Are You Eating Healthier While Eating Less on GLP-1 Medications?

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
All right, Jim, I have a question for you. Are you ready?

James Hill:
Make it easy.

Holly Wyatt:
Okay. If I put you on a GLP-1 medication and you start eating a lot less food, are you eating a healthier diet? Will your diet be better?

James Hill:
Oh, good question. So I'm eating less and I'm losing weight. Maybe a lot of people might assume I'm eating better, but I don't know, Holly. I'm not sure the answer is yes.

Holly Wyatt:
Yeah, so that's one of the things we're going to be talking about. Are you eating better?

James Hill:
Ah, so you're saying eating less and eating better aren't necessarily the same thing.

Holly Wyatt:
Exactly. And we're finally starting to get some data on this. So that's the exciting part. We know a lot about how much weight people are losing on these meds. We know about the side effects. But we know surprisingly little about what they actually eat while they're losing it.

James Hill:
You know, Holly, I've been very interested in this question for a long time because we know tons of evidence that these medications help people eat less. They lose weight. And I think there's this assumption out there that people on the medications are gonna start eating better and moving more. And I don't know that that's right and now we're starting to get some data on diet quality.

Holly Wyatt:
Exactly, so we have several new studies that let us start to ask, I think some really interesting questions. Just like in any study, they give us a little bit of information and it opens it up for a lot more questions, but are people getting enough protein? What happens to fiber? What happens to vitamins? What happens to minerals when your total food intake drops pretty low so that you're losing weight? And what happens when someone is eating so little that getting adequate nutrition is not. becomes a real challenge.

James Hill:
It's an interesting time we live in because you and I are asking questions we never thought we would ask. We asked the question not too long ago in, can you lose too much weight? And now we're asking the question of, are people eating too little? We spent most of our careers helping people eat less, but now we're asking, is that really the answer? Is eating less what we're after? Or is it eating better? Or is it some combination? So interesting, interesting times.

Holly Wyatt:
Yeah. And I think even for some people, we now, I think, need to ask, how do we get enough nutrition into the amount they're able to eat? Never thought I'd ask that question.

James Hill:
I know.

Holly Wyatt:
Never thought I'd be saying, okay, they can only eat this really small amount. Now, how do we pack it full to get just what they need?

James Hill:
And the complexity, Holly, is that it may not be the same problem for everyone taking the medications. We have to look at individual differences.

Holly Wyatt:
Yeah. And that even makes another layer of kind of complexity into giving people guidance on what they should be eating. Someone who can barely finish a small meal may need very different nutrition advice from someone whose appetite is still pretty strong. They're losing weight, but they still have some appetite that's driving them to eat. And so the question I keep coming back to is if you're eating less food, does what you do eat actually become more important not less?

James Hill:
Yeah. So let's look at the data, Holly, because we actually have some real data coming out.

Holly Wyatt:
Okay. This is the exciting part. So Jim, I pulled three studies that have happened in the last year or so, one of them pretty recent, to start saying, well, what does the data show? And so the first kind of part of this podcast, I want us to say, what do we know? And then, of course, me and you are going to tell you what we think.

James Hill:
We then will criticize some of these studies, but nonetheless.

Holly Wyatt:
But we'll start with some data. How about that? All right. So the first study is looking at if people eat less, do they eat better? And it's the CRAVE study. And this study just was published in July of 2026. So, pretty new data for us. But it was a prospective observational study. That's important. They followed people over time, but it was observational, Jim. They didn't give them an intervention. They just said...

James Hill:
They just wanted to see what happens. You give people medication, and you just watch what happens.

Holly Wyatt:
Yeah. So that's important to recognize. These were adults. They were initiating either semaglutide or tirzepatide treatment. So the two of the drugs that are very common. They followed them for 24 weeks, so about six months. It was a small study though. 43 people were enrolled and only 28 completed the endpoints because there's two measurements in this observational study. And there was no structured nutrition intervention. Very important for people to realize. They weren't told what they should eat or whatever happened. They may have been told, but there was no planned intervention in here. They did three-day food records to assess dietary intake. And diet quality, which is really what we're trying to get at, was measured with something that we call the Healthy Eating Index, or we sometimes refer to as HEI. They also measured food cravings, which I thought was interesting. We can talk a little bit about that. So that's kind of how this was set up. It wasn't, you know, here is the GLP-1 plus a diet program. They just followed people who were on a GLP-1. So, Jim, what happened?

