GLP-1 medications have changed the conversation around weight, but they haven’t changed the fundamentals of what our bodies need to thrive. As a Registered Dietitian, I’ve been watching this space closely, and I keep coming back to the same questions: what happens to nutrition when appetite falls away? What do we risk when we stop paying attention to hunger altogether? And how do we build long-term healthy habits?
I sat down with Professor Giles Yeo, leading obesity expert and host of Radio 4’s The Hunger Game, to dig into the aspects of the GLP-1 debate that rarely make it into mainstream coverage.
Sasha Watkins, Head of Health
GLP-1 drugs in a sentence, what do they do?
They’re modified gut hormones – they enhance insulin secretion at the pancreas and make you feel fuller by signalling to the brain.
Food noise – is this a buzzword, or is there a real definition?
I don’t think there’s a real definition yet. I’d never heard the word until GLP-1s came out. So I think we’re going to need to know more about what exactly it is. I get the feeling it’s going to be different for different people.
The pill is coming, is that good news or bad news?
It’s good news in terms of costs and delivering the drug to people who are currently not getting it. It’s bad news in the sense that it’s far easier to create a black market version. So we need more safeguards in place.
How might GLP-1s change the wider food landscape?
We’re already beginning to see it happening. I think GLP-1s are forcing food manufacturers to create smaller portions, but of more nutritionally dense food. I would like to see that happening more broadly, because isn’t that what we’re supposed to be doing? Eating less, but more nutritionally dense food. Let’s see what happens.
What are the top nutritional risks of taking a GLP-1?
GLP-1 drugs make you feel fuller and you eat less, meaning you just eat less of whatever it is you’re already eating. So if your diet was not great to begin with and you eat less, there is a danger of having deficiencies, micronutrient or macronutrient deficiencies, depending on how bad your diet was to begin with. So you do need to continue to think about your diet, even while on these drugs.
What habits can we help people change?
I think we need to get people to think about healthy eating more. Now, what does healthy mean? It depends who you are. Is it a portion control size thing? Is it actually about eating enough protein? Is it about eating more fibre? Is it about making sure you have your micronutrients? I think it’s going to depend on the individual. Because some people could be vegetarian, but a poorly behaved vegetarian and not eat enough protein, for example. But that’s what we need to think about. Macronutrients or micronutrients, fibre or protein – it depends who you are.
When you’re taking these drugs, is muscle loss an issue for long-term health?
I think it is. I don’t think muscle loss is specific to these drugs. Anytime you lose weight quickly, you’ll lose muscle mass as well as fat mass. The clearest marker of health span, healthy aging, is the amount of muscle mass you carry into your old age. As more and more millions of people take these drugs and lose weight rapidly, muscle mass is going to become a really critical concern.