GLP-1 weight-loss drugs like Ozempic, Wegovy, and Zepbound are being prescribed in record numbers, and they may soon be covered by Medicare and Medicaid. While these medications have helped many patients lose weight, they come with some widely reported downsides—unpleasant side effects during treatment, and trouble keeping the weight off once the medication is discontinued. Fortunately, obesity medicine specialists say that diet and lifestyle measures can help in both these areas. If you or a loved one is on a GLP-1 drug or considering taking one, read on for tips to support long-term success.
What Are GLP-1 Weight-Loss Drugs?
For most people, the key to losing weight and keeping it off is a healthy diet combined with regular exercise. But mounting scientific evidence shows that some people face a biological weight-management disadvantage, due to hormonal and genetic factors that drive overeating. Increasingly, physicians are responding by adding weight-loss medications to the mix. The most commonly prescribed are glucagon-like peptide-1 (GLP-1) receptor agonist drugs, including semaglutide, which mimic GLP-1, a hormone that targets areas of the brain regulating appetite and food intake.
When added to a healthy diet and exercise regimen, these medications can result in up to 12% greater weight loss than exercise or diet alone. But that promise can come with some serious side effects, including headaches, fatigue, nausea, indigestion/heartburn, vomiting, abdominal pain, diarrhea, and constipation. Could a change in eating habits help?
How a WFPB Diet Minimizes Weight-Loss Drug Side Effects
Moving to a whole-food, plant-based diet offers many opportunities to ease side effects, says Garth Davis, M.D., a board-certified bariatric surgeon and obesity medicine specialist physician in Houston, Texas, who serves as medical director of Houston Methodist Comprehensive Weight Management Center.
One of the most troubling side effects Davis sees among patients is constipation. “Typically, what we’re seeing is the GLP-1 having a slowing effect on the gut,” he explains. “People aren’t hungry, so they’re not eating as much, and they certainly don’t tend to eat plants, so they will then get constipation-type problems. I get my patients on as high a fiber diet as possible.”
A whole-food, plant-based diet is rich in fiber, low in fat, and virtually free from highly processed foods. It’s also hydrating, says Elise Atkins, M.D., founder of Coastal Vitality MD and a board-certified physician specializing in family medicine, lifestyle medicine, and obesity medicine.
Consuming more fruits and vegetables is a smart way to increase hydration and keep your body functioning as it should. “When we eat foods that have more fluids in them, we’re better hydrated, and that helps reduce nausea,” says Atkins. “It also helps you keep your muscle mass while you’re losing weight, and that’s incredibly important. So we want to not only drink more water but eat foods that help us stay hydrated. And that, of course, helps with constipation as well.”
The Missing Link for Long-Term Success
Despite the documented benefits, only 26.7% of weight-loss drug users report following healthy exercise or diet guidelines. Davis points to a lack of guidance from physicians.
“The big problem with these meds is that all kinds of doctors are just handing them out like candy, and they’re not giving any real lifestyle change advice or helping the patients through it,” Davis says.
While the medications blunt hunger and patients tend to eat less, Davis says most people are just eating less of what they’ve always eaten. In other words, individuals who regularly consume highly processed and/or high-fat diets will still eat these unhealthy foods. “What happens is they don’t lose as much weight, and then if they ever try to get off the medication, of course, they regain weight.”
Research shows that a majority of weight-loss drug patients stop taking medication within two years, perhaps due to factors like side effects and high costs. And further data demonstrates that a significant number of these individuals will regain at least a portion—if not all—of their lost weight.
For example, a 2024 observational study of 20,274 people in the United States and Lebanon who used and later ceased taking semaglutide found that 17.7% of patients regained all of the lost weight or even exceeded it.
How to Transition Off Weight-Loss Drugs Like Semaglutide Without Regaining Weight
Physiology plays a role in this rebound effect, says Davis. “When you lose weight, you lose fat, and fat secretes a hormone called leptin. If leptin drops, your body’s going to make you hungry. It’s going to make you eat more.”
GLP-1 agonists block that effect by signaling satiety, he explains. “But as soon as you stop taking the GLP-1, your brain says, ‘Oh, my leptin’s down. I have to eat,’ and if you go back to eating what you were eating before—calorie-dense, processed foods with meat, dairy, and eggs—you’re going to regain weight.”
Instead, he says, a whole-food, plant-based diet is ideal for transitioning off medications because certain plant foods stimulate the body’s natural GLP-1 production. For example, a Japanese study demonstrated that participants who ate high levels of a fiber called beta-glucan, found in barley (and oats and rye), experienced significantly greater reductions in body weight and BMI than those who did not. There is also evidence that fermentable fibers, such as those in broccoli, Brussels sprouts, berries, apples, lentils, beans, and peas, may increase GLP-1 secretion.
“Fostering a favorable microbiome by eating a high-plant-based diet will generate a microbiome that actually stimulates the secretion of GLP-1,” Davis says. “So if you’re eating a high-plant-based diet, you’re not going to be as hungry, and you’ll be able to eat comfortably and get full without getting enough calories to make you regain weight.”
The Bottom Line
When lifestyle changes don’t work, weight-loss drugs can be a powerful tool. But they are not the whole toolbox. A healthy lifestyle still plays a crucial role in reversing obesity and reducing associated risks.
“It’s not all just about weight loss,” Davis adds. “It’s about cancer prevention, decreasing inflammation, and preventing heart disease and heart attack. And so the thing I like about GLP-1 is that it gives people a moment to just kind of stop and reassess their diet and develop a different relationship with food.”
Positive results can help motivate people to try and adhere to lifestyle changes, such as adopting a healthier diet and a regular exercise routine, that might have otherwise seemed daunting, says Atkins.
“There’s a joy in when something clicks, and somebody understands how to eat whole-plant foods, and then all of a sudden they start telling me things like, ‘I’m craving oranges,’” Atkins says. “And when they say that, then I know that they’re set for life—with or without medication—because they’re doing something because they really love it, not because they were able to force themselves to do it for a week, a month, a year, whatever. So that’s also incredibly important to help people find a way to love the life that they’re leading with their weight loss.”
To learn more about a whole-food, plant-based diet, visit our Plant-Based Primer. For meal-planning support, check out Forks Meal Planner, FOK’s easy weekly meal-planning tool to keep you on a healthy plant-based path.
