Dr. Sarah Stombaugh:
This is Dr. Sarah Stombaugh, and you are listening to the Conquer Your Weight Podcast.

Announcer:
Welcome to the Conquer Your Weight Podcast, where you will learn to understand your mind and body so you can achieve long-term weight loss. Here’s your host, obesity medicine physician and life coach, Dr. Sarah Stombaugh.

Dr. Sarah Stombaugh:
Today, we are addressing a question that I get probably just about every single day, which is how do I be successful on my GLP medications when I’m starting out? How do I do that right? What should I expect when I’m very first starting this journey? And today, that’s exactly what we’re going to talk about. What should your first month on a GLP medication look like? We are going to go through all of the pieces that you need to find long-term success in your weight loss journey. Now, if you are new here to my YouTube channel or if you’re listening on the podcast version, I would so appreciate your likes and subscribes. I am growing my YouTube channel and it really means a lot for every single one of you who is listening and joining us today. So thank you so, so much. We are diving into this topic because you want to get the support. You want to feel like, hey, I can be successful on this journey, and I am absolutely here to help you. We will, of course, help you in today’s YouTube channel. But if you are looking for more one-on-one support, I would so love to see you as a patient in my medical practice. I see patients in person in Charlottesville, Virginia, and by telemedicine in Illinois, Tennessee, and Virginia. Reach out to me at www.sarastombaughmd.com to learn more and get started today so I can help you in your weight loss journey.

So let’s dive into it. How are you going to be successful on those first that first month of GLP medication? Here are the things we are going to talk about. For one, you are going to learn what to expect. You are going to have physical changes. You are going to have mental changes. What are you going to prioritize in your journey? What are the things that I do not want you to stress about, do not want you panicking on? And how are we going to help you create that long-term success piece? So let’s start out and think about this because you are starting your journey and it is normal to experience a whole host of emotions, everything from excitement, maybe there’s some fear or skepticism that’s creeping in. And you might go back and forth, but you know, minute to minute or second to second between feeling those different emotions. And that is okay. That is normal. That is the expected response to have. And I want you to know that it is okay. You are going to be just fine. Now, while these medications are designed for long-term use, you could stop them at any time. It is safe to stop a medication abruptly. So let’s say, worst case scenario, you start the medication and you hate it, just stop. That’s absolutely okay. Of course, talk to your individual doctor to make that decision that’s right for you. But we’re not making a forever decision today. We want you to have this idea of like, hey, is this something that I would do long term? And if you’re open to that, that is all I want you to be committed to. So you’re not making a decision for the rest of your life. You are making a decision for now that if it goes well, then you get to keep this with you for long term. Because I think that can be really overwhelming. Like this is a really, really big commitment when you’re thinking about the rest of your life.

So take away that pressure, take away and just get started one foot in front of the other. So when those emotions are coming up, it’s totally okay. And here is how we are going to be successful in that first month of the medication. So you on that first month are start to notice some changes. You’re going to have some physical changes and maybe some mental changes as well. A lot of people will notice really pretty quickly after taking their first injection that they are noticing differences in appetite. A lot of people will notice two separate things. They may notice that they’re hungry less often and they feel full more quickly. Now, those sound like the same thing, but hunger and fullness are actually two parallel pathways that run in the brain. They do cross-signal with one another, which is why medications like GLP will target both of those two pathways. But what can be the common experience on the GLP medication is we’re getting less hungry less often. And then when we are eating, it doesn’t take as much food to fill us up. So we’re most paying attention to, okay, is my body hungry right now? And then when I am eating, ending the meal when I’m feeling fullness. Now, especially at the very beginning of that journey, fullness may creep up on you really quickly. So it’s really easy to overeat on these medications. Now, major air quotes there, because I’m not necessarily talking about a huge amount of food that creates that feeling of, oh, I really ate too much right now. Especially when you’re very first starting these medications or later on, even, especially as you’re increasing your dose of medications, you might find that it’s not a huge amount of food that creates that feeling of, ugh, I really ate too much. So even if you have like three bites of your dinner and you’re like, you know what, I’m done right now. Sometimes we could be sort of confused by that. Like, well, I didn’t really eat that much. I should probably eat some more. Don’t. At the very beginning of your journey, if you are feeling full, go ahead and end that meal. There will be another time to eat later. But overeating, again, major air quotes, can really drive some of the side effects that can come up with these medications.
So side effects like feeling nausea, maybe having heartburn, indigestion, even having vomiting or some regurgitation where food is coming up can really drive some upset stomach symptoms. So do not overeat. And when you’re starting out, it’s going to look totally different. And the amount of food that takes that overeating feeling can be really a small amount of food that creates that. So just make sure that you are mindful of that feeling and really listening to what your body is telling you. You might notice too that whether you’re overeating or not, that there are some side effects that you’re managing. Most people had some side effects on this medication, but most people had very mild side effects that decreased over time. Things like nausea, for example, diarrhea and constipation. We see these coming up very frequently. So knowing that these medications can come up is something, or that these side effects rather can come up is something that I want you to have on your radar and think about, okay, how do I really reduce this? How do I navigate it? What are the side effects that are coming up for me? Sometimes diarrhea and constipation, those can be hard because some people get diarrhea and some people get constipation and those are opposite of one another. And so do we take a laxative? Do we take something to slow down our bowel movements? How do we manage that? I will say for everybody, fiber is a phenomenal tool, but really paying attention, okay, what is my body feeling? How am I going to navigate these side effects? I think sometimes early on too, there are these changes happening and the scale can be, you’re not sure what to trust. You might see numbers dropping down hugely.