James Hill:
What happened? Well, first of all, people lost weight, Holly. They lost an average of about 9.4% over 24 weeks. Now, that's kind of interesting because that's a good number, right? But it's not the number you hear of people losing 20 and 25 and 30% really reflecting there's a real difference between controlled clinical trials and what happens in the real world. But nonetheless, 9% weight loss is pretty good. A lot of people would be happy with that.

Holly Wyatt:
And I'm going to say that it was 24 weeks, so some people may go on to lose more.

James Hill:
That's exactly right.

Holly Wyatt:
And so they, you know, may have started a slow dose. I mean, there's only 20, yeah.

James Hill:
So they lost weight. They ate less. Their energy intake decreased by about 255 kcals per day. That's fairly substantial. All right. Diet quality. Holly, you know what happened to diet quality?

Holly Wyatt:
We're waiting, Jim.

James Hill:
Actually went down a little bit. Okay? So the healthy eating index goes from 1 to 100, 100 being the best. They started out around 59, which is, you know, it's not great, middle of the pack. And so one of the questions is, if people start eating less and losing weight, are they actually eating healthier? And in fact, their healthy eating index went down to 55. Essentially, not much of a drop. No increase. They did not start eating healthier.

Holly Wyatt:
Yeah, it didn't improve. I think we can say it didn't seem to improve.

James Hill:
It did not improve.

Holly Wyatt:
I don't know if that drop is significant or if it just kind of basically stayed the same. But for our listeners, Jim, I think people, this index, this healthy eating index, we consider greater than 80 good. Just so that they started out not good.

James Hill:
And not too many people are good. I mean, the fact of the matter is most people don't eat a healthy diet. But the takeaway here is just going on a medication, losing weight without any program is not necessarily going to improve your diet.

Holly Wyatt:
I would have hoped maybe, because here's what my thinking would be, Jim. If you're not thinking about food all the time, if the food noise has gone down, if you don't have that drive to eat, could you choose what you're eating and perhaps improve the quality of your diet? Because the pressure may be different. And so I'm, you know, I would have hoped, but this doesn't seem to be pointing us in that direction. It's just one data set, small one.

James Hill:
It’s not positive news. And the other thing, Holly, they saw several micronutrient intakes declined. People were eating less of magnesium, potassium, iron, and zinc. And these are micronutrients that are critically important to maintain health. Average protein intake went to about 0.9 grams per kilogram per day, which is kind of in the recommended range. But I think now more and more people are actually thinking higher protein may be better with weight loss. And a very interesting finding, they found a modest positive association between protein intake and preservation of muscle mass, of lean body mass. We've talked about this before, increasing your protein intake during weight loss could potentially minimize loss of lean body mass. And they found a positive relationship here, meaning those with the higher protein intake lost a little bit less lean body mass or muscle mass.

Holly Wyatt:
Yeah, I will say that it was just…

James Hill:
It's slight.

Holly Wyatt:
It was really slight. It weakened a little bit when they did a sensitivity analysis. And so I don't think we can use this study to say that's necessarily true, but it's starting to show us some signals. It's starting to say...

James Hill:
It does not counter the idea that increasing protein during weight loss may be useful.

Holly Wyatt:
Exactly. And I think you make a great point. Even though that the 0.9 grams per kilogram per day, they were not protein deficient by our definitions, but maybe we need more than that. So it kind of starts to ask a lot of questions, but they weren't deficient in the protein by that standard, which I think was interesting.

James Hill:
But Holly, isn't eating less the point if you're trying to lose weight?

Holly Wyatt:
Yeah, I think that's what we've been thinking for years, and you have to. You have to really eat less. We know that. That nutrition and energy restriction is what drives most people to lose weight, but we're kind of figuring out is that when you remove food, that's where all that protein and fiber and vitamins and minerals and essential fatty acids, that's where it comes from. And so we have to now start to think about that because we have this tool that does a really, really good job of removing food.

James Hill:
Wow. It really makes us think differently about weight management, doesn't it?

Holly Wyatt:
Yeah. So I'm going to ask you a question, Jim.

James Hill:
Okay.

Holly Wyatt:
Do we subconsciously or consciously equate eating less with eating better?

