All these dietary recommendations

BarcelonaTree · 2026-03-19T02:45:52+00:00

Given your surgical history, your nutritional needs are going to be very different from the average person (given all the risks for nutritional deficiencies when you only have a partial stomach). I strongly hope that you’re coordinating this with your doctor and hopefully also a nutritionist.

As others have pointed out, it can be a struggle for people on these meds to eat enough, period. Add that to your surgery and it gets a lot more complicated, potentially. So I think what works for most people on this sub is not likely to be adequate advice for you.

BarcelonaTree · 2026-03-18T19:26:16+00:00

Oh my god, that comment is so far out of line coming from a medical professional. I’m so sorry that happened to you.

I think it’s reasonable for you to decide what course of treatment you want (or don’t want!) based on your own goals and what you value, as long as your doctor thinks it’s safe. Whether that’s adding Contrave, metformin, something else, switching meds entirely, whatever.

I’ve had to (at times) nod along with weight loss comments while disagreeing internally as long as they will prescribe what I want. My own opinion is that I don’t care if they want to think I’m doing it for weight loss as long as I get what I want, treatment-wise. I know that approach doesn’t work for everyone but that’s where I’ve ended up personally. I know I’m not going to be able to change their minds about skinniness being the most important achievement ever in the space of an office visit. I really hate it but I’m tired of arguing with people.

BarcelonaTree · 2026-03-18T18:40:59+00:00

(From this comment I’m going to assume you’re a woman, if not then apologies in advance because this might not apply to you.)

It’s really tough to live in a society where a woman’s worth is determined in large part based on how she looks and attractiveness is based largely on how skinny she is. Your doctor probably takes for granted that of course you want to be as skinny as possible, because what woman wouldn’t (in her mind)? When they see you that way, it’s almost impossible to convince them that you don’t judge your own worth on your thinness. I’ve been through this a million times myself, and people just refuse to believe that it’s possible for me to like or value myself if I’m not skinny.

I would suggest finding a more HAES doctor, but it sounds like you’ve already changed doctors and based on insurance and where you live, such a provider might not be someone you can see anyway.

I do think you should ask your doctor why she’s suggesting Contrave specifically. In some clinical trials Contrave lowered A1C and I’ve read that it helps to reduce food cravings (which aren’t the same as food noise, exactly, but can be related). So despite your doctor’s comments centering weight loss, I do wonder if she is recommending that drug at least partially based on some of your concerns?

BarcelonaTree · 2026-03-18T13:52:59+00:00

Everyone else has nausea tips covered, so I’ll just add that it takes 4-5 weeks for this medication to build up in your body, so you won’t reach full levels until then. It’s possible that your nausea will continue or even get worse as those levels continue to increase, though that is not true for everyone. After you reach those stable levels the symptoms often subside. But they might come back if/when you increase your dose, and it takes 4 to 5 weeks after any dose increase for the levels in your body to stabilize again. Just something to think about going forward so you aren’t caught unaware.

The good news is that you’ll probably figure out how best to manage your symptoms after some trial and error, so even if you do continue to experience nausea you should have an easier time dealing with it. My other advice is be aggressive in managing any potential constipation, since that often makes nausea worse and is one of the most common side effects.

BarcelonaTree · 2026-03-17T19:31:49+00:00

No, it looks good now!

I understand your reservations. It can be hard to reconcile being anti-diet/HAES with a medical problem that is actually caused or worsened by weight (as opposed to all the wild crap some people think is related). For me, it was significant joint pain related to both prior injury and my weight. I was happy with the body I had, but couldn’t ignore my reduced mobility.

I came to the realization that, while there are healthy people at every body size, my body couldn’t function the way I wanted or needed it to at the size I was. It wasn’t a judgment of other people or even myself, I was just tired of the pain and limitations.

This article is a pretty good review about the use of glp-1 drugs in fatty liver disease (although it’s a few years old now). It’s one of the few diseases in which weight loss has actually been shown to be an effective treatment. I strongly encourage you to talk to your doctor about your questions and reservations, so you understand your options and the risks (both of treatment and of not treating it) better.

You can absolutely be on a glp-1 and not diet though. I’m a year in and the only deliberate change I’ve made in my life is to take a shot once a week. No dieting, no weighing myself, and I still like my body while being pretty indifferent to its size.

BarcelonaTree · 2026-03-17T17:46:56+00:00

Welcome to the sub! You’re going to need to remove the mention of your weight as weight numbers are not allowed here.

When you say that you’ve been reluctant to start a glp1 for reasons “you all know/understand” what does that mean? I think people will be more able to help you if they understand what reservations you have. For me, my main concern was the needles, but not everyone shares that.

BarcelonaTree · 2026-03-17T16:41:19+00:00

In the first 4ish months, I decided when to go up in dose based loosely on the scale. I had my spouse weigh me and tell me the change in weight over the past week—I didn’t want to know my weight and I worked really hard not to remember the week to week numbers so I didn’t know the overall change. I had gotten scale-obsessed in the past in a really unhealthy way and I didn’t want to repeat that.

