This content originally appeared on diaTribe. Republished with permission.
By Paul Heltzel
Medically Reviewed by Charles M. Alexander
Key takeaways:
- When taking weight loss medications, eating nutritious foods and getting physical activity are key to staying well for people with diabetes.
- Brief bouts of exercise can help build and maintain strength and cardiovascular health.
- Experts also stressed the importance of mental health support during weight loss, especially if a change occurs in mood or relationships with others.
Weight loss medications have produced dramatic health benefits for many but when used by people with diabetes there are special considerations. A panel of experts recently offered strategies for taking them and staying well.
The panel was led by Dr. Kelly Brownell, a professor and director emeritus of the World Food Policy Center at Duke University, and was joined by the following experts:
- Dr. Lisa Neff, executive director of global medical affairs for Eli Lilly and Company and specialist in endocrinology, obesity medicine, and clinical nutrition.
- Lorena Drago, registered dietitian nutritionist and certified diabetes care and education specialist
- Dr. John Jakicic, exercise physiologist and obesity researcher at the University of Kansas Medical Center
How weight loss medications work
Neff explained that these medications work on the receptors for two naturally occurring hormones – glucose-dependent insulinotropic polypeptide (GIP) and glucagon‐like peptide‐1 (GLP-1) – which together regulate blood sugar and appetite.
“We have a lot of understanding of how they work and how effective they are,” she said.
Lilly’s medication tirzepatide, better known as Mounjaro when used to treat type 2 diabetes and Zepbound for treating obesity, activates GIP and GLP-1 receptors, making it a combination medication. Semaglutide, known as Ozempic when taken by people with type 2 diabetes and Wegovy when taken for weight loss, on the other hand, activates only GLP-1 receptors.
These medications can help regulate blood sugar in several ways. They reduce the amount of glucose produced by the liver and help the pancreas release more insulin when blood sugar is high, improving insulin sensitivity.
Nutritionist and diabetes educator Drago noted the medications also reduce hunger – the physical need to eat – as well as cravings. These medications also slow the digestion of food.
“So both hunger and appetite are reduced, which leads to a decrease in the consumption of food,” Drago said.
Getting adequate nutrition on weight loss medications
Neff pointed out that because people taking these medicines are eating smaller amounts, it’s important to make those calories count by eating foods that help meet nutritional needs.
“Focus on nutrient-rich foods, like lean proteins, vegetables, fruits, and whole grain foods,” she said. “The nutrients we are talking about are really important for so many body processes, including energy production. They’re also important for things like immune function, skin health, and bone health.”
Neff and Drago both emphasized the importance of dietary fiber and protein while taking these medications.
The importance of exercise
The panel explained the need for physical activity while losing weight to offset any loss of muscle mass, by building and maintaining strength and cardiovascular fitness.
Exercise researcher Jakicic explained that even brief amounts of exercise can have outsized benefits.
“You know how you walked from your car to your office and walked back? Just do a little bit more of that. Once in the morning, once in the early afternoon, and once in the evening, take a 5 to 10-minute walk,” he said.
Jakicic acknowledged the challenges of maintaining physical activity for older people and those who are dealing with fatigue. Here are some of his recommendations for easy strength-building and general fitness:
- Resistance or strength training can help to improve muscle quality and build strength. At home, inexpensive resistance bands are an option.
- For those with mobility issues, there are simple exercises that can be done in a chair.
- When watching TV, walk in place during commercials. Or make a game of it by walking in place for one minute when a character on a show uses a familiar phrase.
Jakicic recognized that people of all ages may need to modify exercises and stressed the need for personalization in finding enjoyable, sustainable physical activities.
“If we treat exercises as one size fits all, that’s actually going to translate into one size fits none,” he said. “Everyone will approach exercise in a slightly different way.”
Managing side effects of weight loss medications
Some people taking weight loss medication may experience side effects, which can include nausea and other gastrointestinal issues. In addition to consulting with the prescribing doctor, the panel offered some tips.
“The first thing that I ask is: How long does it take you to eat?” Drago said. “People may eat very quickly and have to readjust.”
In addition to taking more time to eat, she recommended multiple small meals throughout the day. Drago offered several other suggestions for those who experience gastrointestinal issues. She recommended trying food at room temperature vs. hot foods and avoiding choices that are high in fat. When nauseous, it’s best to wait until after meals to drink liquids instead of having them together. For constipation, she suggested high-fiber fruits and vegetables.
“It’s important if people are experiencing these symptoms that they talk with a healthcare professional,” Neff said. “There may be a dose or dietary adjustment that is recommended to help improve those symptoms.”
The importance of mental health
While seeing improvements in health due to weight loss, some people may also face mental health challenges. The experts offered advice for changes in mood after weight loss, or a change in their relationships with others.
“When some people lose weight, they may feel very uncomfortable by the increased attention to their body as a result,” Neff said. “Again, this is another opportunity to reach out to a doctor or a mental health professional for support. It’s important to know you’re not alone.”
Neff said a need exists for greater understanding of the complexities related to obesity as a chronic disease. The American Board of Obesity Medicine can be a resource for finding certified clinicians, she said.
“There are complex biological systems that influence our appetite, eating behaviors, and body weight,” Neff said. “Patients don’t have to feel the shame and blame that they felt for so long around weight. Obesity is a difficult disease, and it has created a lot of burdens and barriers to care for people for many years. I think we’re just starting to see improvements in that. Patients with obesity deserve the same level of care as those with any other chronic disease.”
The bottom line
Incretin-based medications initially developed to treat diabetes can be beneficial for weight management, but it’s important to keep a focus on diet, nutrition, and exercise to stay well, especially if fewer calories are consumed.
Side effects like fatigue and gastrointestinal problems can sometimes be a sign that a dietary or medication change is needed. If you’re experiencing side effects, consult with your prescribing doctor. Changes in meal choices, nutrition, or medication doses may help.
Experts said coupling small amounts of enjoyable exercise that can be done anywhere is key, in building and maintaining muscle and heart health.
Those who experience mental health challenges related to weight and weight loss can benefit from the support of health professionals. As Neff put it, anyone living with overweight or obesity deserves the same level of care provided to anyone with a chronic disease.
Learn more about weight loss medications and diabetes:
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