James Hill:
Absolutely. I think we do. And in the past, we haven't had any real data that would separate them, right? You and I have done weight loss for a lot of years, Holly, and if we could have achieved this 255 reduction in calories per day, every day, we would have been happy. And we weren't worried about, are they nutrient deficient? We would have said, “Wow, this is fantastic.” But because with these medications, you can do it and you can sustain it. And that's the key. Now what you're seeing is over time, the quality of the diet becomes more important. So I think we have totally repositioned how nutrition plays a role in weight management.

Holly Wyatt:
We have, because now we have these tools that can restrict calories successfully. And even in maybe larger than we need amounts, restriction of calories. So now it shifts what we need to look at when it comes to nutrition.

James Hill:
Absolutely.

Holly Wyatt:
Yeah. And so, Jim, before we move to the next study, I think we want to make sure what can we make of this study? There's obviously always strengths and weaknesses to every study.

James Hill:
Again, it's a small study, but I think the one thing that I take away is pretty impressive is simply going on a GLP-1 medication is not going to improve the quality of your diet.

Holly Wyatt:
Yeah, I think that's the takeaway.

James Hill:
And we're going to come back and talk about maybe what you can do about that. One of the things that I've been saying over and over in my talks, prescribing a GLP-1 medication, it's not a comprehensive weight management program. It's one part.

Holly Wyatt:
Yeah. One more thing I think is interesting. They did look at cravings. I mean, this study was called Crave.

James Hill:
This is really kind of interesting.

Holly Wyatt:
Yeah, and this study, interesting, despite the reduction in food intake and weight loss, the overall food craving scores did not significantly change at the group level. So that was a little bit shocking to me, or I wouldn't have anticipated that.

James Hill:
But that's a question a lot of researchers have been asking because, again, it relates to food noise. And the idea is, well, if you're decreasing food noise, food noise may be sort of facilitating these cravings. So maybe when you stop the food noise, you're maybe reducing or changing some of the cravings. And this study didn't find that very much changed in terms of cravings.

Holly Wyatt:
I will point out there have been some other studies that have found some reduction in cravings. So this is one small study. I think we have a lot to still figure that out. There was a lot of individual variability in this study, which also could be part of the problem. Different study designs may help us in the future kind of figure out what's going on there. So more to come on that, I think.

James Hill:
So I don't think we can make any conclusive statement about GLP-1s and cravings.

Holly Wyatt:
No, I don't think so.

James Hill:
I think the strongest one is there was no indication that healthy eating improved with GLP-1 medications alone.

Holly Wyatt:
All right. Let's go to the second paper. This is one where we're going to look again at diet quality and more about nutrient distribution while people are on the GLP-1s. This second paper was published in July of 2025. And it's a cross-sectional analysis of adults that are currently using GLP-1 agonists for weight reduction. So cross-sectional means, Jim, just one point in time. So unlike the first study where we could see a change in time prospectively and observe what happens, this is more of a cross-sectional study. It had 69 participants. They used three-day food records. It looked at diet quality, but also looked at calories and nutrients that were being consumed. It also did the healthy eating index.

James Hill:
Yeah.

Holly Wyatt:
All right. Drum roll.

James Hill:
Again, as you said, this is a point in time, so there wasn't a change. So remember the first study. They went from a healthy eating index of what? About 59 to 55. Okay. This study, looking at what people taking GLP-1s had in terms of healthy eating index, 54, almost exactly what the other study found. So again, it's beginning to impress me a little bit, Holly.

Holly Wyatt:
Well, and I just want the listeners to know that what is the cutoff for poor? I think it's 51, less than 51.

James Hill:
So these people are borderline poor nutrition.

Holly Wyatt:
Yes, poor diet quality right there.

James Hill:
And diet quality was particularly suboptimal in a few categories, including fruits, vegetables, whole grain, dairy, seafood and plant proteins, and fatty acids. And Holly, one really interesting thing, diet quality wasn't any better in people who had been taking these meds for a longer period of time. So this idea of, well, maybe when you first take them, it's bad and it gets better. No indication of that. So simply being on a medication longer didn't appear to teach people to eat better.

Holly Wyatt:
Yeah. And, you know, it doesn't mean that being on the GLP-1s made it worse. We can't say that.

James Hill:
No, no. Right.

