Weight Loss Detective View

GLP-1 injections can be very useful, but in our opinion, they are not a magic bullet. They are not, by themselves, a long-term solution for weight excess. Even if you lose a lot of weight on these injections, if you don’t also improve your diet and lifestyle, you can still be left with an underlying fatty liver and insulin resistance.

How do weight loss injections fit into a weight loss program?

Perhaps you have tried everything you can think of – changing your diet, seeing a dietician or counsellor, exercising, protein powders, supplements – and after all that time, effort and expense, you are still overweight. That is genuinely frustrating.

Please don’t give up. You don’t have to live the rest of your life overweight. If you’ve reached the point where you’re considering weight loss injections, this guide will help you understand them clearly before you decide.

Why being overweight matters for your health

Carrying excess weight for a long time is linked to a higher risk of diabetes, heart disease, high blood pressure, arthritis, dementia and cancer. Obesity also increases inflammation in the body, which speeds up ageing.

The hidden reasons weight loss can be so hard

Becoming and staying overweight is rarely about one single cause. There are often unrecognised metabolic, nutritional, hormonal and emotional imbalances at play – and these need to be addressed before weight loss becomes possible and, importantly, sustainable.

For example, did you know your thyroid blood tests can look perfectly “normal”, yet if you have a fatty liver or poor gut health, your body may be making the wrong shape of thyroid hormone? This leaves you with an underactive thyroid metabolism, making weight loss feel impossible – even though your blood test looks fine. Most people don’t realise that liver and gut health can affect thyroid function this way. Poor thyroid function can also worsen polycystic ovaries and lead to progesterone deficiency, which further adds to weight gain. All these imbalances can be corrected, making weight loss much easier.

This is exactly what the Weight Loss Detective Program investigates

To take a truly holistic approach to weight loss, Dr Cabot created the Weight Loss Detective Program – offering investigation, support and guidance. Our “detectives” are professional nutritionists and naturopaths who analyse your in-depth questionnaire to uncover the hidden issues that could be sabotaging your weight loss.

A healthy lifestyle and eating natural, unprocessed food remain the foundation of managing your weight. But for some people – especially those under high stress – lifestyle changes alone are not enough to achieve sustained weight loss. This is where weight loss injections can offer extra support, as one option within a complete program.

Weight loss injections versus lifestyle changes alone

Many people find it hard to stick with diet and exercise plans long-term. Research shows people get better results from programs that include regular supervision, social support and dietary guidance, compared with programs that don’t.

In one 2022 study, 175 overweight or obese patients given weekly GLP-1 injections lost an average of 5.9% of their total body weight after 3 months, and 10.9% after 6 months.

In a US survey of 1,479 adults, 12% had used a GLP-1 medication. Diabetes was the most common reason (43%), followed by heart disease (26%) and overweight/obesity (22%). For some people cost remains a barrier – 54% of users said it was difficult to afford treatment.

In March 2024, the FDA approved semaglutide to reduce cardiovascular risk in overweight patients who already have heart disease. Medicare appears set to cover semaglutide for that purpose – a notable shift after more than 20 years of not covering weight-loss-only drug therapy.

How much weight can you expect to lose from weight loss injections?

• If you weigh around 91 kg (200 lb): expect to lose about ½–1 kg (1–2 lb) per week.
• If you weigh around 136 kg (300 lb): expect to lose about 7–1.4 kg (1.5–3 lb) per week.
• On liraglutide, most people lost over 5% of body weight over 56 weeks.
• On semaglutide, the average weight loss was almost 15% of body weight over 68 weeks.

How long can you stay on weight loss injections?

Ozempic® and Mounjaro® can be used as long-term therapy, and current studies suggest long-term use is safe when well tolerated and regularly supervised. Regular monitoring is required to ensure there is not loss of lean body mass.

These injections can help maintain a lower body weight long-term, because stopping them usually leads to weight regain if lifestyle and metabolic health is not corrected. Many people can continue on a lower maintenance dose rather than stopping completely. Lower doses are safer.

Research shows that people who stop taking GLP-1 agonists regain around two-thirds of their lost weight within 12 months, and most regain all of it within about 1.7 years. In my experience, this is largely because the underlying causes – insulin resistance, fatty liver, thyroid imbalances, an unhealthy gut microbiome, nutrient deficiencies and other treatable factors – were never identified or addressed.

In fact, around 50 percent of people who start GLP-1 injections stop within a year – often due to cost, side effects, or because results plateau at a new body weight.

