Getting Started on Zepbound or Wegovy
Starting medications like Zepbound & Wegovy can feel overwhelming without the right information.
I know that most doctors prescribing these medications aren’t spending 20 minutes explaining what patients can expect.
That’s why I created this episode—to provide you with the insights you need. I hope you’ll consider sharing it with someone else who is taking these medications. For prescribers, it could make your life a little easier by providing a resource you can share—whether it’s this episode—so you can offer more depth without needing to cover everything in a short clinical visit.
In my practice, I frequently guide patients through starting medications like Zepbound and Wegovy, offering them a clear understanding of what to expect. This episode serves as a more personal way to communicate that information, helping patients feel more prepared and informed.
So, here’s a condensed version of the conversation I have with patients regularly. It’s like you’re sitting down with me, receiving the same advice I’d give in person.
GLP-1 Medications: Who They're For and What to Know
Using a GLP-1 medication like Zepbound or Wegovy is a significant step in managing obesity or weight-related health concerns. These medications are commonly prescribed for both weight loss and diabetes management. However, if you’re using them primarily for obesity or overweight treatment, it’s important to understand the criteria for eligibility.
Doctors often prescribe these medications without fully explaining who qualifies and why, though specific guidelines determine eligibility. Zepbound and Wegovy are approved for weight loss and can also treat type 2 diabetes, where criteria focus additionally on blood sugar management. For weight management, the FDA now allows individuals with a BMI over 25 to qualify if they have related conditions like high cholesterol, high blood pressure, or type 2 diabetes, revising the earlier standard of a BMI of 30.
A recent development allows Zepbound to be used for sleep apnea, marking the first GLP-1 medication approved for this particular condition. Clinical trials showed a notable reduction in the severity of sleep apnea symptoms, with participants experiencing improvements in breathing patterns and overall sleep quality, particularly in cases linked to obesity.
In addition to managing these conditions, Wegovy can also be prescribed to reduce the risk of cardiovascular events for individuals with overweight or obesity and a history of heart-related issues like stroke, heart attack, or peripheral vascular disease.
Doctors may not always go into detail about these criteria, but knowing who qualifies helps create a more personalized and effective plan for managing weight and related health issues.
Who Should Avoid GLP-1 Medications
When considering GLP-1 medications it’s important to understand not only who qualifies but also who may not be suitable for these treatments. Contraindications refer to situations where these medications could pose risks.
The main contraindication is having a personal or family history of medullary thyroid cancer. If diagnosed with this or the rare syndrome multiple endocrine neoplasia type two, these medications are not safe. While the risk is largely theoretical, a boxed warning advises monitoring for symptoms such as lumps or changes in the neck, voice, or throat. Early detection is crucial, so consult your doctor if any symptoms arise.
Additionally, there are risks associated with pancreatitis, severe gastrointestinal diseases like ulcerative colitis, Crohn’s disease, or gastroparesis, and active eating disorders. Your healthcare provider will assess these conditions carefully to ensure safe and effective treatment. Despite these considerations, managing obesity with GLP-1 medications can significantly reduce cancer risks like endometrial, breast, and colon cancer.
Being aware of both the qualifications and contraindications for GLP-1 medications helps ensure a safe and effective treatment plan tailored to individual needs.
A Long-Term Journey with GLP-1 Medications
One of the crucial aspects of taking Wegovy or Zepbound that often goes unnoticed is the expectation of long-term use. Both in real-world scenarios and through research data, we see that when individuals discontinue these medications and switch to a placebo, they tend to regain most of the weight they lost.
This outcome aligns with studies from both newer and older anti-obesity medications. While there may be exceptions—some individuals can maintain weight loss for a period after discontinuing medication—they are not the majority. In my experience, many of my patients have successfully maintained weight loss on other medications, such as older options like Phentermine. However, the vast majority require ongoing medication to sustain their results.
It’s important to go into treatment with the understanding that if a medication is needed for weight loss, long-term use is likely necessary. This is especially crucial considering the cost of these medications, which can be quite high. Starting a medication without the ability to maintain it long-term can lead to more harm than good.
Many patients assume they’ll simply use the medication for a few months and then stop. But this approach can set unrealistic expectations. Similar to other long-term treatments, these medications require continued use for sustained results. Whether it’s through dosage adjustments or switching to a different medication, if these treatments work for you, maintaining them over time is essential.
Side Effects of GLP-1 Medications
The next important aspect to discuss is what side effects you can expect with these medications. This is often the topic most frequently highlighted in the media, and understandably so, as some patients hear horror stories.
However, I often find that many of my patients start the medication and return a month or two later, pleasantly surprised to experience little to no side effects. This is because there’s often a lot of hype surrounding these medications. While I do discuss potential side effects with them beforehand, it’s crucial to remember that the vast majority of people actually experience minimal or tolerable side effects. For example, with Zepbound, most people experience no side effects at all. Similarly, with Wegovy, only about half of patients report any side effects.
Additionally, for those who do experience side effects, they tend to improve over time. There are usually strategies to minimize their impact, and very few people, only around 5-10%, stop the medication altogether due to intolerable side effects.
