GLP-1's: Instant Gratification or Gradual Change?

I thought I knew what to expect when I started my first GLP-1 seven years ago. My doctor at the university weight loss program I was in laid out the requirements for me. I did my daily injection, saw the doctor every three months, and met with a registered dietitian once a month. My doctor was clear that I needed to continue my exercise program, which at that time was spinning on a Peloton bike before work three to four days a week. She was also very clear that because I had done a medical weight loss food program two years before, lost 65 lbs and gained 30 back, my body was probably at a set point, and the loss would be slow. I was not expecting instant gratification, but I was not expecting what did happen.

Why a registered dietitian was my first surprise

The registered dietitian was the first surprise. I thought she was going to work with me on a “diet.” She did no such thing. What she did do was evaluate what I was eating and when, and educate me on why it contributed to my always feeling hungry. She helped me to make small, gradual changes that I could live with, incorporating foods I liked, having me try foods I didn’t eat, and adding to my meals. I learned I often wasn’t eating enough, or enough of the foods that would fill me up. The next thing she taught me was about hunger and satiety. How to really sit with how hungry I was, then really think about when I was full enough at the end of a meal. I couldn't remember ever not eating until I was stuffed. I had been a grazer and snacker for as long as I could remember.

Slowly, before I knew it, I ate breakfast and then I ate lunch. No snack. We slowly worked through lunch, then not needing (notice I did not say eliminating) the afternoon snack. Then a satisfying dinner. I continue to work with a registered dietitian and continue to learn and adjust, and I enjoy it.

Learning to coexist with food instead of restricting it

I’ve been in two university weight loss programs with fantastic medical teams, and I have never restricted anything I eat. I have learned how to coexist with food. That was the second surprise. It wasn’t instant gratification, and it wasn’t gradual change. It was somewhere in the middle.

Quieting the food noise that comes with obesity

The next surprise was the quieting of what we now call "food noise." Back then I just called it the six people in my head who wanted to eat ALL THE TIME and talk about what they were going to eat next ALL THE TIME. When the doctor told me other people had this, and that the GLP-1 was quieting this noise, I was so relieved. I thought it was just me, and I was so ashamed. I started to have more emotional space in my head to do the work to understand why I had picked up these eating behaviors at a very early age, and to really start to understand how I had to take care of myself and my body.

How setbacks like surgery affected my GLP-1 journey

The weight I had gained back came off very slowly over the next 18 months. Retirement and a move to a new city, quickly followed by a cancer recurrence with bladder removal surgery, put everything on hold for a year. But that’s the beauty of a GLP-1 paired with doing the physical and emotional work. I didn’t lose all my progress. I may have stalled, but hey, I had my darn bladder removed. When it was time, I refocused with my medical team on how to get back on track.

What actually keeps the weight off long-term

I have now kept off a 65lb—a 30% weight loss—for almost two years. I had kept off the first 45 pretty consistently, but the last 20 were really hard to keep off. What made this weight loss maintenance I never thought was attainable, is the thing that has really surprised me.

The first thing was something my doctor told me for two years, but I wasn’t hearing her: strength training. I did cardio, but I didn’t like strength training and never did it consistently. Strength training, I've learned, is critical to maintaining weight loss. Bonus: It makes you feel, and look, pretty darn good.

The second thing is that I went back into therapy, but this time with a therapist who works with my program specifically on patients using GLP-1s and those who’ve had weight loss surgery. I never realized my head was going to have to catch up with my body, and my head controls my behaviors. My head needed to, and still needs to, learn that it’s not living in an obese person’s body anymore.

Gradual change that finally feels sustainable

All these very gradual changes, that I have worked really, really hard at, have given me the ability to live this life I never, ever, thought would be attainable. Now that I look back it does seem like gradual change but what’s really important is that it happened and I’m no longer afraid it’s not sustainable.