I thought about how I would love to give a Continuing Education (CE) class on GLP-1 medications from a consumer’s viewpoint. I know TikTok, YouTube, Instagram, Facebook, etc. are filled with people’s experiences, but I was thinking a bit differently. As a former provider, I know what I liked to get out of CEs so here is my informal CE information for medical providers who are new-ish to the GLP-1 meds. I won’t go into the technical aspects of what they do, but just stay focused on the consumer experience.
Disclaimer:
Yes, I am speaking for “my people” – the folks with obesity… Classes I, II, III, IV, and those just like me who have or had Class V obesity. I acknowledge I cannot speak for ALL of my people so if anything/everything doesn’t apply, ignore it.
But, if you are so inclined, please tell us readers what is unique about yourself in the comments.
Class Begins
If you’re at this class, you already know what GLP-1 meds are and what they are for. The two main ones are semaglutide (Ozempic/Wegovy) and tirzepatide (Mounjaro). I have a year’s experience on dulaglutide (Trulicity) and am now on Mounjaro x6 weeks. My HbA1c has gone from a 7.8 to a 5.1. BP is now normal. HR down to 70 from 98 average. Lipid panel is all WNL. And I am down 160 pounds in 18 months.
What you might be wondering, however, is what the heck these meds do to, and for, consumers. How do people feel on them? Why are they so popular? Should you try the meds yourself to see what they do? I’m hoping I can answer those questions so you don’t have to go on a GLP-1 yourself unless you need it, but let me show you what the hoopla is all about.
One more thing… I’m hoping this helps when you counsel patients and clients. All too often, significant pieces of information are being left out. It would be good for them to know as much as possible.
Eons of Knowing What to Do
For our whole lives, those with obesity have been told, “Shut your mouth and move your ass.” We have tried the most bizarre diets and exercise plans as well as the normal ones so many thinner people are able to do without any struggle. We know what to eat. We know how to move our bodies. We know so much about food, calories, carb counts, how many calories are burned eating celery, and a zillion more obscure facts about how to change our bodies.
Now we have the GLP-1s and the veil is lifted on the answer to the puzzles of weight loss. Take Mounjaro and your life changes overnight!
Not quite.
It’s so important for people to know that, even as the weight does come off fairly easily and quickly, we really, really cannot just move from sitting on the couch to standing on the scale.
Getting up and moving our bodies is a new learning experience, too. Even walking outside is foreign for many of us. I encourage folks to walk out onto the porch. Then go for three minutes. Then try five. As with most things, once exertion begins, it’s easier to keep going.
Momentum is the healing-from-obesity person’s friend. On the scale. While walking. Needing smaller clothes. Watching our lab results shift. And for those that brave it out, even going to the gym.
Exercise & the Gym
For the super-fat of us who have obesity, the word “gym” is an expletive. The gym is where skinny, pretty people go to be admired for their loveliness. Working out is merely an excuse to be gawked at.
Of course that is totally incorrect, even ridiculous, but telling someone with serious obesity to “go to the gym” is tantamount to sending them to the salt mines. It can take time, sometimes a great deal of time, for someone with Gym-Aversion to titrate into the good parts of being there. Sweating on purpose seems counterintuitive. An entire mental shift has to occur for so many to get themselves using workout equipment. Even in their own homes. Forever, these treadmills, stair climbers, exercise balls, bench presses, and weights all but scream, “YOU CAN’T DO THIS! WHY EVEN TRY!”
And God forbid someone in the gym laugh at us when we are working out. That’s the exact key to never going again.
It takes intense bravery for someone with obesity to learn to move for joy and to feel wonderful. Moving for all our lives has not felt good. It hurts! That’s why I encourage gradual shifts to moving more. It’s surreal sometimes what I can do with my body now. I rarely remember I can walk without a walker or I can skip the electric wheelchair at the supermarket. It’s ingrained in us to minimize energy.
