Episode 256: Why Am I Not Losing Weight on a GLP-1? 4 Reasons Why

[00:00:00] Welcome back to the Back on Track Achieving Healthy Weight Loss, where I help you get on track and stay on track with your weight loss journey. I'm your host, Dr. Alicia Shelly. So let's get started.

[00:00:27] Welcome back to the Back on Track Achieving Healthy Weight Loss podcast. I'm your host, Dr. Alicia Shelly. And today we're answering the question that I hear all the time. Dr. Shelly, I'm taking a GLP-1, but why am I not losing weight? Now, if you've said this out loud, then this episode is just for you. Because maybe you've been scrolling through social media or seeing somebody say,

[00:00:56] I lost 20 pounds in two months on a GLP-1. Meanwhile, you've been taking your medication, you're stepping on the scale every week, and you're thinking, what am I doing wrong? Why is this not working for me? First, I do want to point out that everyone responds differently to these medications. So that person that says, I lost 20 pounds in two months, we don't know what they're doing with that 20 pounds.

[00:01:24] And on top of that, they may be what we describe as super responders. There are some people who respond very well to GLP-1s, and they do it at lower doses. And so they may take the first dose and they're like, wow, I'm seeing what's going on. And there could be other things that are going on too that we'll talk about a little bit later. But just because you're not responding in the same way, doesn't mean that you cannot lose weight with GLP-1s.

[00:01:54] It just means that your weight loss journey is not going to look exactly like somebody else's journey. And so it's important to when you see that, to just block it out and remind yourself that this is your journey. There's a saying that we have in running, your race, your pace. And that's the same I would say with weight loss as well. And so today I want to walk you through four reasons you may not be losing as much weight as you expected on your GLP-1 medication.

[00:02:23] And what can you do about it? Now, reason number one, you may still be on too low of a dose. Like I said, some people are super responders, so that low dose works well for you. Other people are not super responders, so they need to increase the dose. And this is one of the first things I look at when somebody tells me, my medication's not working. I ask, what dose are you taking? How long have you been on taking this dose?

[00:02:52] Because with many GLP-1 medications, they intentionally started at a low dose. Because these beginning doses are primarily there to allow your body to adjust to the medication and reduce side effects. And then we find that some people will experience side effects initially, but then their body gets used to it and it gets better. And so that means you may not be experiencing significant weight loss immediately. But that doesn't mean you can't.

[00:03:20] It just means we need to increase the dose. And I sometimes have patients who come back after their first month and say, Dr. Shelly, I only lost two pounds. And I have to remind them, guess what? You just started. Good job. You responded. You lost two pounds. And you may also still be on that starter dose. So as long as your appetite, if you notice your appetite's coming back, or if you feel like your weight is stalling, then that may be the next time to go up on that dose.

[00:03:49] And I think it's important to also mention that before you go up on that dose, you want to make sure that you're not having side effects. So sometimes for my patients, they tend to, they may notice a little bit of nausea or acid reflux or sulfiburbs. And they kind of just, you know, they want to keep pushing going up. But these symptoms will get better over time, but you need to allow your body to get used to it.

[00:04:15] And so sometimes if you taper up too fast, those symptoms just get worse. So it's important that if you are experiencing side effects that you stay at that dose for the next month, just to allow your body to get used to it. There's no need to kind of keep jumping up so quickly. Now, the one thing I would say is that just because your body, you know, you're not feeling the same appetite doesn't mean that the medication has failed. It just means that you need another dose.

[00:04:44] And so before declaring that your GLP-1 does not work, ask yourself, am I actually at an effective dose yet? Because for some people, that dose may be closer to the max because that's the dose that works for them. And it's important that you talk with your clinician who's managing this to make sure that they're tapering you up appropriately and based on how you're presenting, like making sure you don't have side effects as you go up. All right. So reason number one, you may be on a low dose.

[00:05:14] And if you think you may be on a low dose, talk to your doctor, especially about increasing the dose at the next month. So reason number two, we may need to optimize nutrition and physical activity. So the second question I ask my patients is, what are we doing in addition to the medications? Because GLP-1 medications are extremely effective tools. But the medication is only one component of a comprehensive obesity treatment.

[00:05:44] So it's important that you look at the other pillars of obesity management. Looking at your nutrition, what are you eating? Are you eating? Because a lot of my patients, because their appetite is curbed, they may be only eating one meal a day. And that meal may still be small because when they eat, they feel full. But guess what? Their body is getting too few calories and it's holding on to the weight and they cannot shed it.

[00:06:13] And so I like to describe this as the starvation mode where your body's holding on. And even though you're eating smaller meals, you may be exercising. You're still not losing weight because you're under eating. So it's important that you look at your meals, making sure you're giving your body the nutrition it needs, making sure you're giving your body the protein it needs.

[00:06:36] And we've talked about how much protein you need in prior episodes because protein makes a huge difference in how you feel. You have more energy. You know, some people complain they're having hair loss, but they're not still getting that protein in. Also, how much fiber are you getting it? You know, are you getting your vegetables? And this is important because the medication can cause constipation. So making sure you're drinking your water and fiber will help you keep regularity.

[00:07:03] And of course, how about those highly processed foods or sugary beverages? Have you given up the eight hour energy or the sodas or the pop? Are you still drinking a lot of alcohol? Because guess what? Alcohol has sugar in it too. And so that can cause you to gain weight. The highly processed foods, are you eating those types of snacks, going to fast food restaurants where they just have highly processed foods? Also frequent snacking.

