Optimizing GLP: Essential Habits Before, During, or in Place of Therapy

Written by: Emily Ostrow, MS, RDN, LD, RYT

This article aims to provide a concise overview of GLP-1 medications and discuss important preparatory and concurrent lifestyle habits to support their use. It does not intend to offer an exhaustive explanation nor advocate for or against these medications.

GLP-1 stands for glucagon-like peptide-1. Medications such as Wegovy®, Ozempic®, Zepbound®, and Mounjaro® mimic this hormone, which our bodies naturally produce to help regulate blood sugar, digestion, and appetite. To qualify, you must have a body mass index (BMI) of 30 or higher, or have a BMI measuring 27 or above with a weight-related health condition, such as:

- High blood pressure

- High cholesterol

- Type 2 diabetes

- Sleep apnea

-Heart disease

Beyond these criteria, it’s essential to consider other conditions and factors. GLP-1s work, in part, by slowing digestion. This often results in constipation or an overall change in bathroom habits. Thus, if you already experience constipation or have a condition such as IBS or IBD, a GLP-1 may worsen these symptoms. In addition to physical effects, many of my patients often report both positive and negative emotional effects. Appetite reduction can lead to healthier eating habits and less overeating, fostering a healthier relationship with food. GLP-1 medications can lead to significant weight loss. Though this is often the goal and seen as a positive, it can challenge and highlight underlying body dysmorphia that many people experience. Thus, it is important to screen for potential disordered eating habits that may worsen or lead to an eating disorder. It is also recommended to work alongside a therapist to talk through changes and challenges that may arise.

 When working with patients and their providers to discuss the potential to start a GLP-1, I always talk through possible scenarios to ensure the medication remains a tool rather than the foundation to meeting health goals. For example:

- How would you feel about stopping the medication after reaching your goal?

- What if insurance no longer covers it or your provider advises discontinuation?

- How would you handle minimal or no weight loss?

These discussions underscore that GLP-1s are tools to support health goals, not the sole solution. Consistent, balanced nourishment combined with regular physical activity remains fundamental, whether on or off a GLP-1.

Insurance providers often require documentation that patients have attempted weight loss through diet and exercise for at least six months before approving GLP-1 coverage. Although there are nuances to each individual, here are three practical goals:

1. Eat Consistently: Aim for regular meals (breakfast, lunch, dinner) with snacks as needed. Incorporate 9-12 hours of overnight fasting. Skipping meals may lead to overeating highly palatable foods later.

2. Prioritize Lean Protein and Fiber: Choose whole food sources and limit processed foods and oversized carbohydrate portions.

3. Stay Active Daily: Incorporate strength training 1-2 times per week, 150+ minutes of steady cardio weekly, and restorative movements like walking, stair climbing, or stretching daily.

Working with a registered dietitian and personal trainer can help tailor these recommendations to individual needs. Building these habits may achieve your goals without medication, or prepare you to use GLP-1s more effectively and safely. Maintaining these habits is crucial when discontinuing GLP-1 medication to support sustained results. Establishing a care team—including a clinical provider, registered dietitian, therapist (if needed), and trainer—will enhance your support and success whether or not you use GLP-1s. Healthy habits are essential before, alongside, and after GLP-1 use. These medications can be life-changing for many, but their use should be intentional and supported by a comprehensive care plan and team.