adherence superhuman’ title I just threw out there and the concept of an adherence spectrum is how I’ll do it. The idea of the adherence spectrum came to me during my last training session. I had recently made this post on my FB page, so weight loss drug thoughts were circling in my head.
As I finished a set of pull-ups, the spectrum concept manifested itself and I couldn’t let it go. I need to share it with you, as I think it’s a great way to visually make my points on these drugs, superhuman adherence, the dangers that come with superhuman adherence, and my solution to avoid those dangers. Here goes nothing!
What is adherence? In the context of this article, particularly dieting, adherence is ‘the act of doing what is required by a rule or belief. For example, you might adhere to a diet, school rules, or religious laws.’
Adherence to a caloric deficit diet is very challenging for some people due to reasons such as, but not limited to:
Needing to avoid the discomfort of hunger
Temptation and pressure due to food being present during so many social activities
Emotional attachment to food
Using food for comfort
Lack of motivation, dedication, and/or willpower.
Whatever the reason(s) may be, it’s no secret that people struggle with caloric deficit adherence and it prevents them from losing weight. People who fit into this demographic represent one end of the adherence spectrum.
The middle of the spectrum belongs to people who do not require the assistance of medication to adhere to a caloric deficit. These people generally possess these traits:
They maintain a healthy relationship with food
They’re able to will themselves through the discomfort of hunger
They’re able to manage food intake and portioning in and out of their comfort zone/home setting.
They’re knowledgable in the topics of calories, macronutrients, micronutrients, and food types.
Prior to the Ozempic Era, this demographic used to occupy the other end of the spectrum. The two ends of the spectrum were as simple as those who could adhere to a caloric deficit and those who couldn’t.
In those days, everyone wanted to believe magic weight loss pills existed, but they didn’t. They were a fairy tale then, but they’re a reality now. The spectrum has changed!
The people who don’t require medication to stick to their caloric deficit got bumped to the middle, while those on weight loss prescriptions, such as Ozempic or Wegovy, took their spot. Natural adherers are no longer the top dogs because the superhuman adherers have entered the building.
Now that we’ve reviewed what the adherence spectrum once was and has presently become, I’ll outline the attributes of each demographic.
Those who struggle to adhere to a caloric deficit and find themselves repeatedly failing in their weight loss endeavors experience:
Lack of maintained progress
Continued weight gain or rebound gain
Feelings of failure and frustration
Health problems associated with being overweight
Those who are able to naturally adhere to their caloric deficit experience:
Healthy progress
Control of their body composition
Feelings of success
Improved health markers
Strength and muscle gain or retention
Those with prescription-induced superhuman adherence benefit in some ways, but also face unexpected negative effects due to a unique situation; unintentional under-eating.
Unintentional under-eating is due to a lack of natural hunger signaling, medically-induced feelings of satiety, and the consumption of fewer daily meals due to slowed overall digestion.
Benefits include:
Seemingly effortless weight loss.
Fewer cravings for highly-palatable/calorie-dense junk foods.
Reduced body fat
Potential for improved health markers
Negative effects include:
Macro and micronutrient deficiencies and their related effects
Increased fatigue and reduction in daily physical activity
Muscle and strength loss
Weakened immune system
Decreased sleep quality
Reduced libido
Hair thinning and loss
Gaunt physical appearance
As you can see, this new superhuman adherer demographic is in a unique situation. They have the potential, and without proper pre-prescription education, are likely to experience both positive and negative effects.
My goal, as the subtitle of this article states, is to help you ‘avoid malnutrition during and after treatment.’
Let’s move on to how this can be accomplished.
New Era, New Issues
Now comes a serious question; with weight loss drugs making it easy, does this mean people no longer need to learn about healthy calorie levels, adequate protein intake, the three macronutrients, and the benefits of micronutrient-dense food choices? What do you think?
To me, the answer to that question is that it’s now even more important for people to learn about and understand these topics.
For people who struggle with naturally maintaining a caloric deficit, these new weight loss drugs are a very effective tool. As I claimed earlier, I’ll go so far as to say that these drugs give them superhuman levels of diet adherence. A calorie deficit, which used to seem impossible to stick to, is no longer a problem.