Minimizing GLP-1 Medication Side Effects
Now, let’s take a closer look at how the common side effects can be managed. These medications work by increasing satiety, helping you feel fuller, and reducing cravings. For example, Wegovy primarily works through GLP-1, while Zepbound combines GLP-1 with another hormone, GIP, to enhance feelings of fullness and satisfaction.
However, these hormonal changes can impact the gastrointestinal (GI) system. Nausea is the most common side effect, ranging from mild discomfort to more severe cases. Eating heavier meals or rich foods can exacerbate this, leading to discomfort similar to that of overindulgence.
With these medications, portion sizes often decrease naturally, and eating beyond what your body can handle may trigger nausea, reflux, or discomfort. Adjusting portion sizes and paying attention to what triggers GI issues can help minimize side effects.
Other common side effects include constipation and diarrhea. Wegovy tends to cause more constipation, while Zepbound may lead to more frequent episodes of diarrhea. If one is particularly troublesome, switching medications may provide relief.
To manage constipation, fiber supplements like Benafiber, Metamucil, or Psyllium husk are effective, especially when paired with adequate water intake. Diet adjustments—avoiding high-fat or spicy foods—can also help reduce discomfort.
Side effects usually improve as your body adjusts to the medication. Nausea and vomiting, for instance, are often most intense within the first 24 to 36 hours after a new dose or injection. Timing your medication around activities can help minimize disruptions to your daily life.
In most cases, side effects are manageable with support and adjustments, leading to significant improvement over time.
Understanding Injections: A Brief Guide
If you're starting on medication that requires injections, it's good to know how they work and what to expect. These medications are typically injected once a week into areas like your belly, thighs, or the back of your arm. They need to be refrigerated, but depending on the specific medication, they can be kept at room temperature for about three to four weeks—just as long as they’re not exposed to heat. After this period, it’s recommended to use the medication rather than returning it to the fridge.
Injection site reactions are rare but can occur, causing redness and itching. Over-the-counter cortisone cream can be used to soothe these symptoms. Additionally, other less common side effects include dizziness, low blood pressure, hair loss, bloating, gas, and occasional GI discomfort.
It’s important to monitor any side effects and maintain open communication with your prescriber to ensure you’re managing your treatment safely and effectively. If you’re obtaining medications online, make sure you have a reliable healthcare provider to discuss and manage your progress.
What to Eat While on Medication
Let’s talk about nutrition. Throughout this guide, I’ve hinted at the importance of meal planning, but let’s dive into it more specifically. We recommend that our patients eat three to four small meals a day. Since you’ll feel full more quickly, it’s important to prioritize protein first. Without sufficient protein, you might fill up on other filler foods like vegetables and grains, which are important, but protein is the most crucial for staying full and maintaining lean muscle mass.
In our clinic, we track muscle mass closely to ensure it remains steady, even as patients adjust to these medications. For women, we typically recommend around 100 grams of protein per day, and for men, 120 grams. Your prescriber may provide more specific targets, but these round numbers—100 grams for women and 120 grams for men—are easy to remember. The minimum recommended intake is 60 grams per day.
You can easily incorporate protein into your daily meals—whether it’s a protein shake, Greek yogurt, chicken breast, or a boiled egg. These options ensure you’re meeting your protein needs without needing elaborate meals. Following your protein intake, focus on adding fiber-rich foods like whole grains, fruits, and vegetables to your meals.
Hydration is equally important. Aim for at least 64 ounces of water daily, though many of my patients aim for closer to 80 ounces. Medications can sometimes decrease the drive to drink, so maintaining proper hydration is essential for feeling your best.
Lastly, portion sizes may need adjustment. Eating too much at once could lead to discomfort, so try starting with smaller portions—about half of what you’d typically eat—and see how you feel. If you need more later, that’s perfectly fine. Just listen to your body and adjust accordingly.
Exercise and Its Role in Your Journey
Exercise is a key component of maintaining overall health. It’s not just about managing weight, but about promoting long-term well-being and longevity. With these medications, it’s a great time to establish or enhance your exercise routine. Research consistently highlights that exercise supports weight loss and helps maintain those results in the long term. As the saying goes, “a healthy lifestyle is built on an active body.
Our goal for exercise is 300 minutes per week, with at least two of those days dedicated to resistance or strength training. If you’re not close to this yet, start with 150 minutes per week—just the bare minimum we all should aim for.
In the first few months of starting the medication, focus on reaching at least 150 minutes. Gradually, by month three, aim to incorporate five 30-minute sessions into your routine. Walking is a fantastic, low-impact option that counts towards this goal. While it may not be the most intense form of exercise, it’s highly effective and manageable for most people.
Between months nine and twelve, aim to progress towards 300 minutes of exercise weekly. For those looking for additional support, I’ve developed an app called GLP Strong, available on the website at GLPstrong.com. This app offers affordable, approachable strength training routines for all levels, focusing on resistance exercises and balance to support your fitness and medication journey.
Managing your journey with GLP-1 medications involves understanding both the benefits and potential side effects. From navigating eligibility criteria to managing long-term use and incorporating healthy lifestyle habits, there’s a lot to consider. If you found this information helpful, be sure to listen to the full episode for a deeper dive into each topic. Don’t forget to share it with others who may be starting their own GLP-1 medication journey.
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