What I Would Tell My Best Friend: When She Starts a GLP-1

What I Would Tell My Best Friend, a Valivera Health series

If you told me you'd started a GLP-1 medication, my first reaction wouldn't be judgment. It would be curiosity. Why did you start? Who is prescribing it, and how are they monitoring you to keep you safe?  I would want you to be honest about any history of eating disorders or even if you are planning on getting pregnant. I would ask if they know your family history, especially if there is a history of thyroid cancer?  

I would ask you about your goals; what are you hoping it will do for you? GLP-1 medications like semaglutide and tirzepatide (you may know them as Ozempic, Wegovy, Mounjaro, or Zepbound) can be effective tools when they're clinically appropriate. For some people, they improve blood sugar, support weight loss, and make it easier to move and feel better.

But a powerful tool isn't the same as a whole plan. So if you were my best friend, I'd want to make sure you started with your eyes open.

What I'd Tell You to Expect

The most common side effects are digestive: nausea, vomiting, diarrhea, constipation, bloating, heartburn, and feeling full much sooner than you're used to. Fatigue and headaches can happen too. They tend to show up when you first start or when your dose goes up, and for many people they ease over time. Some simple habits often help, and they're worth asking your prescriber about: smaller meals, eating slowly, stopping when you feel full, going easy on greasy or very rich foods, drinking plenty of fluids, and not lying down right after you eat.

The Symptoms I'd Never Want You to Ignore

Most side effects are uncomfortable but manageable. A few are not. I'd want you to call your prescriber promptly, or seek urgent care, if you notice severe or persistent abdominal pain (especially pain that spreads to your back or comes with vomiting), fever, pain in your upper right abdomen, or yellowing of your skin or eyes. The same goes for vomiting or diarrhea that keeps you from keeping down fluids; signs of dehydration like dizziness or very little urine; swelling of your face, lips, or throat; a lump in your neck or trouble swallowing that doesn't go away; or vision changes, especially if you have diabetes. If you also take insulin or certain other diabetic medications, shakiness, sweating, or confusion could signal low blood sugar.

Your Muscles and Bones Need a Plan, Too

When your appetite drops, it's easy to under-eat, especially protein. And the weight lost on these medications isn't always only fat. Some of it can be muscle. For women in midlife, that matters even more, because changing hormones are already influencing muscle, bone, and body composition.

This is where my orthopedic side gets very practical. I'd want you eating enough protein, drinking enough water, and strength training from the start, so that what you lose is what you meant to lose. And if you're exhausted on a GLP-1, don't just push through it. Fatigue is often a sign you should pay attention to. It may be as simple as you're not getting enough food or fluids, but it may also be specific to other changes in your body. As we lose weight, other hormones can change or  medications may need to change. We also may be deficient in certain nutrients if our diet has changed. With these possibilities, your prescriber should hear about the fatigue. 

A Tool, Not the Whole Plan

Many people regain some or much of the weight after stopping these medications. That doesn't mean the medication failed. It means the habits you build alongside it, like nutrition, movement, sleep, and stress, are what carry you forward.

So before you start, or if you already have, I'd ask a few more questions. Do you know what success looks like beyond the number on the scale? Do you know who to call, and which symptoms mean call today? Are your other providers, including your gynecologist and primary care physician, in the loop? And do you have a plan for the long term: how long, and what comes next? I don't want you to change everything at once. I want to identify what matters most, start there, and build.

You're More Than a Number on the Scale

So if you were my best friend and told me you'd started a GLP-1, I'd want to help you figure out whether it's the right fit and how to use it well. Because the question isn't simply, "How do we make the number go down?" It's, "How do we help you feel strong, supported, and well for the long run?"

You're not a number. You're not a prescription. You're a whole person.

And sometimes the best way to get the most from a medication is to look at everything around it.

Dr. Liz Dulaney-Cripe

This post is part of a series where I share what I'd tell a friend. Have a question you'd like me to tackle? Send it my way.