Starting July 1, the GLP-1 Bridge expands access to GLP-1 agonist medications for millions people. If you are starting one, managing one, or supporting a patient who is, this is worth reading before day one.
I am Ashley Koff, RD, weight health dietitian for 25 years and author of Your Best Shot. I have been working with GLP-1 medications since 2010, long before they were a household name. And the single most consistent pattern I see is this: people get the medication. They do not get the playbook for how to use it effectively. And when outcomes fall short, the medication or patient gets blamed.
A tool is only useful when it’s used properly. GLP1 agonist medication usage data is showing us that in real-time.
65% total weight regain within a year of stoping.
Debilitating “side effects” treated with additional medication or resulting in premature stoking of the medication
Undesirable losses - bone, muscle, hair, energy, pleasure - simultaneously with fat loss or blood sugar improvements suggest people choose between weight or health.
That changes now. Here is what you need to know.
Three Things Every GLP-1 User Needs to Plan for That Do Not Come with Their Prescription
1. Your digestion is going to change. Know that before you start.
GLP-1 agonists will create or exacerbate digestive issues. This impact doesn’t just create side effects, it dictates outcomes today and tomorrow. If you don’t assess before, during and (if) after, and optimize as indicated, side effects and suboptimal outcomes will occur. That’d not a hypothetical. It’s a fact.
By design, these medications create a sustained delay of gastric emptying. The degree is dictated by dose and individual response.
The good news? Even though GI symptoms are common, they are largely addressable when you know what to expect. What your digestion looks like going in will shape your entire experience on the medication. If you do not have this context, you may suffer through symptoms that could have been managed, or give up on a medication that could have worked for you.
For practitioners: this conversation needs to happen before the prescription is written, not after the first complaint. Assessment and optimization is a part of the prescription, not an optional add-on.
2. More protein is not the answer. Optimal total nutrition is.
The high-protein obsession especially in GLP-1 culture is real and it is causing harm. It’s a diet industry tool to tee up a “thing” as a solution for fastest and most weight loss. And it’s what’s led to the diet failures and epidemic of suboptimal metabolic health — regardless of weight —that’s ushered in the GLP1 era.
Protein chips. Protein powders. High-protein everything. Protein is an essential macronutrient, yes. And when appetite decreases, it’s correct to ensure we consume optimal protein to maintain the body’s resources. But your body needs an optimal amount of all nutrients to function optimally, especially when looking to part with excess fat. Chasing a protein number while shortchanging everything else works against the medication, not with it.
3. This is not a better diet. It is a tool to help your body work better.
The most common and most damaging misuse of GLP-1 medications is using them to suppress appetite and eat less. That is weight loss thinking applied to a weight health tool, and it leads to muscle loss, nutritional deficiency, and rebound fat gain.
GLP-1 agonists provide a sustained and supraphysiologic level of one, two or three hormones delivered directly to their receptors so that the body consistently sends signals to do required work. That’s the “pro” of the medication. It agonists — directs the body to function as designed — where suboptimal function may prevent your system from doing this on its own. The upsides of metabolic wins are significant and resource demanding! Satiety, blood sugar, inflammation and blood pressure improvements, fat loss and food noise occur.
But these come with “considerations”. The aforementioned digestive delay, decreases in “rest and digest” signaling and declines in heart rate variability, along with challenges to function if suboptimal resource levels or when there’s an impaired ability to deliver those resources.
Eating less and strength training more will not optimize these considerations. When this tool is used like a diet, we are and will continue to see results that we’ve seen from decades of dieting: at best short-term numeric wins, unsustainable and partnered with long-term metabolic health challenges.
GLP-1 medications and the GLP-1 bridge need to come with a playbook
I wrote Your Best Shot for this reason. A tool needs an owner’s manual. It will help anyone -- GLP-1 medication or not — to assess and optimize (as indicated) their own weight-health hormones. But 100% of GLP-1 medication users need it for the weight health strategies that enable their GLP-1 therapy to work optimally. Here is how to get it:
The DIY+Support Free Option: Your Best Shot is available at your public library at no cost. Inside, there is a QR code to join our community, get your questions answered, and access resources that guide you toward better outcomes on a GLP-1.
The DIY+Support $20 Investment Your Best Shot is available where books are sold and includes everything outlined above. In our private community, you get access to me and my team to support you on your journey.
The Done-With-You Investment: My company exists to provide weight-health optimization plans and the ongoing support to implement them. Invest with The Better Nutrition Program so our team can work with you to assess, develop and implement a plan that works for you and your body.
The GLP-1 Bridge and Medication Cautionary Tale
Whether you are a patient starting this journey or a practitioner guiding one, access to this medication is only one part of your plan for weight-health optimization. A total solution is what delivers the wins you seek. Optimal health, healthspan, longevity - whatever you choose to call it— make sure you have the playbook to achieve it.
Do not start without it.
Ashley Koff, RD | The Backwards DR
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