Holly Wyatt:
This may show that, in general, we have poor diet quality, and the GLP-1s don't seem to be changing that.

James Hill:
Well, what we have is two now, two studies, two cohorts, taking GLP-1 meds and not eating a very healthy diet.

Holly Wyatt:
Yeah. So there was another thing in this study that I found interesting. They looked a little bit at a pattern about when people were eating, for instance, their protein. And they found that approximately 40 percent, so, a big chunk of the protein intake was occurring with the dinner meal.

James Hill:
So they're getting most of their protein later in the day.

Holly Wyatt:
Yes. It's almost like they're waiting or something to...

James Hill:
Is that a bad thing, Holly?

Holly Wyatt:
Well, I mean, I don't think we know for sure, Jim. I mean, if you're waiting to the end of the day and then suddenly you're full with six bites and you can't get your protein in, that's not going to be good. Or do we know, Jim, can you load up at one point on protein and it be as effective as spreading out protein throughout the day?

James Hill:
That'd be a great study, wouldn't it?

Holly Wyatt:
It would.

James Hill:
You know, one of the things as I'm reading this, that most people get their protein in the evening. You and I, over a course of our career, have been very interested in breakfast, right? And actually feel like breakfast might be that first meal where you can get good nutrients in. And you always tell me, Holly, that breakfast doesn't have to be the most satisfying, wonderful meal you've ever had. You can use it more as a meal to get you started. And it seems like there might be some opportunities here.

Holly Wyatt:
Well, I think it's a great opportunity to study it. We've been talking about an appetite reset meal that you kind of start your day with and having protein in it as a way to kind of start the day. And part of that has been to help regulate appetite or to start kind of those appetite satiety hormones, trying to start them, especially if you're trying to come off the meds. We talk about that in our book, but this may also help if you are wanting to spread out the protein throughout the day, starting specifically, strategically with a meal that has some protein in it.

James Hill:
Well, I think that's really food for great future research to look at that. Could you intervene earlier in the day? Would it make any difference? Maybe it doesn't make any difference. But boy, there's a lot of opportunities to study that.

Holly Wyatt:
And with your meals getting smaller, you may not have the luxury of waiting to the end of the day to actually get what you need.

James Hill:
That's right. You get to the end of the day and you're not very hungry and you don't get it.

Holly Wyatt:
Yeah, it just may not. You may need to spread it out because you're not going to be able to get everything you need if you wait to the last meal.

James Hill:
So these two studies were pretty consistent overall, I would say, and a little bit of a depressing message that just losing weight alone is not going to make you eat better. And you've got a whole bunch of people that are borderline poor nutrition. So I think we've got a problem there, Holly.

Holly Wyatt:
I do. I think as the data keeps coming out, really shift our direction of how we think about nutrition.

James Hill:
But what an opportunity for nutrition researchers.

Holly Wyatt:
Absolutely. And RDs.

James Hill:
Nutrition becomes, I think, even more important in this scenario.

Holly Wyatt:
We need to think more about it because your appetite is suppressed, not less.

James Hill:
We need to think differently. I mean, for my whole career, the goal in nutrition has been to help people weigh less. Now we've got totally different and I think even more important goals for nutrition.

Holly Wyatt:
I agree. All right, let's do the third paper.

James Hill:
Okay.

Holly Wyatt:
And this was a little bit different. This was a, let's see, this was published in, I think, 2025. This is actually a similar cross-sectional look and published by the same group of authors, but looked at a couple of different things, looked more, was published more about total calories and some other things. So this, once again, was cross-sectional. And they found that the average reported intake for people on the GLP-1s was 1,748 calories per day.

James Hill:
Yeah.

Holly Wyatt:
And 77 grams of protein. So we're starting to get data. We just didn't have any data at all about what people were eating. So we're starting to get some numbers and to understand that.

James Hill:
And I do have to put in a plug here. These are self-reports. And there is a problem with self-reported intake, but at least we're getting data that can help us understand.

Holly Wyatt:
Yeah. And once again, also several nutrients were below the dietary reference values. Fiber was below calcium, iron, magnesium, vitamins A, C, D, E, and K. So once again, seeing some low levels of some important micronutrients.

James Hill:
Yeah, I think fiber is becoming at a really important one, Holly, because people don't get enough fiber anyway, naturally. And with GLP-1 medications, if that's going down, I think that could be a potential problem.

