An opinion piece written by Katherine Tom MS, RDN, LD, CDCES

What is semaglutide?

Its a popular drug that belongs to a class of medications that are called glucagon-like peptide-1 receptor agonists (aka GLP-1 RA) and it works in part by telling the body to make more insulin which in turn lowers blood sugar. As a Certified Diabetes Care and Education Specialist of over 15 years, I've encountered this drug in the diabetes space for several decades. Below we'll review three pitfalls that I tell everyone that I see on this medication to be aware of and share several tips to maximize the medication regimen from a dietary standpoint.

Pitfall #1: Eliminating Entire Food Groups

Initial weight loss experienced on higher doses of this particular drug class can be motivating for some people who take it. Often times they will begin to eliminate one or two food groups in an attempt to lose more weight or lower their hemoglobin A1c (a blood sugar average) but this typically backfires over the course of the next few months when the same dietary pattern that is adopted now becomes mentally fatiguing, cumbersome to navigate during social situations or affects the person's energy levels nutritionally. If you find that you are eliminating food groups specifically in an attempt to maximize your outcomes on this medication, I would recommend you work with a dietitian to include foods in that food group in a strategic manner to both ease your mind and give you a solid and informed strategy to remain in a calorie deficit (assuming your weight loss goals are warranted) and/or establish euglycemia (assuming your goals are to maintain and achieve blood sugar targets).  

Pitfall #2: Just Eating Less

Because this class of drug elicits a sense of fullness after meals, people taking it often eat less volume than they did previously. I have met clients who simply eat less and they experience some weight loss and or benefit from a blood sugar standpoint. Conversely, I've witnessed clients who have chosen to make intentional food swaps and incorporated exercise while eating less and they often times achieve even greater changes in weight and blood sugar. No two bodies are the same, so I will not go on to say, "eat this specific macronutrient percentage" or "do this specific workout routine and you will lose X pounds of body weight" because those blanket statements would not be rooted in science or fact. A good place to start if you or someone you know is just reducing portion sizes but wants to achieve more on this drug is to begin by looking at the diet strategically and eliminating what we call, "empty" calories in my field: think soda (or other beverages and snacks that contain high fructose corn syrup), candy and alcohol for example. Then work with an expert on the fitness side or nutrition and diabetes space (like a CDCES) to make intentional food swaps to maximize your medication regimen. I will note, the changes that you make will be dynamic. They will need to be tailored and changed often to maximize the benefit on this regimen. Avoid plans and patterns that endorse parking yourself on one routine indefinitely. 

Pitfall #3: Withdrawing From Social Eating Situations and or Meal Prep

People who take semaglutide for longer periods of times describe to me that their relationship with food changes and this change may be unexpectedly positive or at times, negative. They may go on to state that they don't think about eating as often during the day, maybe their cravings for particular foods are reduced or they don't occupy their time thinking about meals as often as they did prior to taking the medication. This sometimes leads to them withdrawing from social eating situations, meal prepping routines with family or friends and general time spent around food. Staying close to meal time behaviors and keeping involved in meals with others is a component of health that is well studied in the longevity space --particularly speaking from a Mediterranean style of eating associated with parts of the world where many centenarians reside. Here at North Texas Nutrition Associates we support healthy relationships with food that promote mental wellness. If you or someone you know who is taking this medication is experiencing changes in their relationship with food that keep them from enjoying aspects of their life, consider working with a mental professional for some help and guidance. We provide our clients with intentional connections to professionals in our area to assist them in achieving mental wellness.

In conclusion

Medication regimens and nutrition often go hand in hand. In the particular case of semaglutide, starting the medication can be a catalyst for adopting new eating regimens and trying new movement routines that enhance overall wellness. A comprehensive care team that includes a physician, mental health professional, fitness expert and dietitian can support a person on their wellness journey.

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