It’s not uncommon that in the first month or so, people might drop huge amounts of weight, like they lose five, 10, 15, 20 pounds and they’re like, oh my gosh, and either, oh my gosh, am I wasting away or oh my gosh, this is amazing. I want you to know that, and that’s not always the experience. Sometimes the scale is slow, but if the scale’s really fast, that can mess with your mind as well for good or for bad. Or like I said, you could sometimes be sort of flip-flopping between those two emotions. So not getting too hung up on this scale can be really important, especially in that first month, because your body’s going to settle into a pattern. If you lost 20 pounds the first month, you were not going to continue to lose 20 pounds month over month. A lot of times that represents someone who had some inflammation, some swelling that their body was ready to drop. Maybe it was a transition in as their body had certain energy stores. A lot of times when our body is holding glycogen in the muscles, when we lose that, there can be a major diuretic defect that happens with that. But all of that to say there are a lot of different reasons why sometimes the rate drop weight drops really quickly at the beginning. It will slow down and do not let that mess with your mind. On the other hand, if you are someone whose weight is coming off very slowly, that could be really discouraging as well. For one, you may know other people in your life who are taking GLP medications. You may see stories on social media and you might start to wonder, like, oh my gosh, is my body broken? Am I not responding in the way that I’m supposed to? Am I going to be the person for whom this medication doesn’t work? I want you to take a big deep breath.

The first month, the scale can be wild. Sometimes it’s too high, sometimes it’s too low. Every once in a while, we get someone who’s right in the middle and things go swimmingly, but the scale during the first month can really throw us. So I don’t want you to put too much stock in it. So we’re just feeling out, okay, how is my body feeling? What does fullness feel like because it feels different right now? What does hunger feel like because it may be experiencing that differently right now, playing around with those things, as well as the change in food noise. So you hear this on social media all the time that people are like, oh my gosh, the food noise is gone. And food noise is the emotional and sort of psychological hunger that we have. It is, however, very hormonally driven. So there can be physiological drivers of it, there can be psychological drivers of it. A lot of times it’s the two together. So we may have things like insulin resistance, for example, that drive us to crave processed carbohydrates like flour and sugar and that type of thing. And then there can be the psychological component where we’ve had a behavioral response where we’ve had those cravings in the past, we’ve given into them because they’re really intense cravings a lot of times. And so we oftentimes have these very intense desires that come up for certain types of food. And one of the things that can be most shocking to people is when the food noise is gone. It is quiet, it is not screaming at them in the way that they have experienced for years in the past. And that can be really surprising to people.

I have a lot of patients who’ve described that they’ve never really felt like they’ve experienced physiological hunger, like stomach growling, that they really just are responding to, like, oh, this sounds good or that sounds good, or it’s time to eat. For example, it’s my work break, it’s my family’s eating, and not really responding to true physiological hunger. And it is wild when the food noise is gone, being able to then hone in, okay, what is my body physically asking me for? The experience can be a little bit jarring and can take some time to get used to. Some people have the experience of realizing, like, oh my gosh, I’ve gone a really long period of time without eating because I just didn’t have the same triggers to eat as I typically would have had. And so there’s some adaptation that crosses from the physical into the mental standpoint, but we see these different adaptations coming up. Now, in that first month, there’s a couple of things I really want you to be thinking of in order to help optimize your weight loss journey. Now, if you were someone who’s realizing, oh my gosh, my appetite suppression is really significant and I feel like I could go the entire day without eating, that is not the goal of these medications. I want to make sure that you are eating regularly, ideally at least three meals per day. Talk to your own doctor about what will make sense for you, but making sure that at least three times per day we’re getting a serving of protein, ideally getting a serving of fiber as well. This doesn’t have to be the Instagram worthy meal that you would share with people. This can literally be a protein shake and an apple. Keep it simple, especially at the beginning, especially when your appetite is not too significant and you’re thinking about, okay, nothing really sounds good right now. The idea of having a protein shake, maybe a protein water, many of those have become really popular. Something like a Greek yogurt or some of the yogurt drinks that are available on the market, maybe even bone broth if you’re, you know, desiring more of that savory or salty profile.