Holly Wyatt:
Well, I think that's what we're seeing, Jim. We already have a poor quality to our diet.

James Hill:
Poor quality diet. And this is making it worse in some respects and not making it better overall.

Holly Wyatt:
Yeah. And I had hoped, and I think we kind of wondered and we'll still see. And there could be individuals where this isn't the case. Some individuals may say, “Okay, I am eating better. I am eating more vegetables. I am really concentrating on things.”

James Hill:
But the other thing this does, Holly, is to give us a starting baseline for if we then try to do intervention studies to say, “Look, this is what happens when you do nothing. Now what happens when you do something?”

Holly Wyatt:
Yeah. All right. So let's just briefly kind of say, what's the story these three studies or three papers have told us? I think the first one, you start a GLP-1 therapy, food intake decreases, you lose weight, but diet quality doesn't automatically improve.

James Hill:
Two out of three are good. But it's that third one that's a problem.

Holly Wyatt:
Yeah, yeah. Paper number two looked at people already taking the GLP-1s. Remember, it was just one point in time. Diet quality is suboptimal, and much of the day's protein comes late.

James Hill:
Right, right.

Holly Wyatt:
Okay? And the third paper looked specifically at nutrient intake, and several nutrients seemed to be inadequate, gave us a little bit of self-reported data on how much people are eating. So three different studies, I think, coming together to get us to maybe ask more questions about this now.

James Hill:
And Holly, these should just be taken right now as pilot studies. They're small. They're not definitive. But one of the things that impressed me is they all basically found the same thing. So take this with a grain of salt. We need larger studies. We need studies that are better powered. But these three studies together raise some serious questions about what happens with GLP-1 medications without any nutrition advice.

Holly Wyatt:
I think of them as kind of a signal, just a signal to study. Like this is the signal, this is the direction we need to start looking and doing more studies to really get more data in this area. All right, Jim, let's talk about what this means.

James Hill:
Yeah, I think it changes the questions we ask, Holly.

Holly Wyatt:
Yeah, I do too.

James Hill:
The old question, and I spent 40 decades asking this. How do we help people eat less and lose weight?

Holly Wyatt:
Yeah, me too.

James Hill:
That's not the right question anymore.

Holly Wyatt:
Yeah, that was it. It was all about how can I kind of design the diet so that they can lose weight?

James Hill:
Now we have to ask, if I'm already eating less and able to sustain that, how do I make sure I'm eating well? Different question.

Holly Wyatt:
Yeah, I think we've got to think differently about a lot of things. And I even catch myself, we're doing some GLP-1 meals here at the center at UAB. We have a metabolic kitchen. And what do they look like? Now I'm so used to really trying to make sure they're designed to help restrict calories successfully. The whole purpose now kind of changes somewhat when we're coming up with meal plans or meals.

James Hill:
Totally. But this is the way that science works, Holly. We're learning. We take gradual steps. Now, as you said, we've got a signal. That signal says, hang on, there may be a need to do something different nutrition-wise in people taking these medications. Next step is we're going to try some things to see what can you do to actually improve the quality of the diet of people taking these meds.

Holly Wyatt:
Yeah. We concentrated so much, or I did, on energy density.

James Hill:
Yes.

Holly Wyatt:
Now I think we're going to switch and concentrate on nutrient density.

James Hill:
I couldn't agree more.

Holly Wyatt:
Which is different. It's very, very different. But I think that's the shift that we're seeing. And so, Jim, do you think that nutritional monitoring, I'll call it that, should become a routine part of GLP-1 obesity treatment? Are we going to go there?

James Hill:
I think we have to. And I think we have to get back to the fact that prescribing a GLP-1 medication is not a comprehensive treatment plan. And we have to look at what a treatment plan involves. Now, the GLP-1 medications are doing the hefty lifting on weight loss. That's amazing. So I don't want to minimize the critical nature of these because without these medications, people weren't able to sustain the changes in intake. Now we've got the medication. And the question is, how do you surround the medication with the comprehensive treatment plan? So you get those two important things. They eat less, they lose weight. But how do you address the third one? They're also eating healthy, living a healthier lifestyle.