Providers, applaud every forward movement your patient makes. Even if it is merely leaving the cane in the car. The word “exercise” is a horrid word, especially when we’ve been told to do it forever and ever. I tell people, “Move your body in ways you couldn’t before.” Let us know how happy you are we are making changes, even when they seem so small to you.
I give more ideas below when talking about muscle loss.
Hunger & Feeling Full
It’s really weird to not know something we should know instinctively. It’s a complete re-learning of what hunger and fullness feel like.
After spending thousands of hours with many hundreds of people with obesity, both in real life and virtually, I understand (and know first-hand) that hunger really is a foreign feeling for most of us. Is it when the food voices tell us to eat? Look at a clock? Or do we wait until we’re dizzy… then do we need to find something quickly?
Ahhh, Food Noise. Food Voices. Food Chatter. I call it the low hum telling me to forage at all times. I go deeply into Food Noise in this post, but when we are on the GLP-1 medications, for the great majority of us, the Food Noise vanishes. If it does, then we cannot use that directive to think we are hungry. We have to find other paths towards knowing our new stomach and brain.
Is it when we get an empty feeling? Do we wait until our stomachs are growling? What does hunger really feel like? It’s going to be subjective, of course, but I encourage people to play with the different options the body offers. Try waiting a little longer. Do you forget you were thinking about being hungry? Or do you still feel the need to fix some food.
I encourage people to fill their plate a quarter to half what they typically would, then eat slowly. If they are still hungry (another foreign feeling), then have a couple more spoonfuls at a time until full. Not stuffed like Thanksgiving full. But being mindful of what their bodies are feeling. “Do I want more? Am I still hungry?”
I find a lot of people are really confused by the feeling of fullness, some even thinking it is a part of the possible GI symptoms that can come with the GLP-1s. I ask people to sit with the feeling and consider stopping sooner next time. It takes a bit of time for the body to register the food intake and by the time it does, we might have eaten way too much. It’s a new skill, this learning to stop eating before we expect we might be finished. It’s a lot like making something artistic. The artist paints, or molds… then sits back and looks at what is being created. Then, after thinking for a few minutes, goes back to creating again. Finding that full threshold is just like that.
Weight Loss is Fun;
Labs Are the Touchstone
There isn’t enough focus on our labs with these GLP-1s. I’m going to make this tee shirt:
That way when people hear I am on a GLP-1 and roll their eyes, perhaps they will think twice when I point to my shirt. My weight loss will be secondary. Is it a thrill to tell people my weight loss total? Absolutely! But I am trying to create the real joy of normal lab results inside my own head first, and then with all those who learn I have been on “those shots.”
I’ve also found MRI images of visceral and body fat loss inspiring. I wish there were more images to choose from, but these seem to be the most available. Being able to show what our insides look like with fat surrounding our organs compared to when the fat vanishes can be enlightening as all get out!
Using these, you can also remind the client that the more muscle mass a person has, the more calories burned. And, the more muscle, the slimmer the person will look.
These GLP-1 medications seem to be diminishing muscle mass along with fat loss, so it is crucial to find a way to get people on some sort of keep-your-muscle pattern. Telling people to go to the gym is often financially or physically impossible, so giving them low-tech ideas helps a lot.
They can start with walking, then add carrying and lifting soup cans while on their walks. As they feel things get easier, adding bigger cans and longer walks are great. Move to larger plastic bottles of something like ketchup or mustard, working up to Costco-size laundry bottles. Be creative with your patients! It can be a fun experience to see food as a help instead of always being a not-healthy burden. Resistance bands are also fairly inexpensive (under $20) and can be used creatively. “Classes” are online via YouTube and many specifically geared towards people with all classes of obesity. Getting on the floor for us is virtually impossible, so everything needs to be geared towards sitting or standing (for short periods of time), especially in the beginning. At this writing, I am down 161 pounds (weighing 244 pounds) and still cannot get on the floor to do anything. I exercise while in a chair, on the bed, or standing as long as I can do it without hurting too much.