Thinking about something that’s going to get you some protein, get you maybe some fiber, get you some hydration. You may need to pull in something else of that. You might do a fiber supplement, you might do a piece of whole fruit, be thinking about, okay, how am I getting protein and how am I getting fiber? Am I getting at least three servings of those per day? Your first month or so, you’re probably not going to be just hitting exactly perfect in terms of calories or in terms of macros, but I want to make sure that you are at least eating and that you are getting it in some regular interval.

There will be over time that we can adapt, transition your body to more whole type foods. And so, do we want you to be relying on protein shakes for two meals per day for the rest of your life? Absolutely not. That is not the goal. And that can be a really good tool, especially as you’re just kind of getting into the routine, helping your body navigate as you’re feeling pretty significant suppressed appetite. Some things like protein shakes can be a really nice tool in that situation. So we want you to make sure you’re eating. I want you to make sure that when you’re eating, you’re getting protein and that you’re getting fiber and that you’re doing that about three times per day. Now, I also want you to be thinking about hydration. Now, if you’re doing some of the fiber drinks or protein drinks like we’ve been talking about, you are already well on your way to your hydration goals. But hydration is really important as well. Making sure that we are staying well hydrated throughout the day, eating, drinking and eating regularly in order to support ourselves can be important as you’re getting into some of the warm weather months. We’re not there at the time this recording, but we’re just around the corner, I think. And as you get to those warm weather months, we’re thinking not just about are you getting water in your body, but the electrolyte piece as well. So if you are sweating out, do you want to be replacing any of those electrolytes? Certainly we get electrolytes from our food as well, but especially at the beginning of our journey, I would say an electrolyte beverage, a protein beverage, maybe even a fiber beverage, looking to some of those beverage supplements can be a really great way to support yourself. So thinking about all these different pieces, eating regularly throughout the day, getting protein, getting fiber, getting hydrated.

Now, I don’t want you to panic though, because there are certain things that can really get in our heads during that first month. Sometimes we have this like very all or nothing mentality of like, oh my gosh, I’m like not eating really the foods that I know that I should be eating. I’m relying a lot on supplements, or I’m relying a lot on, you know, shakes and smoothies and bars and that type of thing. I don’t really want to be eating this long term, maybe release realizing, oh, I’m not exercising very much this first month. I’m feeling kind of dealing with these side effects and oh my gosh, how do I navigate that? And is the scale moving? Is it moving too much? Is it moving that at all? And I want you to say, just take a big deep breath. There is this getting used to what is going on with your body and the decisions that you’re making right now, the things that you’re doing right now, do not have to be permanent. They could be a means to an end where eventually you are eating entree salads with a serving of lean protein. But if the volume of that type of food sounds like too much at the beginning of your journey, which it likely will, then do not panic. An apple and a protein shake is going to serve you just fine. That is not going to be your dietary advice for the rest of your life. I also, we talked about a little bit before, do not want you to get into a panic on the number on the scale. I want you to connect with your doctor who is prescribing this medication and talk about, okay, what do these goals look like?
A lot of times after the first month, our body is starting to settle into a rhythm, whether it’s starting to pick up in terms of weight loss, whether it’s starting to slow down if you were someone who had really significant weight loss. Now, a lot of times we’re already thinking about, okay, I should be moving on to the next dose of medication. Maybe you are seeing, whether you are, I guess, or not seeing benefit, maybe you are and you’re like excited to keep it up. You want to lose as much weight as you can as quickly as you can. Maybe you’ve not seen the movement on the scale that you’re went to and you’re ready to move on to the next dose. I do not want you to be thinking about moving on to the next dose before that first month, though. So sometimes we’re like a week or two weeks into the journey and you’re already thinking about that. And we absolutely do not want to be making that decision until you’re ready to get your refill of medication. Now, when I’m thinking about moving someone up on their dose, there’s three different things I’m thinking about. I’m thinking about one, what are they feeling in terms of the way the medication feels in their body, both the good effects as well as the negative side effects? So are side effects well managed? If someone’s having significant side effects and we’ve not been able to well manage those, we are not ready to move up on their dose of medication in terms of the way the medication is feeling in their body, in terms of how hungry they are, how in terms of how often they’re able to eat or what food noise is experiencing. My goal is to support them in a dose of medication that allows them to regularly fuel their body. The goal is not to stop eating altogether. If you have a dose of medication that, as you continue on that dose for a period of time, is keeping you from wanting to eat any food, you’re feeling incredibly sick, you’re getting nauseated all the time, maybe you’re even throwing up and you just cannot eat on the medication. That is not the goal. If you are feeling that way, you absolutely should not move up on your dose of medication. And if you are at anything above the starting dose of medication, I would even think about scaling back to a lower dose. So talk to your doctor if you feel like you’re not able to fuel your body at all, if you’re feeling so nauseated that you’re not able to really eat much. That is not the goal.