Possible side effects

• Loss of muscle mass: Weight loss usually comes from both fat and lean body mass. Your lean body mass comprises your muscle, bone and collagen. Losing muscle is not ideal, because muscle keeps your metabolism, strength and physical performance higher than fat tissue does. If muscle mass isn’t preserved while on these injections, and the medication is later stopped, much of any regained weight tends to be fat rather than muscle. Ozempic® in particular can cause a loss of fat and muscle from the face – sometimes nicknamed “Ozempic face” – which can make you look older.
• Digestive issues: Some people experience constipation, nausea, indigestion and reflux. Slower stomach emptying can also cause burping, bad breath and small intestinal bacterial overgrowth. Semaglutide tends to cause more digestive and mouth-related issues than some other GLP-1 brands.
• Dry mouth: Known medically as xerostomia, dry mouth can distort taste, cause bad breath, and increase the risk of gum disease. If vomiting or reflux occur as well, this can erode tooth enamel over time.
• Vision changes: A common but temporary effect when starting these injections is blurred vision, caused by blood sugar changes temporarily altering the shape of the eye’s lens. This usually resolves within 3 to 4 months.

Simple remedies for common side effects

Protecting your facial fullness

Many people worry about losing facial fat and looking older while losing weight – a realistic concern, since we naturally lose facial fat as we age, contributing to skin sagging. One effective remedy is to chew more tough foods. This helps build muscle mass and bone density in the face, supporting the skin for longer. Most modern diets are full of soft foods – porridge, smoothies, sandwiches, eggs, pasta, chips and soup – which require very little work from your jaw and facial muscles.Research shows that deliberately adding tougher foods to your diet increases facial bone density and muscle mass, reducing future skin sagging. Try tougher cuts of meat with some fat and gristle, raw nuts, raw coconut and raw vegetables. Chewing mastic gum or using a jaw-strengthening device can also help.

Protecting your Muscle and Bone:

The most important prevention to loss of lean body mass is physical exercise and it is vital to have a regular exercise program. This should include walking, some resistance exercises, swimming, Tai Chi, and Pilates. Playing a sport or joining a gym is a great way to stay in shape.On a GLP-1 injection, your appetite for protein-rich foods may drop – partly because slower stomach movement makes meat harder to digest. Protein is essential for maintaining your muscle, bone and collagen. Animal protein provides a full set of essential amino acids, particularly leucine. Supplements such as branched chain amino acids (leucine, isoleucine and valine), HMB and glutamine can reduce muscle breakdown and support muscle growth – helpful, since around 60% of your muscle is made of glutamine. Ultimate Muscle Food powder is a blend of glutamine, branched chain amino acids and HMB in a natural, vegan, lime-flavoured powder – a useful option for people struggling to maintain muscle protein while on a GLP-1 RA drug such as Ozempic®.

Easing dry mouth:

Drinking more water, practising good oral hygiene, chewing xylitol gum, and (where prescribed) the medication pilocarpine can all help relieve a dry mouth and related bad breath.

Who should not use these injections

Should never be used if you have:

• A personal or family history of medullary thyroid carcinoma (a type of thyroid cancer)
• A personal or family history of Multiple Endocrine Neoplasia syndrome type 2 (MEN2)
• An allergy to any ingredient in the medication

Extra caution is needed if you have:

• A history of thyroid cancer
• A history of pancreatitis
• Gut motility problems: these medications slow stomach emptying and are usually avoided in gastroparesis or severe inflammatory bowel disease, as they can worsen nausea, vomiting and bloating.
• Liver or kidney disease: use requires extreme caution and often lower doses.
• Eating disorders: usually avoided with an active history of anorexia or bulimia, since these drugs reduce appetite.
• Pregnancy or breastfeeding: not recommended, and should be stopped at least two months before trying to conceive.
• Upcoming surgery: delayed stomach emptying increases the risk of aspiration under general anaesthesia, so these drugs are usually paused before elective surgery.

Other diabetes medications: combining with insulin or sulfonylureas significantly raises the risk of dangerously low blood sugar (hypoglycaemia).

Doctors now have 20 years of clinical experience with GLP-1 medications, and the consensus is that in correctly matched patients, the benefits outweigh the risks. With the right support and guidance, GLP-1 therapy can be a valuable part of a holistic weight loss program.

Weight loss injections are a powerful tool – but they work best as part of a complete plan, not a stand-alone fix. We can prescribe weight loss injections if you become a member of our weight loss program but we will need to carefully evaluate your medical history to see if you are suitable.

The Weight Loss Detective Program is designed to identify and address the hidden root causes of weight gain alongside any medication you choose, so your results last.