I admit it. I get taken aback when I see professional athletes like tennis star Serena Williams touting the benefits of taking GLP-1 meds. GLP-1s (Glucagon-like Peptide-1 Receptor Agonists) such as Ozempic and Wegovy (semaglutides) and Mounjauro and Zepbound (tirzepatides) were once prescription meds. Now, they are being marketed by celebrities and have quickly gone mainstream.
GLP-1s work by curbing one’s appetite and slowing gastric emptying. A user feels full for a long time because the food stays in the stomach longer. This curbs hunger and food noise—incessant thoughts about food that can fill one’s brain. These changes lead to weight loss, freedom from incessant food thoughts, and higher self-esteem. (The fact that self-esteem and self-worth even get measured by weight is a sad statement. No one should have to lose weight to be good enough—but that is a different article!)
Both casual and competitive athletes are expressing interest in these meds—either for themselves or someone in their lives. Rave reviews about “magical” weight reduction are compelling. Yet very few people mention the downside to GLP-1s. These popular drugs can easily contribute to malnutrition due to scanty food intake. Health professionals and consumers alike are overlooking this problem. After all, the meds are supposed to squelch hunger, cause you to undereat, and lead to weight loss. Most GLP-1 users don’t even think about the risk of nutrient deficiencies. They just feel very proud of (finally) being able to “barely eat.” They revel in the number of pounds they have lost, their lower BMIs, and their stylish new clothes.
GLP-1s curb hunger. Hunger is actually a safety signal that protects us from becoming malnourished. If you, an athlete, didn’t get hungry, you would never think to eat. You would starve to death. Some GLP-1 users are, indeed, starving themselves (as do many dieting athletes). Over time, they notice health changes related to malnutrition: muscle loss, chronic fatigue, thinning hair, light-headedness, reduced bone density, shrinking stature, cold hands, and cold feet. As one formerly plump triathlete bemoaned, “I’ve had to stop swimming. Without my body fat, I get too cold.” She didn’t know she was getting so cold because she was severely underfueled. Many swimmers are skinny and stay warm enough to swim. They eat enough calories to fuel their body’s furnace.
GLP-1 drug-induced malnutrition is escaping public concern. I’ve seen GLP-1 users (as well as many athletes) who have grayish skin; they look terrible and are way too thin. Yet they get praised: Congrats on losing all that weight! Unfortunately, we live in a culture where weight loss is admired, eating less is a goal, thinner is better, and low body fat is deemed healthier. Previously unsuccessful dieters are now finally able to succeed at losing undesired body fat. Even if they feel unwell, they feel like winners: No more body shame! Some GLP-1 users live with nausea, constipation, and lethargy. An estimated 50% to 75% of GLP-1 users stop taking the meds within a year. They are not a “walk in the park” for everyone.
As a dietitian, I recognize there is a time and a place for GLP1s. I’m fine with them being prescribed within established guidelines and used with medical oversight. Obesity and overweight are serious health conditions that deserve competent attention from a healthcare team with a registered dietitian (RD). Weight loss is far more complex than just take this med or just eat less and exercise more. RDs can help GLP-1 users figure out how to eat adequately and “normally”, so they consume enough calories, protein, vitamins, and minerals, particularly D, iron, calcium, thiamine, and B-12. If you are consuming only 800 calories a day, what you eat needs to be nutrient-dense! While GLP-1s are not inherently dangerous, they do require intentional eating. GLP-1 users who work together with a RD have greater long-term weight-loss success than those who have to figure it out on their own.
Weight is an outcome involving complex metabolic systems, sleep, stress, the environment, and access to health care. GLP-1 users commonly have a complicated food and weight history with dysfunctional eating styles, if not outright eating disorders they have never addressed. Losing weight doesn’t resolve dysfunctional eating. Dysfunctional eating is often the symptom of stress, body image issues, and I’m not good enough beliefs. Family dynamics can change when a person who used to eat heartily now barely eats and sheds lots of weight. How is the family adjusting to the new body —with pride, jealousy, or discontent?
Achieving one’s dream weight may not even make the GLP-1 user as happy as anticipated from reaching a long sought after weight goal. No number on the scale will ever be good enough to do the enormous job of creating happiness. Happiness comes from within. With weight loss, the body is simply smaller—and the dieter holds the same bag of life’s problems. Hence, GLP-1 users may continue to feel inadequate, not “good enough”—just as they did when they were living with excess body fat. Some users may even feel ashamed for resorting to GLP-1 meds, believing they are cheating. Most are extremely fearful (rightfully so) of regaining weight if they were to stop taking this drug. How long can they afford to take it? Weight loss is complex…
Due to lack of long-term data on the lived experiences of many GLP1 users, we don’t yet have a clear picture how this weight loss era will evolve. Will “everyone” be taking GLP-1s like a vitamin pill? Will vanity dieters and weight-conscious athletes use them occasionally in micro-doses? Will every four months be enough to manage health issues? Right now, we know that people who want to maintain their weight loss need to stay on the med for their lifetimes. That’s because obesity is a disease, like high blood pressure. (If you go off blood pressure meds, your blood pressure goes up. The same holds true with GLP-1s; weight goes up.) In a few more years, we’ll better understand the benefits and costs of these popular weight loss aids. Stay tuned to see how this all evolves.
Nancy Clark MS RD CSSD counsels both fitness exercisers and competitive athletes in the Boston-area (617-962-4382). Her best-selling Sports Nutrition Guidebook is a popular resource. For more information, visit NancyClarkRD.com