We’re also looking at what does movement look like on the scale. The person who sees 20 pounds of weight loss in the first month, we are not going to be moving up their dose likely compared to the person who’s seeing maybe they lost a pound or two, their side effects were pretty minimal, they’re feeling maybe a little bit of effect from the medication, but the effect is pretty subtle. That person, it might make sense to move up on their dose, where the person who lost a lot of weight has severe appetite or suppression that is going to make sense to stay at their current dose. And again, if you’re on a higher dose, maybe even being at a slightly lower dose of medication, but have a conversation with your physician about that. And I want you to know, guys, that neither one of these is wrong. I think sometimes we think that, like, oh, like being on a low dose forever is the ideal. And like, no, it’s not. Like different people respond differently to these medications. And you are not a better, more superior person if you are responding on a low dose of medication. So, or you know, like that’s just that’s you, that’s lucky, that’s wonderful. But the dose of medication that you are taking is the dose that your body needs. And I would not get caught up comparing yourself to anybody else and what their journey looks like. I also wouldn’t panic in terms of when we’re seeing sometimes exercise that first month, you’re like, okay, I need to be doing all of the things and you’re not really doing it yet. It will be our goal to get you regularly moving in a way that feels good, that’s helping you to burn calories, that’s helping you to move muscle. It is not my top priority in the first month to make sure that is happening. If you were someone who was already exercising, awesome, just keep up with your regular routine. But if you were not someone who is regularly exercising, gentle movement like walking, or honestly, if you do not exercise at all because that was your baseline in the first month, that is okay as well. Do not feel like you need to go all out. Do not feel like you need to beat yourself up. Your goal is to transition into this in a way that feels smooth, in a way that feels sustainable. Because my goal for you is that we create that sustainable change. I think so often in diet culture, there’s this very all or nothing thinking where you’re doing the exercise, you’re doing the macros, you’re doing the calories, you’re like doing the GLP, you’re like doing all of the things. And if you’re not doing all of the things, then you’re doing none of the things. That is not the goal. I want the GLP medication to be the tool that allows all of the other things to take effect in a way that they haven’t been able to before, in a way that allows you to eat foods that are in line with your goals, to feel satiated with appropriate portions, to feel like you’re not craving and desiring food above and beyond your caloric needs or outside of what your food goals are, to feel like your body feels energized, to feel like you can move, to feel like you can live in a body that feels good, that feels strong. This does not happen overnight. It is going to take time. And sometimes we’re so ready. We like to get started and we want to see the progress at six months, 12 months, two years, five years, and it will come. But going there slowly and major air quotes here as well, because slowly is good. A lot of times it means we are building continuous change. If you got 1% better every single day, you would be a totally unrecognizable person. And I don’t even mean physically, I mean mentally.

If you did 1% more in line with your goals every single day, at the end of six months or 12 months or two years or five years, you would be a completely different person. And I want you to think about that because the next time that you are in your head and you’re thinking, oh my gosh, like it’s just not working. I feel like I want to be doing all of the things or like I just need to be trying harder. That is such a common experience. And if you are having that, I would be so happy to help you reach out to me. I would love to support you in your weight loss journey. If you are starting these medications, I hope today’s episode was awesome. If you are farther into your journey or know someone who’s starting these medications as well, please share today’s episode with them. I would really appreciate it. Thank you for joining me today. I’ll see you all next week.