The Principle that Changes Everything About Weight Loss Medications …

Over the past couple of weeks I’ve been sharing my views about the most talked about topic in the weight management space – weight loss medications.

In my first blog, I shared how the new wave of GLP-1 receptor agonists have changed the weight management game for good. I acknowledged the massive potential benefits, but also the notable downsides … including the clear research findings that most people regain weight once they stop taking them. 

In my second blog, I encouraged people interested in weight loss medications to place the first piece of the weight loss medications puzzle, and work with a great doctor. Based on my experiences working alongside doctors who have a special interest in weight management pharmacotherapy, I argued that their ability to optimize your experience made them an investment well worth making.

Today, I want to close the loop by talking about two more pieces of the puzzle that I consider equally important – and the ones I’m most qualified to speak about – the behavioural and psychological elements of the weight loss medications journey. 

In doing so, I want to introduce you to a principle that I think can reframe the entire weight loss medications conversation.

The ‘Lowest Effective Dose’ Principle

There’s a framework I want to share with you today – I use it with my clients and I think it represents an empowered way to think about your journey with weight loss medications.

In medicine, there is a concept called the ‘lowest effective dose’* – the smallest amount of a medication that achieves the desired therapeutic effect. It’s a principle that balances medication effectiveness with minimising unwanted side effects and costs.

Many of my clients would eventually like to be free of weight loss medications, or at least be on lower doses where the side effects and costs are more manageable. Some are also worried about developing ‘a tolerance’ for their medication or the long-term consequences of staying on them forever (which is understandable, given the long-term effects are currently unknown).

While I never guarantee that a client will be able to come off weight loss medications, I do talk with them about the lowest effective dose principle, and how – by working on their mindsets and habits – they can guarantee that they’ll be on the lowest effective dose for them. 

A Real-Life Example

Here’s an example of what addressing the behavioural and psychological pieces of the puzzle can look like in practice, using a client we’ll call ‘Sally’ (who is taking Mounjaro in consultation with her GP):

Nutrition habits.

Sally was eating less since starting her medication, but was feeling tired and lethargic. And – although her portions were definitely smaller – she was still eating sweets most nights. Some work with our dietitian, Shauna Summers helped her to eat more nutritiously, which brought her energy levels back up (and also saw her eating more protein, which supported her muscle mass as she lost weight). And Sally and I worked to reduce her overeating in the evening, which we had identified as mainly emotionally-based. This is a good example of what I call ‘doing the parts the medication doesn’t do’ – rather than relying on the medication to do all the heavy lifting, supporting your powerful medical tool by changing your habits and mindsets to make it more effective.

Movement habits.

Sally wanted to be more physically active, but was intimidated by the ‘bougie gyms’ she was considering joining. After some discussion and problem solving, I referred her to a great exercise physiologist, who created a workout plan she could do at home. Ironically – with building her fitness at home combined with her weight loss – Sally gained the confidence to join up at a bougie new gym that opened up near her! Sally, her ex-phys, and I were all happy that the resistance training had helped to maintain her muscle mass, and – as importantly – she was building habits that would support her long-term, no matter what she chose to do with the medication.

Mindset transformations.

You can see from the examples above that psychology was a key component in Sally making the habit changes she wanted to. This is an invaluable contribution of psychology – exploring why we don’t make the changes we desire and overcoming any barriers using the power of our minds. As well as helping with changing habits, psychology can also help you to take the weight loss medications journey in a more empowered way – in Sally’s case, this looked like supporting her through some weight plateaus and helping her stay the course when life got difficult.

Sally is a great example of following a blueprint for weight loss medications success. Rather than expecting the medication to magically fix her eating habits, she used it to support her to create a more nutritious way of eating. And rather than dismissing the importance of physical activity because she was losing weight, she used the opportunity to create some regular exercise habits that support her health and wellbeing. Of course, these improvements in habits and mindsets helped to optimize her results from a body composition perspective. But – as importantly – they set her up for lasting success – a success where she can be on the lowest effective dose of her medication over time.

In our last session, Sally said to me that – for the first time in decades – she’s happy with her weight, and she is now working with her doctor to reduce her dose of medication.** Will she be able to come off the medication for good? The reality is, we don’t know …

When people use the medication – while simultaneously building the habits and mindsets that support it – the medication has to do far less work, and one of two things tends to happen:

1. For some people, the lowest effective dose becomes zero – they no longer need the medication to maintain their results.
2. For others, the lowest effective dose becomes a lower maintenance dose – one that comes with fewer side effects and at a significantly lower cost – creating a far more sustainable long-term picture.

In both cases, you’re working with the medication instead of overly relying on it, and you’re building the foundation for results that last.

The Importance of Wraparound Care

You’ll note in the example that Sally received close interdisciplinary support from her allied health team. I wrote in my last blog that if you want better than average results, it requires you to take the weight loss medications journey in a better than average way, and – for this – it often helps to enlist the support of better than average care.

For over twenty years, I’ve been an advocate for what we call ‘wraparound care’ in weight management – the idea that people get the best outcomes when they have access to not only a great doctor, but also a qualified dietitian, a knowledgeable fitness professional, and a caring psychologist, all working together.

When I started advocating for wraparound care – particularly in the context of supporting bariatric surgery patients – these conversations were difficult. Many surgeons weren’t convinced that psychology – or even dietetics – added much beyond surgery itself (fortunately, this has since changed!). We had to advocate hard for the importance of the whole team in supporting patients.

But fast forward to today, and something really heartening is happening. Recently, whenever I have presented on weight loss medications at conferences, workshops, and symposiums – alongside GPs, endocrinologists, surgeons, dietitians, and exercise physiologists – every single person in the room is advocating for the importance of wraparound care to support patients to achieve best outcomes!

The health professionals conducting the research – as well as those supporting patients day-in-day-out – realise the importance of a team all working together to support the most important member of the team – the patient themselves!
 

The Take Home Message

If you do decide to undertake the weight loss medications journey – or if you are already on it – I want you to be prepared to get the best results possible. And I think this involves at least three things:

1. Acknowledging the pros and cons of the medications – so you can make informed decisions about their use.
2. Working with a great weight loss medications doctor – who can help you to minimise the risks and maximise the benefits.
3. Building healthy habits and mindsets alongside the medication – setting yourself up for the long-term.

When you do all of these things, you are following a blueprint for weight loss medications success: creating a way to transcend many of the potential downsides of the medications, whilst maximizing your chances of them becoming everything you wanted them to be!

Thank you so much for taking the journey of these blogs with me. I’ll be sharing more about exactly how to put this blueprint into practice – including how our team approaches it – in something I’m hosting very soon.

Yours in supported, collaborative, and sustainable transformation,

Glenn

P.S. To help you access the support of a great weight loss medications doctor, dietitian, exercise physiologist, and psychologist, I am running a 4-Week Weight Loss Medications Mastery Program in my online community starting June 29th, secure your spot! 

*Also often called the Minimum Effective Dose or ‘MED’.

**It should be noted that Sally and I also worked on her body image – this helped her to be happier with her lower weight, even though it may not have – in her words – made her ‘a skinny mini’.