[00:07:32] Are you, you know, nibbling on nuts all day? Like, you know, these are things that can make a difference. And then next, you need to look at your physical activity. Are you exercising? You know, or did your exercise change? A lot of times people were very active and then something happened. They may had to work more hours at work or somebody got sick at home. And so now they're not doing that same exercise and they're wondering why their weight has stalled.

[00:07:59] And that's because of the fact that your activity has changed. So it's important that, you know, looking at where you are, am I moving regularly? Am I exercising? Because as we start to lose weight, our body goes through something called metabolic adaptation, where it starts to decrease your metabolism as well as increase your hunger hormone called ghrelin and decreases your fullness hormone called leptin. And so which basically makes it harder.

[00:08:28] You have to do more in order to burn the same amount of calories you did when you first started. And the GLP-1s can help block the hunger hormone. So you're not feeling that, which is good. However, it makes it easy for your body to get used to what you're doing and you kind of slow down and not lose as much weight. And so that's one way how you can kind of work through it to kind of break through that plateau. Also, it's important to look at resistance or strength training because as you tone your

[00:08:56] muscle, that actually burns more calories at rest than body fat. So the more that you're doing, the more calories you're burning and increasing and maintaining your metabolism as well. So reason number two is to kind of look at your healthy habits, your pillars, how you're eating with your nutrition, how you're moving with your exercise, stress. How are you managing your stress? Are you sleeping enough?

[00:09:25] Like these areas are so important in managing obesity and they can also play a role. And I like to think of medication as a tool that you can make implementing these behaviors easily. And if you're less hungry, you're getting full sooner. You're thinking about food less often. And we can use that opportunity to build habits that support your long term health. So reason number three. And I said this before and I'm going to say it again.

[00:09:53] You may be eating too little. And like I said before, I know this does not surprise you, but I sometimes will ask a patient what they ate yesterday and the answer was like one meal. Or I had some coffee in the morning and then I had a little dinner. And like I said, our goal with obesity treatment is not to see how little you can eat. Our goal is to improve your health while helping you lose excess adipose tissue and preserve

[00:10:22] as much lean muscle. So if the medication suppresses your appetite so much that you constantly cannot meet your nutritional needs, then that deserves attention. That means you need to talk to your doctor about maybe you go down to the next dose so that you can start to eat and get what you need and be fuel that you need so that you can start to lose more weight. Because when you are eating too few calories, your body's just going to hold it on anyway.

[00:10:49] And I know sometimes people will tell me, well, I'm afraid if I eat, I'll gain weight. But that's the problem. You're not eating and you're not gaining weight. So maybe we should try something different. And then once again, it's important to make sure you're getting your protein in.

[00:11:04] And, you know, if you're someone who's routinely skipping meals because you can't eat or struggling to get protein in or feeling weak or excessively fatigued, it may be time to talk to your clinician about other alternatives. Or maybe starting with getting protein shakes, things like that. So you're getting your calories and the protein you need, but it's not making you feel full because going up on the dose in this case is going to harm you instead of help you.

[00:11:34] And so it's important that you make sure you're getting your calories and your protein in as well. And eating a balanced diet. Your body needs it and your body will thank you. And then reason number four, your treatment may need to be adjusted. So just because you're on one medication, you're tolerating it, it's working for you, but you notice that you've gotten to the max dose of this medication and you're still kind of have not been losing weight.

[00:12:01] Then it may be that you need to combine a different medication or you need to switch medications altogether to something that may be a little bit stronger. And it just depends on where you are. But sometimes speaking with your clinician, that can help but decide which is the best management and goal and pathway that you need to make. Because not everyone responds equally to every obesity medication.

[00:12:27] Like I said before, some are high responders, some are average responders, and some have little response. And it's just trying to individualize medications, a weight, obesity medication, so you pick the right medication that works for you. And so if you've given a medication an adequate trial at an appropriate dose and you're still not getting the expected response, that's a conversation you need to have with your clinician on what's the next steps.

[00:12:53] So if you don't see the scale is moving before you decide that your GOP-1 has failed, ask yourself four questions. Number one, am I still on a starter or lower dose? Number two, have I optimized my nutrition, physical activity, sleep, or other lifestyle factors? Number three, am I eating enough to meet my nutritional needs, especially protein? And working to preserve muscle with resistance training and strength training?

[00:13:22] Or number four, is it time for my clinician and me to reassess my dose and overall treatment plan? The last thing I want you to remember today is to do not compare your chapter two to someone else's chapter 10. And what I mean by that is the person on social media who says they lost 50 pounds may have a completely different starting weight than you do. Medical history, medication, dose, nutritional plan, activity level, treatment duration, the list goes on and on.

[00:13:51] And the goal is not to lose weight as quickly as somebody on Instagram or TikTok. The goal is to find treatment that is safe, effective, sustainable, and improves your health. So if you're taking a GOP-1 and thinking, why am I not losing weight? Do not automatically assume that you've failed or that the medication has failed. Sometimes we simply need to figure out what piece of the puzzle needs to be adjusted. Thank you for joining me on another episode of the Back on Track Achieving Healthy Weight Loss podcast.

[00:14:20] I am Dr. Alicia Shelly. If today's episode encouraged you, I'd love for you to subscribe, leave a review, and share this episode with somebody who needs to hear it. And until next time, stay strong, stay committed, stay consistent, and remember, we are stronger together.