But, and this is a serious concern of mine, how will people using weight loss drugs maintain a healthy conservative caloric deficit, and not a malnourishing oversized deficit, if their natural hunger signals and appetites are blunted?
The conservative deficit causes fat loss, but also promotes strength and muscle retention, along with higher energy levels and increased nutrient ingestion.
The oversized deficit also causes fat loss, but results in muscle and strength loss, fatigue, reduced activity levels, nutrient deficiencies, and a host of other health implications.
I have an analogy to explain why I’m worried about the nutritionally-uneducated falling into the oversized deficit trap without even knowing it.
Here goes; it’s like touching a hot stove without the natural hand-to-brain signal relaying that you’re getting burned. It’s terrible for you, but you’re unaware of it happening. It isn’t until you realize the stove is on and recall your knowledge about hot things burning you, that you pull your hand away.
In our weight loss treatment situation, the oversized deficit is the hot stove and your body is the hand.
Your body is being harmed by the oversized deficit, but there’s no gut-to-brain signals telling you to up your macro and micronutrient intakes. In this case, nutritional education and guidance provide the knowledge you need to know better and ‘pull your hand away,’ meaning to ‘transition to a healthier conservative caloric deficit.’
In summary, and sadly, without guidance and knowledge of how to eat for healthy fat loss, energy, muscle retention, and a lengthened healthspan, the average person undergoing weight loss treatment is being guided away from those things without even realizing it. This really bugs me, as they’ll surely suffer short and long-term consequences.
The Solution is Knowledge
Boiling it down, using these new weight loss drugs without learning healthy habits to implement during usage, and after treatment stops, is the same as running a starvation diet, rapidly losing weight, ending the diet, and putting the weight back on. In that type of situation, the individual ends up more unhealthy than they were before even starting their diet!
This is the cycle we see people struggle with time and time again; specifically people who were given fish for a day, but not taught how to fish.
This has been a decades-long problem surrounding sub-optimal dieting followed by regaining the weight, and it's going to be an even bigger problem throughout the Ozempic Era…unless doctors start educating patients and/or patients educate themselves. Remember, the ongoing maintenance of our own health is not anyone's responsibility but our own.
The secret to personal long-term body composition control, improved daily quality of life, and a lengthened healthspan is gaining and applying knowledge. It will always be this way.
To summarize, the solution is to avoid muscle loss and malnourishment-related effects by gaining knowledge in foundational nutrition and dieting-related topics and applying that knowledge to yourself.
Even though that may come across as intimidating, understanding these topics and implementing what you learn is less complicated then you’d expect. If you apply yourself, these concepts will become second-nature to you before you know it. Here are the topics I believe are most important:
Understanding what healthy weight loss looks like.
Ensuring adequate daily macro and micronutrient intake.
Choosing advantageous and beneficial foods.
I promise you, learning about and implementing these topics, as you undergo weight loss treatment, is going to drastically improve your present and future quality of life.
Topic One - Understanding What Healthy Weight Loss Looks Like
One of the most, if not the most, important lessons to take away from this article is this:
When it comes to weight loss, losing too much, too fast, is not ideal. Rapid weight loss is generally not quality weight loss.
Of course, this lesson leads to the questions:
How fast is too fast?
What constitutes rapid weight loss?
I’m going to give you the sauce around rate of loss, and while I know it feels great to see rapid weight loss when shrinking down is your main goal, I’m begging you, please please please place more value on quality than quantity.
The consensus among science-based experts, as well as my own recommendations based on 15 years of client data, is to track weight loss on a ‘per week’ basis.
Also, set your weekly goal using a percentage of your body weight. Using a percentage will personalize your goal, which just makes sense. On top of personalization, it will keep your expectations reasonable, especially as you continue to lose weight.
When determining the optimal percentage of body weight to lose per week, I’m factoring in four key variables:
Avoiding malnourishment through under-eating
Promoting fat loss, not muscle loss
Maintaining motivation and enjoyment during the process
Having energy for daily life and added activities
In order to achieve these four keys, for most people, the target falls between losing 0.5 and 1.0% of their body weight per week.
This range finds a happy medium between seeing enough movement on the scale to be continually motivated, enthused, and energetic, but also not losing so quickly as to cause concern for muscle loss and malnourishment.