Remember, ANY movement is great. Encourage patients to walk to the bathroom and back and forth two or three times each time they are up. Small changes shift into giant changes. We are proud we are even out of a chair at all!
Celebrations!
Most cultures surround celebrations such as birthdays, anniversaries, graduations, and holidays with food. While we are on the GLP-1 meds, it is easier to contend with these experiences. However, something has cropped up called a “GLP-1 Vacation.” This is when people stop their meds so they can eat during these times… especially when they go on vacation. This horrifies me! If there ever was a time to not gorge, it would be on vacation. But then, I don’t miss eating. I don’t miss missing eating, either. I feel I have eaten enough during my lifetime, I can let go now and enjoy movement as opposed to putting food in my mouth.
You can see the mindset shift here. I speak as a super-fat person trying to counsel you medical folks who might be be seeing more people like me than those who have 30 pounds to lose.
Simply be aware of the “Ozempic Vacation.”
Edit: I wrote an entire post about this topic… Holiday Vacation from Weight Loss Medications
Medication is Forever
People seem weirded out that these medications are meant to be taken forever. They would think nothing of using something to keep their sex drive up, or regrow hair, but for some reason, something they can’t measure themselves seems offensive.
If they choose to go off, what they will be able to measure themselves is their weight. For those that balk, you can stress that gaining weight is a signpost to getting back on the GLP-1s. Oh, and your labs, too, of course.
These medications are not a Diet Plan! This is not Jenny Craig. This is not something to go on and off of. We don’t know if the medications might stop working in someone who randomly takes and stops them. They might find themselves trying them to lose weight again and they don’t work. Will there eventually be a term called “GLP-1 Resistance?”
Again, we just don’t know all the repercussions of these strategies yet. It’s far safer to stay on them than use and stop them willy-nilly.
Reminding patients that many medications are lifelong including birth control (until menopause), meds for epilepsy, prostate problems, many mental illness meds as well as insulin for Type 1 diabetics (and previously Type 2 diabetics… until now). There are worse things than using a medication for the rest of their lives.
Reminding them the secondary illnesses such as high blood pressure, heart problems, liver issues, and diabetes will need to be medicated for life unless the GLP-1s remove those secondary illnesses.
The primary illness… obesity… still has to be taken care of with meds. For life. They can choose: one weekly injection (and oral pills before too long) or using a pill box to hold all the other meds necessary to keep them healthier and alive.
Please Ask About Suicide Ideation!
Losing weight can be mentally weird. Losing 190 pounds after my gastric bypass freaked me out. I was scared of men looking at me and because of that, started eating again. Not being aware of our spatial changes, the body dysmorphia, weight loss in general, can all send people feeling scared and unsure of how to cope. Therapy, one that integrates the old you and the new you, can be one path to understanding the new life.
And there are early reports of suicidal ideation in those that take the meds. I wish I could question them (as someone with Bipolar Disorder 1 and knows ideation well) to explore what came first, the thoughts or the changes. Nevertheless, asking these questions are important.
PLEASE use normal language, not med-speak.
“Are you having thoughts you have never had before? Do you think about hurting yourself? Do you ever get scared by random thoughts that, if you did them, would not end well?”
These are the ways to ask self-harm questions. Saying “suicidal ideation” means nothing to a lot of people. Also the word “suicide” can trigger either shut-down or vigorous denial because they don’t want to be hospitalized.
And please take your time with this question. Make it near the end of your visit and sit if possible, looking at the patient. Not charting. Not in a hurry. Not bored. Not judgmental.
It helps to give resources to all clients in case someone just kept their mouth shut in the office.
Class Dismissed!
I hope this helped in some way. I know it was long, but it needed to be.
If you have questions, please feel free to ask in the comments or email me at HealthAtAnyCost@Gmail.com.
all photos by Barb Herrera except MRI and Canva tee shirt photos