Holly Wyatt:
Yeah. And that really moves us into, we're starting to see things like GLP-1 friendly on certain meals or certain foods. Is there one GLP-1 diet or is there one, what makes something GLP-1 friendly, I think is a big question because I see a bunch of different people needing different things. For instance, you may have one person that says, “I can barely eat. I get full after a few bites. And so it's really about getting enough protein and nutrients into a very, very small volume of food.” You know, not something that we've worked on very much in the past. And then you have the second person who says, “The medications are helping, but I still have a strong appetite.” And so they still may need to work a little bit with eating foods that are satisfying and still managing total energy intake to some degree. And food volume might still be helpful in that individual. So it's complex to me about how we're going to label or what we're going to tell people to eat.

James Hill:
Yeah, it is complex. And also keep in mind, people are starting at different places. GLP-1 usage is throughout the population. It's being taken probably by people who need to lose weight but are actually eating pretty healthy already.

Holly Wyatt:
Exactly.

James Hill:
It's taken by people who need to lose weight and are eating terribly. So again, what we're seeing are some averages now, but I think it really relates to your question before. Are we going to have to monitor on an individual basis? So if you put someone on a GLP-1 medication, Holly, they need some support. They need to talk to someone that can help monitor their nutrition. They need to talk to someone that can look at their physical activity. They need to help manage their negative symptoms. This is a comprehensive plan. Just the medication alone is not.

Holly Wyatt:
Yeah, I agree. They're going to need monitoring, management, but also individualization. And that really fits with what we've talked about in terms of this precision nutrition and personalizing and one size doesn't fit all. So you can add that on top of that kind of management plan. Now we've got to plug it into what that individual person needs. What's their appetite response to the treatment? How fast are they losing weight? All of these different factors that are going to play a role in how you help them or give them advice on what to eat.

James Hill:
So a question for you, Holly. Everybody's still talking about the weight loss phase. How does all this relate to weight loss maintenance? Because once you get the weight off, you have to keep the weight off.

Holly Wyatt:
Well, but Jim, this is key because yes, you've got to keep it off. But also when I think about weight loss maintenance, I'm thinking about something forever. So the nutritional part of it, if you have some deficiencies in micronutrients and that's forever, that can be a big problem.

James Hill:
Yeah. We talk about these medications as really reducing chronic disease, but you might have the opposite effect going on from poor nutrition. You might actually be facilitating some chronic diseases.

Holly Wyatt:
To have some deficiencies for six months or even a year while you're losing isn't optimal, but I don't worry as much about that.

James Hill:
But weight loss means it's forever, 20, 30, 40 years of being nutrient deficient.

Holly Wyatt:
Yeah. And what does that do to so many other systems in your body in terms of your health that we may be really seeing some diseases that we haven't seen before. If people stay on these GLP-1s and consistently eat a diet that is not as nutrient deficient. Now, going against that, because I know some people will say, “Well, Holly, we're already eating a diet. You're already seeing that these diets are poor.”

James Hill:
That's true. We're eating poorly already.

Holly Wyatt:
I don't know. So maybe I'm worried about something that isn't going to happen.

James Hill:
And again, this does not take away from the importance of these medications. These medications are fantastic. And we've done podcasts before about all the wonderful things they do in addition to weight loss. But it's important to point out potential problems and how we can mitigate those problems. And I think we definitely can do that.

Holly Wyatt:
All right, Jim, let's move then to what should or what could you do about it? You know how I like to put some pie on the plate. And so, someone listening and taking a GLP-1, what could they actually do with this information, basically? I'll go with, I think we came up with four or five. I think we came up with five. I'll go with the first one. Pay attention to how much you're actually eating. Don't assume that less is always better.

James Hill:
Yeah.

Holly Wyatt:
I think that's different, right? Is my appetite moderately reduced or am I struggling to eat enough? And recognize that, be aware of that.

James Hill:
A second one, Holly, is make protein intentional. Protein is still very important. And the data we have suggests that on a recommended basis, people are getting adequate protein. But I think the data is suggesting more and more that people might need more protein. And the other thing we're seeing is most of those get their protein later in the day. So there's a real question about how we might use the food intake earlier in the day to actually boost protein intake a little bit.

Holly Wyatt:
At this point, I would recommend, I don't have great data for this, to spread out the protein. I think that that's what I would recommend until we have other data. I wouldn't just wait to dinner.

James Hill:
There's no downside to doing that.

