Weight-loss jabs have become so popular that a quick rummage inside any midlife woman’s fridge might be enough to reveal an injection pen nestling alongside the sugar-free yoghurts and diet drinks.
Recent figures suggest that more than half a million people are taking either Mounjaro or Wegovy (the version of Ozempic approved for weight loss rather than diabetes control).
And because the jabs – also known as GLP-1 drugs – remain very difficult to get on the NHS, an estimated 95 per cent of users are buying their pens privately. The decision to try the jabs shouldn’t be taken lightly because side-effects can be severe and, in the light of increasing stories of hospitalisation and even death, taking them without supervision can be dangerous. Always inform your GP.
Although some pharmacies and private clinics offer nutritional advice, most people receive their pen in the post each month with precisely zero information on what or how to eat while using it.
It’s not surprising, then, that so many people are turning to Facebook support groups or TikTok videos for advice and guidance, with ‘what I eat in a day’ meal photos and ‘come Ozempic food shopping with me’ reels garnering tens of thousands of views.
But medics are now concerned that in their ill-informed quest to stay in a calorie deficit (eating fewer calories than your body is burning) far too many people are at risk of falling into a nutritional deficit too.
This is particularly important for women at midlife when your body and brain are struggling to cope with the hormonal upheavals and the natural march of age-related decline.
Without the right nutrients in your diet, you might slim down, but at what cost? Your hair might fall out (a common consequence of rapid weight loss without nutritional support), you could find yourself vulnerable to every cold and flu bug going around, you might be blighted by mood swings, anxiety and an acceleration of menopausal symptoms, and you could even put yourself at risk of bone fractures.
Medics are concerned that in their ill-informed quest to stay in a calorie deficit (eating fewer calories than your body is burning) far too many people are at risk of nutritional deficit
GP Dr Shashi Prasad, an expert in hormonal health and weight-loss management for the Marion Gluck Clinic in London (mariongluckclinic.com), says that as women approach midlife, natural hormonal changes linked to perimenopause and menopause can impact metabolism, resulting in insulin resistance, reduced muscle mass and bone density.
‘Rapid weight loss can accelerate all of these changes and so nutritional requirements need to take this into consideration,’ she says.
Nataly Komova, a registered dietitian with It’s Me & You Clinic (itsmeandyou.co.uk) agrees, warning that midlife women ‘risk long-term deficiencies, muscle loss and worsened metabolic health’.
‘The mistake I see too often is prioritising low-calorie, nutrient-poor foods out of habit – but when you’re eating less, every calorie must deliver value,’ she says.
So, if your main focus is weight loss, you’re rarely hungry, frequently a little nauseated and you only eat tiny portions, what can you do to ensure that every mouthful packs a nutritional punch?
Protein on your plate is an essential
The basic rules of healthy weight loss when using the GLP-1 injections are to restrict your calorie intake and to eat plenty of protein to help preserve muscle mass (plus strength training to protect those muscles), fibre to ward off constipation and to drink plenty of water.
On TikTok you will find compelling videos of young women browsing supermarket aisles to pick out anything branded ‘high protein’, seemingly oblivious to the fact that these highly processed products can be high in calories and – apart from containing fractionally more protein than their ordinary counterparts – nutritionally poor.
The dietitians I spoke to were unanimous in their recommendations for jab users to steer away from highly processed foods and make lean protein (chicken, fish, eggs, pulses or tofu) the hero of your plate three times a day.
This is even more important for women at midlife and beyond because protein gives the body essential amino acids it needs for hormone production and our protein demands increase with age – partly because of accelerated muscle wastage and partly because we become less efficient at metabolising the protein we do eat.
Dr Prasad recommends midlife women aim to eat 1-1.2g of protein per kilogram of target body weight. So if your target weight is 70kg that means eating at least 70g of protein every day – that’s one whole chicken breast, a tin of tuna and two eggs.
You can see how it might be difficult to meet protein targets when your appetite is suppressed and you’re feeling a bit queasy.
‘There is a real risk of reduced protein intake with smaller meal sizes,’ Dr Prasad says, ‘so this needs to be actively taken into consideration.’
Make sure you don’t forget about fibre
For optimal health we are encouraged to eat 30g of fibre a day. But when there’s 8g in a bowl of Bran Flakes, 2g in a slice of wholemeal bread and 2-3g in an apple, you can see how tough it might be to come near those targets when you can only stomach mini meals.
One of the most common side-effects of the weight-loss jabs is constipation because they slow the passage of food through your gut. Jabbers are usually strongly motivated to eat salad, vegetables and fruit (as well as a gentle laxative if necessary). But experts in midlife nutrition are keen to highlight the increased importance of eating fibrous foods which nurture a gut microbiome compromised by slower gastric emptying.
Weight-loss jabbers are usually strongly motivated to eat salad, vegetables and fruit – but experts are keen to highlight the increased importance of eating fibrous foods
Dr Prasad recommends her jab clients eat six to eight portions of colourful vegetables a day and low-sugar fruit such as berries to provide fibre and antioxidants to support detoxification of the body.
