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How Can Behavior Education Mitigate the Side Effects of Semaglutide (GLP-1) Medications?

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How Can Behavior Education Mitigate the Side Effects of Semaglutide (GLP-1) Medications?

— By Dawn M. Sweet, Ph.D.

Helping patients with obesity modify their eating and exercise behaviors could help them achieve healthier and more active lifestyles — both on and off weight loss medication.

Behavior and lifestyle education are foundational to any successful weight loss program. Anti-obesity medications with semaglutide as the active ingredient (e.g., Ozempic and Wegovy) are effective strategies for weight loss. However, because of the side effects associated with these drugs, they may not be suitable for long-term use. For example, semaglutide side effects include depression as well GI issues such as nausea, vomiting, and diarrhea.1 Providing patients with strategies for how to deal with the side effects of semaglutide is a critical part of effective patient care. Because proper nutrition and exercise are necessary for successful weight loss and weight maintenance, working with patients to modify their behavior could ultimately help patients with obesity achieve healthier and more active lifestyles.


Behavioral Lifestyle Interventions

Research has consistently demonstrated the utility of behavioral lifestyle interventions built on healthy, reduced calorie diets and increased physical activity.2 Benefits of modifying eating and exercise behaviors include not only weight loss but also the prevention and mitigation of co-morbidities such as type 2 diabetes. For example, as observed in the Diabetes Prevention Program trial, an intensive behavioral lifestyle intervention reduced the incidence of diabetes by 58 percent.3

In a systematic review of 12 studies2 investigating the efficacy of behavioral modification, the following criteria was met: a formal intervention that included medically supervised diets, dietary restriction (< 800 kcal/day) or meal replacements; individual or group sessions and coaching,  physical activity, and education. Participants across all studies included in the review were over 18 and had a BMI ≥35 kg/m2 with an upper limit of 48 kg/m2. Changes in weight were the primary outcome measured and follow up was at least six months POS baseline assessment.

The behavioral interventions ranged from six weeks to one year. Twenty-two behavioral lifestyle interventions had a dietary component with 18 providing daily recommendations for energy and macronutrient consumption, three recommending a Very Low Calorie Diet (VLCD) (< 800 kcal/day) 13 recommending a Low Calorie Diet (LCD) (≥ 800 kcal/day, 500 kcal deficit or 80% basal energy), and two recommending macronutrient control (e.g., ≤ 30 g/day).(nan) There were 23 physical activity interventions that included specific goals such as the time and number of steps per day, e.g., 30 – 60 minutes of moderate exercise 5 days/week and more than 10,000 steps per day. Clinically significant weight loss was observed and multi-component behavioral interventions (i.e., diet, exercise, and coaching) were most effective.

How to Help Patients Deal with Side Effects of Semaglutide

When working with patients to manage the side effects of semaglutide medications, it is important to counsel them on the importance of a healthy diet that includes lean protein to ensure lean muscle is preserved during weight loss, high fiber foods, fruits, and vegetables. Including nutritionally designed shakes/beverages can help shore up nutritional needs and help patients meet their daily recommended allowances for vitamins and minerals. This is especially important because the GI side effects associated with semaglutide medications put patients at risk for nutritional deficits.1 Other behavioral changes health care providers and dieticians should consider exploring with patients on semaglutide medications include smaller portion sizes and consuming fewer (if any) high fat, fried, or processed foods. Smaller portion sizes and eliminating unhealthy foods can help mitigate GI side effects.

As soon as a semaglutide medication is prescribed, health care providers and dieticians should educate patients on the importance of building healthy eating habits and introducing appropriate levels of physical activity into their daily routine. Helping patients modify their behavior can facilitate weight loss and potentially transition them away from semaglutide medications more quickly. Because there are no serious GI or mental health issues associated with healthy diets and exercise, these remain the sine qua non to weight loss and weight maintenance. In fact, healthy eating and exercise have been consistently shown to improve mental health and cognitive functioning.

Teaching patients about the importance of consuming nutrient-dense foods in conjunction with nutritionally designed shakes/beverages and increased physical activity can help them manage the side effects of semaglutide while building the foundation for a healthy lifestyle through behavioral change.


1 Gastrointestinal tolerability of once‐weekly Semaglutide 2.4 mg in adults with overweight or obesity, and the relationship between gastrointestinal adverse events and weight loss

2 Behavioral lifestyle interventions for moderate and severe obesity: A systematic review

3 Safety of Semaglutide

4 10-year follow up of diabetes incidence and weight loss in the Diabetes Prevention Program Outcomes Study

5 Ozempic side effects: What they are and treatment options

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: For 45 years, Robard Corporation’s medical obesity treatment programs and nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at, email us at, or call (800) 222-9201.

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