55. Balancing Acts: Empowering Weight Loss Through GLP-1 Advocacy

In this episode, Dr. Stacy Heimburger delves into the transformative world of GLP-1 medications and their role in weight loss and emotional eating. Discover how these medications, which mimic the hormone glucagon-like peptide-1, can help manage cravings and support your weight loss journey.

Dr. Heimburger discusses essential lifestyle changes—such as improved dietary choices, increased physical activity, and effective behavioral interventions—that complement GLP-1 therapy for lasting results. Learn why these medications are not just a quick fix but vital tools that alleviate the symptoms of emotional eating, allowing you to focus on the underlying issues.

Join us as we explore the intersection of medication and mindful planning, and how you can incorporate these strategies into your weight loss journey. Whether you’re considering GLP-1 medications or looking to enhance your approach to dieting, this episode offers valuable insights for anyone seeking sustainable weight management.

Tune in to empower your journey towards mindful eating and lasting weight loss success!

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This episode was produced by The Podcast Teacher.

Transcript

Welcome back to the podcast! I'm Dr. Stacy Heimburger, and this is Weight Loss Made Simple. I want to talk to you about GLP-1 medications, and I know I’ve talked about them before, but I’ve just heard more people talking about them in the last couple of weeks saying things like, “I was gonna try it because I’m ready to cheat,” or “I’m gonna try it because I just give up.” I think that’s not the best way to think about these medications, so I wanted to talk about it.

Number one, I get a little bit of pushback. Like, how can I be a weight loss coach that is teaching people how to lose weight without these medications and still be an advocate for these medications? I don’t think that those things are mutually exclusive. So that’s what I wanted to talk about a little bit today about some studies and some lifestyle changes that need to happen to be successful long-term on these medications.

So what’s a GLP-1? These are medications that mimic a hormone that we already have in our bodies; it’s glucagon-like peptide-1, and it plays a role in appetite control. So it’s not just about losing weight; it’s about appetite control. The reason these were first developed was because one of the other ways they work, besides just making you feel full faster or longer, is that it actually helps expedite the body’s natural process of processing sugar. So sugar is not hanging out in our bloodstream as long as it is without these medications, which is why it works great for diabetics.

So when we eat, that food is broken down into our bloodstream. That is actually toxic to the bloodstream. I don’t know if people really realize that, but our bloodstream—like our blood vessels—do not like sugar hanging out in there, especially our smallest blood vessels. So insulin is released from the pancreas. The insulin grabs that sugar and tries to get it out of the bloodstream as fast as possible and put it into our muscle cells or anywhere else that needs immediate energy, and then store the rest as fat.

So these GLP-1 agonists, right? They’re helpers that expedite that process. That’s some of the diabetic complications we see—that’s from the tiny blood vessels in our eyes, and getting some nerve damage and loss of feeling in our feet—again, small blood vessels, poor wound healing. You can see where this is going, right? Kidney disease is also related to those little tiny blood vessels.

So these medications were developed to help get that sugar out of the bloodstream as fast as possible. They also do this wonderful appetite control, and then it just reduces our cravings for a number of reasons. These medications can lead to significant weight loss; in studies, participants lost 5 to 10% of body weight in about a year. The newer ones affect appetite by hitting an extra receptor. I’ve read reports of up to 20% of total body weight lost in a year, so expediting that whole process after we eat, then slowing down gastric emptying, and then reducing cravings.

So these studies were all done with lifestyle changes. It was not just medicine. It wasn’t “take this medicine, never think about anything again, and you’ll just magically lose weight.” It’s not “take this ice cream still like every night for dinner.” You might not be hungry, but it’s OK if you still like only eating dessert—that’s not going to give you long-term results.

Lifestyle changes were studied with these. It wasn’t about the medical intervention; this is like a support system. I heard—I was listening to a book today about anxiety medication, and it was talking about how the medication is not the cure; the medication is a symptom reliever so that we can work on what’s causing the problem. I think these medications are exactly the same thing. The medication is not a magic wand. It’s not gonna cure your emotional eating. It’s not gonna cure this emergency eating, scarcity eating that happens. It is going to alleviate the symptoms so that you can work on the long-term changes that need to happen for the cure.

With regards to anxiety medication, it was talking about how our body uses anxiety as an alarm that something else is wrong. When we can use medications to reduce our anxiety, we can start to work on the things that our body has been warning us about. I feel like these medications do the same thing for overeating and weight loss. When we have food scarcity eating, our thoughts about eating can feel very emergent, desperate, and problematic.

These medications don’t undo all the years of diet trauma or all the past programming of food scarcity or whatever else is leading to our emotional and emergent cravings for overeating, but they’ll take the temperature down on those cravings so we can do the work. I think that’s what everyone is missing with these medications, and again, I’m a huge advocate for them, but we have to do the work. These medications will help with the symptoms so that we can do the work.

