Welcome to the new weight loss drug era – a moment that has been years in the making. GLP-1s were approved in the USA in 2005 and then in Canada in 2011.
For many people that have struggled with their weight these drugs may seem like a dream come true. And for the most part, they are the best that the market has seen in years. But like all pharmaceutical treatments, these drugs come with their pros and cons and when used, should be seen as part of a comprehensive weight loss strategy, rather than the entire strategy.
What is a GLP-1?
Your body naturally produces a hormone called glucagon-like peptide 1 (GLP-1). GLP-1 helps your body manage hunger. When you eat, GLP-1 sends your body the message: “I’m satisfied.” It’s been found that people with type 2 diabetes need more GLP-1 than others. This may be because their body is producing less. It may be destroying GLP-1 faster or not responding to normal levels. Experts now believe that this may be true in people with obesity too.
How do GLP-1s Work?
GLP-1 meds add to the GLP-1 your body makes with a synthetic form of the hormone. This slows stomach emptying, increases insulin production and reduces sugar released from the liver. Your brain gets the message that it’s time to stop eating.
Who is Using GLP-1s in Canada?
According to a survey done by Dalhousie University, the results of which were released in March 2024, GLP-1s are used by a varied demographic, with a slight majority of males (11 percent compared to 10 percent for females) and millennials taking the lead at 12 percent. Ontario boasts the highest usage rate in Canada at 13 percent, while Prince Edward Island records the lowest at four percent. A majority of users (79 percent) have been using these drugs for more than three months, indicating a significant dependence on them.
Guidelines For Usage
The interesting thing is that with 1 in 10 Canadian adults using these drugs now, the guidance around how to use them by the medical profession seems to be lacking. At least until now. Guidelines have recently been released in the US by some major medical organizations on how to support people on GLP-1s, and they made one thing clear: GLP-1s alone are not enough for healthy weight loss.
The research found that patients who pair GLP-1 therapy with structured nutrition, behavioural and nutrition support are more likely to be consistent with treatment, lose more weight, and actually maintain weight loss after stopping medication.
Here is something people don’t realize, when you lose weight you lose a combination of body fat and muscle mass. And for people taking GLP-1s the muscle loss tends to be more pronounced.
To understand in greater detail why this matters you can read a previous post but in a nutshell, our muscle is one of the biggest contributors to what we loosely refer to as our metabolism. The more muscle we have, the higher our metabolism is. And so, a loss of muscle mass leads to a ‘slower metabolism’ which would require an individual to continue to cut calories lower and lower in order to maintain weight loss. On the opposite side, an individual that gains muscle mass can actually continue to eat the same amount but in theory lose weight as their metabolism is now increased.
But the good news is, you can minimize the risk of declining muscle mass by lifting weights two to three times per week and eating enough protein. And notice I used the word ‘and’. If you lift weights without enough protein you will be spinning your proverbial wheels. You need the protein to provide the building blocks for the muscle synthesis.
How much protein should you consume? Unfortunately there is no consensus, you can read my Definitive Guide to Protein here to get a full take on my opinion, but here is my take in a nutshell.
The RDA [Recommended Dietary Allowance] that’s been established for the average healthy sedentary adult is 0.8 grams of protein per kilogram of body weight per day. However, it’s essential to note that ‘recommended’ is not ‘optimal’. Many studies show we need more than that if we want to be optimal, especially if you are older or pregnant.
So what should we aim for? I’d recommend 1.2 – 1.6 grams of protein per kilogram of ideal body weight per day for optimal health. But if you are trying to lose weight and gain or maintain muscle you may need to increase that up to 2 grams of protein per kilogram of ideal body weight. I will add that in order to trigger something called Muscle Protein Synthesis you need to consume approximately 25-30 grams of protein in one sitting, ideally containing 2.5 to 2.8 grams of Leucine in it.
For example, someone who wants to weigh 165 pounds should be consuming on average 120 – 150 grams of protein per day if they want to lose weight and maintain muscle.
Now, what was also interesting was that this paper outlined eight key nutritional priorities to support patients on GLP-1 medications, adequate protein intake and strength training to preserve lean mass, being just one of them.
They also emphasized the importance of nutrient-dense, minimally processed diets, prevention of micronutrient deficiencies and promoting other lifestyle changes around activity, sleep, mental stress, substance use, and social connections to maximize long-term success.
Sleep Quality: Poor sleep messes with your hormones, namely leptin and ghrelin, that control hunger, which can work against GLP medication. Goal: Aim for 7-9 hours of quality sleep per night.
Alcohol intake: Not only will alcohol mess with the quality of your sleep, but it is empty calories and can increase the risk of GLP-1 side effects. Goal: Aim to minimize, or even better, eliminate alcoholic drinks.
Stress Management: Chronic stress induces cortisol, which increase your cravings and messes with your insulin levels and decreases your ability to burn fat. Goal: Find ways to mitigate stress through walking, yoga, talk therapy and more, just not alcohol (see above!).
Social Support: We know that individuals that surround themselves with people who understand and support their health journey make it more likely that they will stick with it. Goal: Try to find an accountability partner or support group or a friend to share this journey with!
The Final Takeaway
These medications aren’t a magic bullet – they’re a tool. And like any tool, their effectiveness depends on how we use them. GLP’s are one piece of a comprehensive weight loss strategy, they should not be the entire strategy themselves.
