I lost 20 pounds on a GLP-1 but couldn’t stand up — here’s what I was missing

Yes, I was looking at my phone when I tripped and fell at Disney World. But that wasn’t why I hit the asphalt. “Do you need help?” asked a man who saw me tumble, my knees starting to bleed. I was super embarrassed and tried to scramble up like it was no big deal…but I somehow couldn’t get up on my own. “Thank you,” I said, and accepted his outstretched hand. This wasn’t the first time that year I had been seriously unsteady. I mean, I was never the most graceful human on earth, but at the age of 49, I was suddenly a legit “fall risk.” What was going on? 

It turns out my clumsiness was an unfortunate side effect of taking a GLP-1 — or more accurately, a side effect of not taking care of myself while taking a GLP-1.

After battling early-stage breast cancer, I was prescribed a GLP-1. At the time, I weighed a little over 180 and my doctor mentioned that losing weight could help reduce the risk of the cancer coming back.

In the eight months I was on it, I saw what felt like success: I'd lost 20 pounds. Yet I was doing it blindly, having received no direction whatsoever from my primary care provider. As a result, I lost a lot of muscle, and felt like I lost my ability to stay upright.

I had other, um, “disruptive” GLP-1 side effects as well, the ones most people don’t talk about in polite conversation. For two or three days every week, beginning about 24 hours after my Sunday night shot, I literally couldn’t leave my house because I needed to use the bathroom urgently and often. 

On a beautiful Friday when I thought I felt fine and dared to take a quick walk around my suburban neighborhood, I had an accident after three blocks, tore home, threw my shorts in the trash bin, and showered for a very long time. I couldn’t stop wondering: How did other people tolerate these horrible side effects and still function?

When my routine blood work came back indicating I was severely dehydrated, I decided to stop taking the medication. And while I felt better, over the next eight weeks, I gained back every single ounce of the 20 pounds I’d lost — including an extra five pounds for good measure. I felt ravenous, significantly more out of control around food than I did before starting. So I brought my larger-sized clothes back up from the bins in the basement and couldn’t help but think about the damage I might have done to my body.

Around that time, I noticed some local moms had started a GLP-1 Facebook support group. While I wasn’t on a GLP-1 any longer, I still looked at the posts — and wow, did I get an education from the other women in the group, whose doctors prepped them much more than mine had. I realized that — by not changing my habits from my pre-GLP-1 days — I’d likely been contributing to my unpleasant side effects and damaging my health to boot. 

“GLP-1s on their own don't get you to your goals. They support your biology and your physiology to make it more effective, and often more doable, for you to change your lifestyle,” says Kerri Masutto, M.D., vice president of clinical and behavioral programs at Weight Watchers. 

The patients who have the best response to GLP-1s, adds Dr. Kevin Gendreau, M.D., a board-certified primary care and obesity medicine physician based in Boston, “treat the first one to two months taking the medication as their lifestyle ‘training phase.’” They work hard at creating a workout routine, including strength training a few times a week, and prioritize protein, fiber, and staying hydrated. Those are steps that could have minimized the muscle loss and gastrointestinal symptoms that plagued me, notes Masutto. 

I mulled over the intel from the Facebook group while allowing my body to recover for a few months. Then, I decided to try a GLP-1 again. And this time, I vowed to do it differently. 

I started with some important, fundamental changes: I found a different doctor with expertise in weight management, who could better guide me through the lifestyle modifications I should make. I also switched to a different GLP-1.

“Any medication can have different effects in different people,” says Masutto. “This is one of the reasons it's really important to work with a clinician who is an expert in this class of medication. They're much more likely to have seen the wide spectrum of reactions to these medications, and to tailor a care plan based on how the medication is actually working.” 

Here’s what else I changed:

• I tracked what I ate and drank
  Since I was significantly less hungry, I had to be very deliberate with my food choices on a GLP-1, and make sure every bite delivered the nutrients my body needed. I started tracking protein, fiber, and water through the WW app, following the Weight Watchers GLP-1 Success Program. I paid special attention to what I ate in the mornings to front-load as much of the good stuff as I could early in the day. 
  I also started shooting for 100 ounces of water a day, which meant drinking and refilling my huge Owala bottle three times. (You might have different needs, so talk to your doctor about a good goal.) I do still have some gastrointestinal issues, but now that I am eating better and drinking more water, they are manageable and intermittent.

• I started lifting weights 
  This was huge. Working with a personal trainer, I  had someone I was accountable to every week, who could teach me how to strength train safely, so I wouldn’t be losing as much muscle as the scale went down. At her recommendation, I started taking Pilates reformer classes, too — and I loved it. Since the reformer builds core strength, balance, and functional muscle, it's a perfect tool for people like me who are losing weight relatively quickly (something that ups your risk for muscle loss). 
  
  

• I joined a virtual community
  Why go through this on my own? I got really helpful food and nutrition suggestions from an online support group — including the most delicious protein drink (hello, Core Power Vanilla) which has become a staple. They also suggested edamame and cheese sticks for protein-packed easy snacking. Now that I’m following the GLP-1 Success Program, I also take advantage of the built-in community in the app, including the social network Connect, and the virtual Workshops. 
  
  

• I changed my attitude 
  I still struggle mightily with motivation, but I’m trying to make systems based on progress, not perfection. I do a big order from the grocery store every weekend to make sure the fridge is always stocked with what I need. If I can’t get the recommended twice-weekly strength training done at my gym, I work out at home. I even keep dumbbells under my desk for sneaky sets between Zoom meetings. (Weight Watchers' on-demand, in-app workouts help me make the most of even a 15-minute break.) Most importantly, if I don’t meet my goals one day, I simply try to do better the next. 
  
  

So far I’m down 15 pounds, and it feels totally different this time. I’m not worried I’m going to tumble down the stairs or have an accident if I take a walk. I can actually feel my body getting stronger, not weaker. And nothing is more motivating than that.