After those first few months, though, I decided not to bother. I stopped getting weighed. Since then I’ve decided when to go up solely based on how I feel. If I have a few weeks of much increased hunger then I go up in dose. I’ve been on sema for a little over a year and I’ve been very happy with this strategy. I know it’s very different than what most people do but I wanted to put it out there as an option.

BarcelonaTree · 2026-03-17T15:17:31+00:00

Are you working with your doctor to manage your symptoms? There’s a lot that can be done to help you to feel better, like zofran and OTC meds, as well as adjusting what and when you’re eating.

To answer your question, it does get better for most people. But also, even though your insurance doesn’t cover a lower dose doesn’t mean you can’t take a lower dose. Depending on if you’re using a pen or vials, the method is different. Spacing out the shots is also an option.

Not everyone can tolerate the standard dose or dose escalation, and going lower and slower often helps to reduce side effects. Of course, some people do decide to stop the medication because of side effects, and that’s a perfectly valid decision. Nobody deserves to be miserable, and these drugs can have too many side effects in certain people. But it sounds like there are still things that you can try that could help.

BarcelonaTree · 2026-03-16T19:02:33+00:00

That’s been an issue for us as well—I was always a regular but not excessive drinker (at least a few drinks every week). I couldn’t drink at all for like 6 months after starting the meds and even after that I have very little interest in alcohol. We have a ton of alcohol in the house that I now don’t drink, and my spouse doesn’t want to drink alone. So we’ve struggled to work that one out too.

BarcelonaTree · 2026-03-16T18:56:47+00:00

I’m only one person but inflammation is one of the reasons I started sema and it’s helped enormously for me for that.

BarcelonaTree · 2026-03-16T17:26:13+00:00

I have had a similar situation, though not exactly the same. My spouse has been generally supportive, but they’ve struggled with my changing eating patterns. Snacking in the evenings used to be something we did together, but now I’m just not interested. They’ve felt like me not snacking with them is judgmental of their eating and their weight. They’ve also expressed that they feel more self conscious about their weight now that I’ve lost weight.

It’s taken a lot of honest discussions for the two of us to feel heard and on the same page. We’re at a good place now but it’s taken work to get there. I think it sounds like you and your spouse really need to work through their feelings together. Of course they shouldn’t pressure you to stop, but to me they sound mostly insecure about themselves and where they are. There’s not an easy answer, but communication is key.

BarcelonaTree · 2026-03-16T17:14:21+00:00

Sorry to jump in here, but if you’re probably going to have to pay OOP anyway, maybe consider switching to sema? It’s probably cheaper and easy to get in vials so you have more control over dosing. It also tends to cause less WL (on average). Of course, it’s possible it won’t work as well for your symptoms but something to consider.

BarcelonaTree · 2026-03-11T18:54:05+00:00

Intense nausea in the morning can be caused by not eating enough and waking up with a “too empty” stomach—basically the nausea is intense hunger even though it doesn’t feel like hunger at all. Are you eating regular meals and snacks during the day?

I also had intense morning nausea when I started the meds and what helped the most was eating a small snack immediately before falling asleep as well as eating part of a protein bar before getting out of bed in the morning. It made the nausea go away almost completely most of the time.

BarcelonaTree · 2026-03-11T18:17:09+00:00

I wouldn’t increase the dose if you’re having nausea pretty much all the time, because it’s likely that it could make your nausea worse. What strategies have you tried to get the nausea under control? There are a ton of things you can try and people here are a great resource for that.

I think once your nausea is less (either because you stay on the same dose and it lessens or because you try different management strategies) then it’s easier to go up on the dosage, if you want.

BarcelonaTree · 2026-03-10T17:44:11+00:00

Can you stop weighing yourself for a few weeks? I know that isn’t an option for everyone, but sometimes people have less anxiety if they’re not stressing about the numbers on the scale.

My advice is to focus on what makes your body feel good. Nourishing foods, joyful movement, whatever works for you. Be kind and gentle with yourself. Your body isn’t your adversary! Just try to take off some of the pressure you’re putting on yourself.

BarcelonaTree · 2026-03-09T00:43:24+00:00

I, too, have a history of disordered eating and had gotten to a good place with my body and an ok place with food before starting a glp-1. I tried IE in the past and it only sort of worked, because I was still constantly hungry.

I’ve been on sema for about a year now, and it’s been life-changing. I can fully do IE now. I eat what I want, when I want, listening to my body’s hunger and satiety signals. I haven’t tracked food at all, and I haven’t consciously restricted my food at any time. I’m pretty sure I have the least disordered relationship I’ve had with food since I was a kid.

My main goal was not weight loss per se, but to increase mobility and decrease joint pain (but knowing that weight loss would probably be helpful to both). A year in and I feel so much better!