Holly Wyatt:
All right. Three, ask what else your food is bringing with it.

James Hill:
Oh, yeah.

Holly Wyatt:
So protein matters.

James Hill:
Protein matters.

Holly Wyatt:
Right. But I would also think about the fiber, the fruits and the vegetables, whole grains, dairy, healthy fats and the vitamins and minerals. If you're eating less food, choose foods that bring what I would say more nutrition with them, more of those things with them. Make conscious decisions. The appetite may be down. You may not be thinking about food. So when you do eat, let's bring some strategy to it.

James Hill:
Right. And that goes with the number four, match that strategy to your appetite. So if you're barely able to eat, you're not hungry, you just don't want much food, you really have to critically think about getting more nutrition and less volume. And some people eat more. They still have a substantial appetite, and you may benefit from more volume for fewer calories.

Holly Wyatt:
Yeah, so you know yourself and you know I sit down and, you know, five bites and I'm done. You now gotta make those five bites have a lot of nutrients and energy in them. But if you're not someone that's still a little, you know, I'm still hungry, I'm still eating a good volume of food, you're gonna wanna think about it differently. And then number five, don't assume weight loss means the diet is working perfectly.

James Hill:
Right.

Holly Wyatt:
I think so many people, we're so tied into that. If I'm losing weight. I'm doing good.

James Hill:
Scale is the only thing that matters.

Holly Wyatt:
The scale tells you something important. We believe in weighing in and we believe in looking at the scale, but it doesn't tell you whether you're getting enough protein. It doesn't tell you whether you're meeting your nutrient needs. It doesn't tell you the quality of your diet. It doesn't tell you if you're maintaining muscle. So you really want to pay attention and not just assume that weight loss means you're on the perfect diet, the diet's working.

James Hill:
Good. So five good tips. Okay, do a couple of listener questions, Holly.

Holly Wyatt:
All right, you start, Jim.

James Hill:
Okay, here's one. I'm barely hungry on my GLP-1s. I've heard that a lot. Should I make myself eat?

Holly Wyatt:
I get this question often.

James Hill:
Yeah. Again, the goal isn't to eat as little as possible, it's to eat enough of the right things to support your health while the medication helps manage your appetite. Even though you're not very hungry, prioritize foods that deliver proteins and nutrition in manageable portions. That's just why, you know, oftentimes we recommend working with a registered dietitian who can help you look a little bit about the quality of your diet. But again, you want to make sure that however many calories you're taking in, you pack that as much as possible with nutrient-dense foods.

Holly Wyatt:
Yeah, and this is a shift. The goal isn't to eat as little as possible.

James Hill:
And if you aren't hungry all the time, that's a challenge for getting healthy nutrition.

Holly Wyatt:
All right, here's the second question. I'm still hungry on my GLP-1. I get this question too. I get some people say I'm not hungry at all. I can't eat anything. I get people who say I'm still hungry on my GLP-1. Does it mean it isn't working? And the answer to that is no. We're going to be looking at what's the scale doing. I think we hear the stories of I can't eat anything. And so everybody feels like if they don't have that exact response, that means the medication isn't working. I would love for people to be losing weight and, yes, still have a little bit of appetite. You know, not to be completely shut down. I think appetite serves a purpose. So if you're not losing weight, that's a different question. But if you're a little bit hungry, I think that could be a good thing. And that actually may help with some of these deficiencies. I think you still need to go in and purposely, we found out that everybody, a lot of people have a poor diet quality regardless of whether they're on a GLP-1 or not. So still thinking about what you're eating but I don't want you to think, oh, my appetite has to be completely cut off for you to be having success.

James Hill:
All right, Holly, I'll do one more. This is a good one. Is there a GLP-1 diet I should follow? And the answer is no. I mean, we spent, gosh, half a century figuring out that there's no best diet for weight loss. I think we'd hopefully don't have to spend that long to understand there's no best diet for GLP-1 users.

Holly Wyatt:
Oh, Jim, this is good. This is good because hopefully we can learn from our, mistakes where we screwed up. Right?

James Hill:
Look at the literature of comparing this diet to that diet, and what we finally figured out is they all work if you follow them. And hopefully we won't make that mistake with GLP-1 medications. So if you hear out there that somebody has discovered the perfect GLP-1 diet, take that with a grain of salt, because I think what we need to learn is how to evaluate the person to give them the support they need. It's more, Holly, right in the lines of precision nutrition.