Now, I know you’ll hear people say to simply pick a number to lose, like 1 or 2lbs per week. This is certainly common advice, but it’s generic. I’m not into generic, as it’s just not on the same level as specific advice, for you, an individual. Also, aiming for a set number like 2lbs per week has no built-in adjustment as you make progress and weigh less.
Perhaps you start off at 250lbs and losing 2lbs per week isn’t that difficult, rapid, or unhealthy. In fact, it falls within the 0.5-1.0% range. But, what happens months down the road when you’ve whittled your weight down to 175lbs? Is 2lbs per week still ideal? Well, if we calculate the expert consensus range, it’s 0.87 to 1.75lbs per week. All of the sudden, that 2lb per week generic recommendation starts leading to problems. Here are some of those problems:
It’s harder to maintain, leading to feelings of failure and demotivation.
If you do maintain it, energy levels suffer, leading to a lowered quality of life.
Decreased energy means decreased activity, leading to muscle loss.
The likelihood of malnourishment increases.
Also, it’s important to note that as the number on the scale drops, striving for that same weekly goal of loss only exacerbates the above problems. Using a percentage-based goal of loss removes this issue.
Now comes the part where you use the knowledge you just gained, assess how much weekly weight you’ve been losing during your weight loss treatment, advocate for your own health and quality of life, and proceed accordingly.
Are your weekly loss numbers consistently within that 0.5-1.0% of bodyweight range? If they are, continue without concern.
Are you consistently losing less than 0.5% or more than 1.0% of your bodyweight per week?
If you are, consider meeting with your doctor to discuss modifying and individualizing your dosage. This is advocating for yourself.
Do you have a concern about your current rate of loss? Reach out to me and let’s talk about it.
Topic Two - Ensuring Adequate Daily Macronutrient Intake
Per the British Heart Foundation, ‘macronutrients are the nutrients we need in larger quantities that provide us with energy: in other words, fat, protein and carbohydrate.’
Understanding the ins and outs of macronutrient consumption is crucial to:
Feeling your best while losing weight
Achieving your healthiest body composition at the end of your weight loss journey
Taking care of the one body you have in this life
Ensuring balanced daily consumption of macronutrients (proteins, carbs, and fats) is essential for great health, adequate energy levels, and total body muscle/strength retention.
Let’s look at macronutrient intake guidelines to work towards, which place a focus on building/retaining muscle and strength, as you move through your weight loss treatment. I’m going to use excerpts from another nutrition-related article (A Walk Down Dieting Lane) of mine when explaining these macro guidelines.
Protein Intake
A large portion of our bodies is composed of proteins. It’s more than just our muscles, but when we’re focused on building a great body and losing fat in a healthy way, muscle is always a priority. Muscle looks the best, feels the best, is useful for life, and is metabolically active.
We need adequate protein to build new muscle and maintain current muscle. This is especially true when undergoing prescription weight loss treatment.
Do your best to meet your goal protein intake each day. Overreaching and consuming over your goal amount is fine, but try to avoid landing under it.
General anti-muscle loss protein recommendations range from .75 to 1.25 grams per pound of lean body mass.
Check out these articles for more on protein:
Fat Intake
Next up is fat, which is also a very important macronutrient. This may seem counter-intuitive, but it’s only because fat has an undeserved negative stigma around it. Not only is it a physical descriptor of obesity, it’s also been demonized in earlier dieting eras.
For many years, it was thought that fat made you fat. We now know this isn’t the case. It’s the over-eating of calories in general that makes you fat. There’s a huge and important difference there.
So why is fat intake important? Fats are important for the function of our nervous system and they’re also precursors to our hormones…including hormones that support muscle growth, strength, and fat loss. Without consuming a variety of fat types, our nervous systems won’t function properly, nor will we maintain healthy hormone levels. Clearly, these are two areas we need working properly if we want to feel and look our best.
To benefit from fats, it’s wise to diversify your fat sources. There are four types of fat:
Polyunsaturated
Monounsaturated
Saturated
Trans
It’s widely recommended to consume fat sources that provide saturated, polyunsaturated, and monounsaturated fats. Aim to eliminate trans fats in your diet.