‘Prebiotic foods provide the soluble fibre our gut bacteria need to produce short-chain fatty acids that support good gut health, such as onion, garlic and asparagus,’ she says, also recommending daily consumption of probiotic foods such as live yoghurt, kefir, kimchi and sauerkraut to boost those bacterial populations.
Dr Rimas Geiga, registered dietician at The Glow Bar (theglowbarldn.com) says: ‘These medications can disrupt the delicate balance of the gut microbiome, certain artificial sweeteners can exacerbate gut issues but prebiotic foods like onion and garlic can help nourish beneficial gut bacteria and mitigate these side-effects.’
Strong bones need calcium
Rapid weight loss can lead to bone loss as the body fights for precious nutrients in our meals. While this is an important issue for dieters at any age, women at midlife face a greater risk because declining hormone levels mean bone loss often accelerates at menopause.
‘I’ve seen women unknowingly sabotage their bone health by not prioritising calcium and vitamin D-rich foods, thinking less food automatically equals healthier. I find this to be a dangerous misconception,’ says Dr Geiga.
For optimal bone health, eat dairy products such as yoghurt, milk and cheese and leafy greens such as kale, spinach, broccoli and almonds.
Dr Prasad says for midlife bone protection, calcium intake should be 1,200mg daily and vitamin D 1,000 IU daily, perhaps with a supplement while you’re dieting. ‘Bones can be strengthened with a high intake of vitamin D, which helps the body absorb calcium better and strengthens bones,’ she says.
Hormone balance is really key
When you’re focused on counting calories, it is easy to be seduced by ‘low-fat’ labels and to avoid so-called healthy fats (such as olive oil, avocados, nuts) for fear they could slow your weight loss.
But healthy fats and the phytoestrogens you find in soy products and flaxseeds can be really useful for the midlife body, helping to support hormonal balance – a key focus during menopause.
‘Omega-3 fatty acids are vital for heart and cognitive health and reduce inflammation,’ says Dr Prasad, who recommends her clients try to find room on their plate for oily fish including salmon, mackerel, and sardines and/or flaxseeds, chia seeds, walnuts and avocados – despite the calorie load. ‘It would be sensible also to add in an omega-3 supplements as midlife women benefit from high doses of this nutrient.’
Take a multivitamin pill every day
Most of the nutritionists I spoke to recommended midlife women using the weight-loss jabs take a multivitamin every day – just to ensure all the nutritional boxes are ticked when your food consumption is reduced.
‘When you have bariatric surgery you have to see a dietitian and you are advised to take a multivitamin for the rest of your life, and I believe the same should apply to those on the jabs, particularly if you are taking the medication for a significant length of time,’ says Dr Charlotte Norton, chief medical officer of The Slimming Clinic (theslimmingclinic.com).
Dr Prasad adds: ‘With age, our ability to absorb B12, zinc and magnesium may decrease and this can have an impact on energy levels, cognitive function and the immune system.’
A multivitamin could help to protect you from the hair loss many jabbers report at the three-month mark. ‘Any hair loss is most likely to be linked to low levels of selenium and zinc and the body responding to the “stress” of losing weight fast,’ says Dr Norton. ‘Your hair will grow back, but losing hair is a strong visual sign of nutritional deficiency and much more obvious than if you were lacking in calcium or vitamin C.’
Dr Geiga says: ‘I’m deeply concerned about the simplistic advice often given to women over 50 using weight-loss jabs. We need to move beyond generic healthy eating and address the hormonal and metabolic shifts unique to this age group.’
If those using weight-loss jabs work to establish healthy dietary changes when their appetite and food noise is suppressed, these habits have a better chance of becoming embedded.
Then, when you reach your target weight and start weaning yourself down the dosage scale, you are likely to have better control of blood sugar spikes and be less tempted by cravings once your food noise returns.
Should you adjust your HRT dose?
‘If you’re taking HRT while on the jabs you may find you need to adjust your dose,’ says Dr Prasad.
After menopause, our fat cells are deployed to produce oestrogen to help top up dwindling supplies. So, she explains, if you lose a lot of body fat, that oestrogen supply might drop. However, this could be offset by other factors.
‘Gut bacteria can encourage oestrogen to be reabsorbed back into the circulation,’ she adds. ‘But the efficiency of this process might be affected by jab-related factors such as slower gut motility.
‘Keep an eye on your symptoms and, if necessary, discuss any changes with your doctor both while you are taking the jabs and afterwards if your weight fluctuates.’
Fancy a drink? Sip, don’t gulp
For many people, the weight-loss jabs remove the urge to drink alcohol so you may find yourself naturally cutting back. As most drinks provide ’empty’ (zero nutrition) calories, abstinence should help to speed your weightloss journey and dietitans would encourage you to take advantage of the jab’s suppression effects.
Some jabbers may find beer and fizzy mixers exacerbate gut-related side-effects so if you do want a drink stick to small measures (sip, don’t gulp) and increase your water intake to compensate for alcohol’s dehydrating effects.