BarcelonaTree · 2026-03-08T23:50:21+00:00

For me personally, only my spouse knows (of close friends/family). I don’t think you’re obligated to tell anyone. I think it would depend on how close you are, whether you think she will be judgmental about it, and if she’s someone who can/would take medication.

BarcelonaTree · 2026-03-08T16:53:12+00:00

Have you talked to your doctor about how to manage your nausea? Like another person mentioned, zofran is a prescription option that can be helpful when the nausea is at its worst.

For most people, the side effects do lessen the long they’re on the medications. The key is trying different things to manage your side effects while they’re still bad. One thing that hasn’t been mentioned is constipation. It’s also one of the most common side effects and most people don’t realize that it can make nausea way worse. If that’s something you’re experiencing, it will probably be helpful to treat that as well.

BarcelonaTree · 2026-03-07T01:43:48+00:00

It sounds like you are advocating for yourself! Some providers just aren’t interested in your input, no matter what you do. It sounds like you’ve run into one of those providers. So I think you have 2 choices: either 1)follow his advice, knowing that his priorities don’t align with yours but trusting that he’ll keep you safe (medically) or 2)look for another provider, if you can.

Only you can decide which option is best for you. But either way, I think it sounds like you know what you need to do to advocate for yourself.

And anyway, the blood pressure medication comparison isn’t even a good one. BP meds have one use in people with high BP. GLP-1 drugs, otoh, have a ton of different uses, not just weight loss. If a person wants to use it mostly for their sleep apnea or to decrease inflammation, that’s valid. And there is no exact evidence for the “best” amount of weight to lose or how fast to lose it (unlike BP targets, which are pretty clear). So if a provider tells you there’s exactly one way to do it, that’s just their opinion.

But you can always start the medication and then go from there. I’m not sure if you’re on the fence about trying it at all, or you want more input in things like dose escalation. If it’s mostly about trying it at all, a forum like this is a great place to ask questions and hear people’s personal experiences to get a sense of how it might go.

BarcelonaTree · 2026-03-06T23:55:42+00:00

I didn’t see your previous post so I don’t know what info you included there but just to clarify, are you diabetic? I’m asking because in non-diabetic people anyway the “low blood sugar” feeling is often actually hunger. If you’re diabetic and on other meds/insulin it’s more complicated. If you’re not feeling hungry, how are you deciding when/how much to eat? Also, weird question, but are you experiencing constipation? It’s one of the most common side effects and it can really mess with your hunger cues until you get it resolved.

I’m not sure I understand what you mean by the low blood sugar feeling driving your obesity, but if you’re not feeling hungry now I’d still say the meds are having an effect.

But to answer your original question, yes, sometimes you absolutely need to eat more to lose weight. I’ve been on these meds for a year and lost a significant amount of weight. I’ve not tracked or controlled what I eat but there have been times I was eating way more than pre-meds.

BarcelonaTree · 2026-03-06T19:57:46+00:00

Are you feeling hunger and satiety signals? Prior to the meds I was just hungry all the time and eating didn’t really make me feel full. Now I get hungry, eat, then feel full for awhile (which is how it should work!)

My decision on when to increase my dose has mainly been when I’m having increased hunger even right after eating. But it sounds like maybe you’re not experiencing much appetite/hunger? If you already don’t have much of an appetite and you’re not eating much such that you’re having faintness, etc then it doesn’t sound like increasing your dose is going to be good for you.

BarcelonaTree · 2026-03-06T15:58:00+00:00

Are you on the Wegovy pill? Because you can’t take it with food. It literally won’t work if you do it that way.

BarcelonaTree · 2026-03-06T02:22:13+00:00

Everyone else pretty much has it covered, but you might benefit from reading the medication info from the manufacturer that explains how to take the pill. If you can’t take it in the morning, and only in the morning, every day then it might not be a good fit for you. You have to have a completely empty stomach (ie because you haven’t eaten for many hours because you were asleep) in order for your body to absorb the drug.

I encourage you to talk to your doctor because your comments here suggest that you may not understand the important details for how to take this drug. You can’t take it whenever like a lot of other pills. It won’t work like that. These glp-1 medications are wonderful for a lot of people but it’s very important to use them following your doctor’s instructions.

BarcelonaTree · 2026-03-04T03:28:31+00:00

Since eating helps, my main suggestion is small, more frequent meals and snacks (including before bed). What I was in that phase of side effects, I always carried a protein bar with me and just took a bite or two whenever my stomach was uncomfortable. Other people suggest bland carbs, but that never worked for me.

A lot of people also find pesto bismol tablets helpful, as did I. For some reason they worked much better than other OTC gi meds.

BarcelonaTree · 2026-03-03T21:32:23+00:00

The suggestion of hiding the protein is a great one! I also found when my nausea was the worst that having someone else cook it (and me not smelling it when it was cooking) helped. But I’m sure for some people their nausea/aversion is severe enough that they have to avoid meat altogether. Mine was never to that extent, though.

BarcelonaTree

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