It’s also recommended that fat calories make up between 20 and 35% of total daily calorie intake.
Carb Intake
Carb intake is the least essential in terms of our three macronutrients and the amount of carbs we can consume and still function, feel good, perform physically, and lose fat is highly variable.
Carb sources exist in three primary categories; starches, sugars, and fiber. Aim to obtain all carb types by consuming a variety of fruits, green leafy vegetables, and starches such as rice, oats, beans, whole grains, potatoes, and other starchy vegetables.
Your daily carb intake is determined by how many calories remain after subtracting your protein and fat calories from your daily total calorie goal.
As an example, if your calorie goal is 2000 per day and your combined protein and fat calories total 1500, your goal carb intake will be 125g. Carbs contain 4 calories per gram, so 125g amounts to those 500 remaining calories (2000 - 1500 = 500).
Summing up adequate daily macronutrient intake for healthy fat loss looks like this:
Protein - 0.75 to 1.25 grams per pound of lean body mass.
Fat - 20 to 35% of total daily calorie goal.
Carb - Determined by how many calories remain after subtracting protein and fat calories from your daily total calorie goal.
Personal Nutrition Coaching
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Topic Three - Choosing Advantageous Beneficial Foods
Through years of research and living through multiple nutrition eras, as well as learning from the past mistakes, failures, and successes of others, we can safely conclude that if we want to consistently look and feel our best while losing weight, eating micronutrient-dense whole foods the majority of the time is how it’s done.
The best way to ensure you’re choosing beneficial foods is to focus on two criteria when doing your shopping:
Prioritizing Whole Foods
Prioritizing Micronutrient Density
Whole foods are viewed as unprocessed or minimally processed. Examples of whole foods include unprocessed meats, nuts, seeds, fruits, vegetables, and whole grains.
Sadly, whole foods do not make up the majority of the average American’s food choices each day. This makes sense because they don’t come close to making up the majority of grocery store inventory either.
While this is our country’s reality, it doesn’t need to be your reality. What you eat and how much you eat are up to you; never forget this.
One more thing about whole foods; every food you eat does not need to come from this category. As you make your food choices, aim for the majority of your foods to be whole, but know that every single choice doesn’t need to be. Choosing extreme paths leads to failure.
The second part of the beneficial food equation centers around micronutrient-dense foods.
Per Merriam-Webster, micronutrients are ‘chemical elements or substances (such as calcium or vitamin C) that are essential, in minute amounts, to the growth and health of a living organism.’
It’s entirely possible to consume purely whole foods, but still be deficient in micronutrients. This happens when someone relies too heavily on just one category, perhaps eating only meats. Over time, they’re highly likely to become deficient in those micronutrients meat doesn’t provide.
To avoid this trap, it’s important to consume micronutrient-dense foods from several categories, such as fruits, vegetables, meats, legumes, nuts, and seeds.
Did you notice the similarity between the whole foods and micronutrient-dense foods lists? Often times, choosing whole foods will result in inadvertently choosing micronutrient-dense foods and vice versa. This is great news, as it makes meeting these two criteria much easier.
As a bonus, it’s likely that your chosen weight loss drug will also blunt your cravings for highly-palatable processed foods, making it easier to gravitate towards whole micronutrient-dense foods.
This is a great thing, but eating these beneficial foods is only part of the equation, you still need to eat enough of them to ensure your weight loss is healthy.
Of course, since you’ve read everything up to this point, you already know this.
The Main Point
If you remember, the very first section of this article explained why I wrote it. I want to help you.
We’re in a new era of dieting, but nutritional education and understanding how food amounts and food choices impact the body are still necessary for you to live your healthiest life during and after treatment. This is just the nature of the beast, so I strongly encourage you to embrace the knowledge in this article and live better for it. Take your health into your own hands!
I want you to feel confident enough to reach out to your doctor if you’re losing weight too rapidly, experiencing negative side effects, or something just doesn’t feel right. Knowledge builds confidence and confidence creates the ability for you to advocate for yourself.
One last thing; feel free to reach out to me with any nutrition-related question you might have. I want to help you and I like answering questions.
Thank you so much for reading.