So what did they study? What lifestyle changes? They studied things like dietary choices, physical activity, and behavioral interventions. These are the things that coaches work on. I do a lot of nutrition counseling. I’m certified in lifestyle medicine, which is all about nutrition. Research indicated that these medications reported improved habits when they weren’t so emergently hungry.

We can think about things like fruits, vegetables, and whole grains, and maybe not eating as much processed food. But we have to be mindful and recognize that that’s what we need to do. We feel fuller, faster, longer with smaller portions, so if we can use these medications as an opportunity when we don’t need as much to feel full, and we’re not feeling so scarce about food, and it doesn’t feel emergent, we can start honing in on our nutrition.

We can start prioritizing protein and fiber. These medications help with smaller portions and to start making long-term nutrition choices. The Journal of Obesity found that patients using these medications were more likely to engage in physical activity. Why? When we lose weight, we usually have a little bit more energy and a little less fatigue.

I can tell you from the fasting research—and if you’ve ever been in a fasting group—when we eat only what our body needs, we don’t feel as tired. Our energy level is higher, right? People that do fast say all the time that their energy feels amazing. So when we’re eating just what our body needs—or even a little less—we’re losing weight, and we can often have higher energy levels.

Then I coach people through all of our thoughts about exercise and all the rules about exercise so that we can get more comfortable with just moving our bodies. Behavioral interventions and coaching are one of those interventions. You will get greater weight loss. You will get healthier coping mechanisms. You will identify your trigger behaviors, and this will help you sustain whatever weight loss you get on these medications.

Let’s talk about the possibility that people will need to be on these medications for a little bit forever. I don’t think anyone should look down their nose at that, right? It’s the same thing as an anxiety medication. If we’re taking anxiety medication to relieve the symptoms, to work on the things that are causing our anxiety, and we realize that there have just been too many alarms in our life—too much trauma, too much to unpack—all of it, we don’t think twice about people on anxiety medications forever.

It’s the same thing with these medications. If you start doing the work and realize that your diet trauma, food scarcity, and emotional overeating are just so strong that you’re even having problems with these medications, you might need to be on them forever, and that’s OK. That’s not a problem. We can still do the lifestyle change work on these medications when our heads are a little clearer, and then maybe we can come down a little bit on the dose or maybe we can come off if we want.

Psychological benefits: individuals on these medications experience improvements in psychological well-being, including reductions in anxiety and depressive symptoms. They just did a huge study to dispel the hypothesis that people can be more suicidal—not true at all. These medications help with psychological well-being, too, and I think part of it is that all the food drama that has been going on for years and years just quiets down to a level that’s not emergent. It makes you feel better mentally, and then you’re more likely to keep doing those positive health behaviors, which supports the weight loss and the maintenance efforts.

Eating in an emergency? These medications just alleviate the emergency. They alleviate that feeling of super urgent craving. They allow you to think a little bit. It allows me to help you open up about what’s going on for you. You just said five minutes ago you weren’t hungry. You got a phone call, and now you’re looking for food. What happened on the phone call? It gives you that space where things are not so urgent that we can talk about what’s going on with our thoughts and feelings that are causing us to make some of these choices.

Medications are a tool in the toolbox of other weight loss medications. I think they are so helpful because they really do alleviate that symptom of urgency, that food demand, that emergent craving. They help you feel fuller so that you don’t need to eat as much, making it easier to be mindful about what you’re actually eating.

All the studies were done with lifestyle changes as well. I actually have a couple of clients that I coach who have taken or are taking these medications. A lot of your doctors or providers don’t know the coaching techniques or don’t have the time to go through and coach you on these things. Part A is taking the meds, but part B is where the work is. They don’t have the time or they’re not trained, and that’s why I think it’s vital to find a coach or psychologist—someone to talk to—to help you with all the mental aspects of being on these medications.

Lots of people come to me with so many questions and want to understand what’s going on mentally for them on these medications so that they can eventually come off or move down to the lowest dose, or whatever their goal is for these medications long-term. Long-term success does demand that we do some of the mental work.

So I want you to take a moment to reflect on your weight loss. Do you think a GLP-1 medication fits into your plans? I don’t think you should view it as cheating or giving up; that’s not the case at all. We still have lots of work to do. It’s just alleviating some of the urgent symptoms and giving you the mental space to do the work.

If you’re in Louisiana, I can help you with coaching. If you’re anywhere, remember this is your journey. Your weight loss journey is yours alone; you don’t have to listen to me, and you don’t have to listen to anyone else, either. If you’re on this medication or thinking about these medications and someone’s trying to shame you for them, you have the option of not listening to them.

If you’re on these medications and you need help, please reach out. We have to do the mental work. It’s not just, “Take this, and I’ll just eat ice cream for dinner and won’t eat anything else all day.” That’s not sustainable; it’s not healthy, and your body is not gonna like that. So we gotta figure out how to maximize nutrition.

I want to maximize your weight loss using these medications, and it comes with a combination of both medication and coaching. Alright, if you like this episode, please share it with a friend or leave a review. I would love that! Otherwise, I’ll see you next week. Alright, bye!