Nutritionists in the ‘Age of GLP-1s’

Glucagon-like peptide-1 (GLP-1) medication — better known as Ozempic, Wegovy or Mounjaro — have flooded the weight loss market and popular culture in recent years.

Originally developed for the treatment of diabetes, now they are being lauded for their weight loss benefits. Many may be curious if these medications will replace traditional diet and exercise regimes, and Kevin Huggins, associate professor of nutrition science in Auburn University’s College of Human Sciences, has the answer.

“GLP-1s are remarkable in diabetes control and weight loss,” Huggins said. “But your body knows when you’re not getting the right amount of calories, and it will fight against that. There is always going to be a place for nutrition professionals to empower people to maintain a healthy weight.”

Science behind slimming side effect

 Our bodies naturally make GLP-1, an incretin metabolic hormone. After we eat, our small intestines release it to help secrete insulin from the pancreas. Combined with another incretin hormone, GIP, GLP-1 helps get glucose into the muscle cells to be converted to energy — known as the incretin effect.

The medicines — Ozempic, Wegovy, etc. — are GLP-1 agonists developed from a peptide, a portion of the natural hormone. Drug companies developed the synthetic agonist, which helps the naturally occurring GLP-1 hormone bind to its receptor in the blood and stay in circulation longer.

“GLP-1 agonists like Ozempic and Wegovy hang around in the blood a lot longer. The weekly injections help the pancreas secrete more insulin and the brain curb appetite,” Huggins said. “The insulin effects help with the glucose control and the appetite effects help for the weight aspect.”

Huggins conveys that the drugs’ impact on the brain to inhibit appetite and promote a feeling of fullness are effective.

“The central effect on the brain of those satiety and appetite centers are not well-understood,” he said. “Anecdotally, people report that they feel full and are no longer constantly thinking about food and triggers that cause them to eat when they’re not hungry.”

Will power + nutrition education = success

While the reduced caloric intake is good for weight loss, it’s less optimal for nutrition.

“From a nutrition standpoint, those who eat too little on these GLP-1 medications will miss out on some critical nutrients,” Huggins said. “The shift in the nutrition and dietetics industry is to incorporate these drugs to help people with will power while promoting healthy eating and exercise.”

Many weight loss programs — including Weight Watchers and Noom — are now incorporating GLP-1s into their methods. Nutrition education combined with appetite control will make for a sustainable, healthy lifestyle.

“Understanding healthy food choices and how exercise helps you maintain your weight is essential, especially if people want to eventually get off the GLP-1 medication,” Huggins said.

While common side effects of the medication are reported to be moderate, Huggins warned that the long-term effects of the drugs are yet to be known and the short-term effects may weaken the body.

“My concern is always muscle loss,” he said. “When you lose weight, you’re going to lose lean muscle mass. Where nutrition professionals come in is to help people using these drugs lose fat, not muscle. We want to make sure they’re getting their protein and that they incorporate resistance and weight training to mitigate the muscle loss.”

Next generation of nutrition professionals

Huggins has incorporated lessons about GLP-1s into his upper level macronutrients metabolism course.

“You don’t see information about the incretin effect in textbooks yet,” he said. “I teach about the basic physiology behind these drugs because most of our students are going to become medical professionals or dieticians — they most certainly will have patients using these drugs.”

He maintained that GLP-1s are a powerful tool in managing diabetes and obesity.

“Our mission is to help people achieve a healthy weight, and there’s so much left to be researched and understood about these drugs, their long-term effects on weight management,” he continued. “GLP-1 drugs are not going away.

“As dieticians and nutritionists, we have to educate our patients how they are just one part of maintaining a healthy lifestyle.”