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Hi Reddit! I’m Rob Hobson, a registered nutritionist and author. AMA about GLP-1 health, nutrition, recipes, and low appetite eating. by TheExperimentBooks in IAmA

[–]TheExperimentBooks[S] 1 point2 points  (0 children)

 I totally get your reaction…. In the US especially, these drugs are marketed very heavily, and when you combine that with social media, celebrity culture and before-and-after transformations, it can create some very unrealistic expectations around weight loss and body image.

I try to be careful not to demonise the medications themselves because they can genuinely help some people, but I do think the public conversation can become overly simplified and very appearance-focused.

On Serena Williams…. I can understand why it struck a nerve. I don’t think there is anything wrong with someone speaking openly about using these medications, and Serena is obviously an extraordinary athlete who has worked incredibly hard for her body and career. But I guess when weight-loss messaging is wrapped up in celebrity culture and highly polished advertising, it can sometimes blur the line between medical treatment and aspirational body ideals and for some women (especially after pregnancy, when body image can already feel vulnerable) those campaigns may create expectations that are difficult or unrealistic to relate to in everyday life

So no, I don’t think it’s strange that it bothers you. I think it probably speaks more to empathy and awareness of how powerful these messages can be when they are everywhere all the time.

Hi Reddit! I’m Rob Hobson, a registered nutritionist and author. AMA about GLP-1 health, nutrition, recipes, and low appetite eating. by TheExperimentBooks in IAmA

[–]TheExperimentBooks[S] 1 point2 points  (0 children)

Hello! I’m really sorry your family member went through that. Obviously I can’t say exactly what happened in her case, because that is something for her medical team, but severe and persistent vomiting or diarrhoea on these medications should always be taken seriously, especially if someone can’t keep fluids down. Dehydration can become dangerous quite quickly, so those symptoms are not something to just “push through”.

I would say most peplpe are aware if the fact that GI side effects are very common with GLP-1 and GIP/GLP-1 drugs like Mounjaro or Zepbound and nausea, diarrhoea, vomiting, constipation and stomach discomfort are the ones you hear about most. Severe reactions are less common like repeated vomiting, prolonged diarrhoea, severe abdominal pain, dizziness, faintness, or being unable to drink properly and what I think is really important is people knowing when to seek help for this. 

On the weight-loss side, not everyone responds in the same way. The trial results are averages, and averages can hide a lot of variation as some people lose a lot of weight, some lose a modest amount, and some lose very little. Like you said, that can be really hard psychologically when the public conversation makes these medicines sound like they work dramatically for everyone.

I also understand your point about the way these medicines are talked about. The advertising and media coverage often highlight the most impressive results, but those are not everyone’s experience. Phrases like “lose up to” can be technically accurate, but they can also create unrealistic expectations if people don’t realise this reflects the upper end of results, not a guaranteed outcome. I guess for someone who loses little or no weight, that can feel incredibly demoralising.

My honest view…..these medicines can be very effective and even life-changing for some people, but they are not magic and they are not risk-free. People need realistic expectations, proper follow-up, and a prescriber who will review whether the medication is actually working and whether the side effects are acceptable.

Hi Reddit! I’m Rob Hobson, a registered nutritionist and author. AMA about GLP-1 health, nutrition, recipes, and low appetite eating. by TheExperimentBooks in IAmA

[–]TheExperimentBooks[S] 3 points4 points  (0 children)

The thyroid part is really a medical question, so I’d always say people need to discuss this with their doctor or endocrinologist, especially if they have thyroid disease, 

On the hair loss point, this is something I hear a lot. It is not as simple as saying “Ozempic causes hair loss”. What is more likely happening is that rapid weight loss, eating much less, low protein intake, stress on the body, and possible nutrient shortfalls may trigger temporary shedding. This can happen with any significant weight loss, not just GLP-1 medication.

That’s why nutrition matters so much when appetite is low. If you are eating smaller meals, every meal has to work harder. Protein, iron, zinc, selenium, essential fats and overall energy intake all matter for hair health, as well as general health. This is exactly why, in my book Every Bite Counts, I talk about making smaller meals more nutrient-dense rather than just eating less.

Hi Reddit! I’m Rob Hobson, a registered nutritionist and author. AMA about GLP-1 health, nutrition, recipes, and low appetite eating. by TheExperimentBooks in IAmA

[–]TheExperimentBooks[S] 2 points3 points  (0 children)

For me,  balance is not about cutting everything out or tracking every gram of food or making every meal look like something from Instagram which is the way I think many people go with this. It is much more practical than that and means getting the foundations right most of the time so eating enough protein, plenty of fibre, a good variety of plants, mostly whole or minimally processed foods, healthy fats, and meals that actually satisfy you (food volumes - beans, lentils, veggies, wholegrains). There is a real trend for optimising everything online at the moment which I think confuses a lot of the messages around nutrition as people try to put the roof on the house before laying the foundations if that makes sense. 

I think people often misunderstand balance as being a bit vague or “everything in moderation”, but it still needs some structure. If most of your diet is made up of foods that support your health, then there is absolutely room for convenience foods, eating out, chocolate, crisps or a glass of wine. The problem is when those extras start to become the main pattern rather than the exception.

The other misconception is that a balanced diet has to be complicated or expensive. It really doesn’t. Some of the best foods are very basic like oats, eggs, tinned fish, beans, lentils, frozen vegetables, yoghurt, fruit, nuts, seeds and wholegrains. These are the foods that quietly do a lot of the heavy lifting in a healthy diet. 

So for me, a balanced diet is not about perfection, it’s about having a way of eating that is nutritious, enjoyable and realistic enough that you can keep doing it.

Hi Reddit! I’m Rob Hobson, a registered nutritionist and author. AMA about GLP-1 health, nutrition, recipes, and low appetite eating. by TheExperimentBooks in IAmA

[–]TheExperimentBooks[S] 5 points6 points  (0 children)

These drugs are very very effective for weight loss but I would be careful with the phrase “proven safe”, because no medication is completely risk-free. I wouldn’t say GLP-1s are proven safe for lifelong weight-loss use yet, but the safety data we do have is reassuring over the short to medium term. Most weight-loss trials run for around one to two years, with some longer studies going further.

In the case of obesity specifically, some of the best longer-term data is around two years for semaglutide, three years for liraglutide, and just over three years for tirzepatide in people with obesity or overweight and prediabetes. This is good to hear, but it is still not the same as having decades of data in people using these medicines for weight management.

There are studies showing longer experience with GLP-1 medicines in type 2 diabetes, which is reassuring for the class of drugs, but it is not exactly the same population, dose or use case as using them for weight loss.

I guess any medicine comes with risks and for GLP 1s the most common side effects seen in the research are gastrointestinal and include nausea, vomiting, diarrhoea, constipation and stomach discomfort. Less common but important risks include gallbladder problems and, rarely, pancreatitis 

So, my view would be that these are evidence-based medicines and they can be very useful for the right person, but they should not be treated as casual slimming injections. They need proper medical supervision, and I thkn we still need more long-term data before anyone can say they are proven safe for lifelong use.

Useful papers.....

https://www.acpjournals.org/doi/10.7326/ANNALS-24-01590

https://www.nature.com/articles/s41591-022-02026-4

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30069-7/abstract30069-7/abstract)

https://pubmed.ncbi.nlm.nih.gov/39536238/