This blog was written by Isabelle Bouchard, MS, RD. She is the owner of Bamboo Nutrition in Columbia, Missouri and Rochester, Minnesota.
Those on a GLP-1 Medication Should Meet With A Registered Dietitian. Here’s Why.
You get prescribed the GLP-1 and likely don’t receive any specific nutrition education.
Can anyone else see the problem with this system?
To give someone a medication that will directly have an impact on the body and nutrition intake, but give no nutrition education (or recommend a dietitian), is like giving someone a plane ticket to a country that speaks a different language, has a completely different culture, they’ve never been there, but yet you don’t tell them where they’re going, provide them with a simple packing list, no google-translate, no hotel-recommendations, just figure it out.
Maybe you think that is an exaggeration, but as a registered dietitian, I am seeing with my own eyes that it is not. Individuals with poor nutrition behaviors and very little nutrition education are taking a medication that has a direct impact on their GI tract and metabolism. Appetite is lost, diarrhea and vomiting may follow, and yet daily activities remain the same and poor nutrition behaviors remain the option when appetite is present.
No change in behavior. No nutritional changes are recommended, and malnutrition ensues.
This is not the case for everyone on a glp-1.
I definitely do not want anyone to think the problem is with the individual. Those who get on a GLP-1 sincerely hope for a better life. For an opportunity once they are off this temporary medication to pursue things they have been waiting a lifetime for. The hope is real! Some folks are proactive and seek nutrition guidance from a dietitian, or learn to cook, change their movement routine, etc. on their own- Wonderful!
The issue is that these lifestyle changes should be strongly encouraged and your prescribing provider should be helping you make those changes or find the professionals who can help.
2. Weight-biased care becomes the standard and the priority.
To remain on a GLP-1 there are weight goals that need to be reached. Often the weight is priority over the body’s labs. This further enables weight-biased, fat-phobic care, and displaces the priority of focusing on health on the back-burner.
3. A dietitian will support your goals while protecting your health.
Muscle Loss
One of the first things to go is muscle mass. When someone’s appetite and intake decreases substantially, your body doesn’t go to the fat stores first. It’s easier to break down muscle to make energy than to break down fat. So muscle mass is typically the first thing to go.
A dietitian will help you prevent this by discussing protein intake, consistent eating throughout the day, and movement.
Disordered eating behaviors
When you lose your appetite, you’ll find yourself eating at odd times, giving less focus to food and nutrition, and reaching more for convenient, tasty, items rather than nutrition dense foods that will help your body run on such low fuel.
The disordered eating continues, as the focus is on the number on the scale, not on the food, and these problematic nutrition behaviors never improve.
So what happens when you get off the medication, and appetite comes back? Without foundational knowledge of how to feed yourself appropriately, you’re fully dependent on a medication to keep the weight off.
A dietitian will help call our disordered eating behaviors and keep your attention on nutrition. Using the time your on a GLP-1 to learn more about nutrition, grow in confidence in making food decisions, and building good habits, will set you up for success once you’re off the medication.
Preventing malnutrition
GLP-1s cause malnutrition. Its simple as that.
ASPEN (American Society for Parenteral and Enteral Nutrition) sets malnutrition criteria as losing greater than or equal to 5% of body weight in 1 month or less; Or losing greater than or equal to 7.5% of body weight in 3months or less; in addition to muscle and fat loss and reduced grip strength.
Success on a GLP-1 is measured by how much weight you can lose, and these numbers are commonly met. This is malnutrition being recommended as the standard of care.
A dietitian doesn’t want to prevent the GLP-1 from helping you, but we want to ensure nutrition and health are maintained throughout the process. This may mean working against your appetite to stay nourished and lose weight at a slower, healthier pace. Again, this will set you up for success in the long-term.