Holly Wyatt:
Yeah. And how you're responding to the GLP-1. Yeah. Personally. Right. Precision nutrition. All right, Jim, I want to do some rapid fire.

Holly Wyatt:
I always find these fun. I always find these really interesting. All right. Let's alternate.

James Hill:
Okay.

Holly Wyatt:
Okay. So, eating less or eating better?

James Hill:
Yes, both.

Holly Wyatt:
Both matter is what you're going to say. Okay.

James Hill:
Yeah. All right, Holly, protein at breakfast or save it all for dinner?

Holly Wyatt:
Oh, don't save it all for dinner. Do it across the day.

James Hill:
Okay.

Holly Wyatt:
Huge salad or small nutrient dense meal?

James Hill:
You're giving me all these yes answers. Yes. It depends on the person's appetite.

Holly Wyatt:
I'm Jan Tricky.

James Hill:
All right. Protein shake, yes or no?

Holly Wyatt:
And once again, I think it depends on whether it will work for you or whether you need it. I don't think there's a yes or no to that.

James Hill:
There's a trend here.

Holly Wyatt:
All right, Jim. Is no hunger the goal?

James Hill:
No. I finally got a no question.

Holly Wyatt:
There we go.

James Hill:
All right, Holly. One question everyone taking a GLP-1 med should ask themselves.

Holly Wyatt:
Ooh, hard one. One question. Am I getting what my body needs from the amount I'm eating?

James Hill:
Ah.

Holly Wyatt:
From the amount I'm eating, right? Not someone else is eating, the amount I'm eating. There we go.

James Hill:
All right. Let's do vulnerability.

Holly Wyatt:
Okay.

James Hill:
All right. I'll do you first.

Holly Wyatt:
All right.

James Hill:
All right, Holly. We spent decades teaching people how to eat less to lose weight. Isn't it strange that we may now have to teach some people how to make sure they're eating enough of the right things?

Holly Wyatt:
Yeah, it's totally strange. I catch myself all the time now. We're designing diets and I'm talking to registered dietitians. I catch myself all the time going, wait a minute, it's shifting. I never thought I would be here. So it is strange because I've spent my whole career really looking at how to help people lose weight and using the diet to do that, and now I don't need the diet so much. I don't need to design the diet so much to help them lose weight as I need to design the diet to make sure they're getting enough of the right things and to really work on quality. So now, Jim, maybe for the first time, and I'm just thinking out loud as I'm talking. For the first time, because we can achieve weight loss, we're going to be able to focus on quality.

James Hill:
Absolutely.

Holly Wyatt:
Yeah. All right, Jim, here is one question. What's something about nutrition on the GLP-1s that you think the obesity field may have gotten wrong or maybe underestimated?

James Hill:
Yeah, Holly, that's a good one. I'd have to say, I think a large part of our field assumed that when people started taking GLP-1 meds and losing weight, they were going to automatically seek out healthier diets, that this weight loss was going to stimulate them to say, “Now I want to improve my lifestyle.” So restaurants started offering healthy stuff. Food companies started doing healthy thing, assuming there's going to be a demand that people are looking for healthier options. And I think the studies we just saw maybe make us question that. That may not be a reasonable assumption that just because you eat less and lose weight doesn't necessarily mean you're going to be motivated to eat healthy.

Holly Wyatt:
Yeah, I think more data on this craving question could help because why are people, you know, what's the reason why people are still eating the same, it appears that they may be eating the same quality diet. I don't even know that for sure, but a poor quality diet is because they're craving things that bring in the calories that don't have a lot of nutrients associated. Is it habit, Jim? I mean, I don't know. But I do think we're going to need to look a little bit closer at that and not just make that assumption that that's going to happen.

James Hill:
Totally agree. All right. So let's wrap it up. GLP-1 medications are remarkably effective in helping people eat less and lose weight. No question. But the emerging research is maybe telling us something that might be important. And that's that eating less and eating well are not the same thing. And when you're eating substantially less food, you have fewer opportunities to get the protein, fiber, vitamins and minerals, and other nutrients your body needs. So nutrition does not become irrelevant. It actually becomes more important. So I think we're seeing a new golden age for nutrition.

Holly Wyatt:
Right. Becoming more important, not less, with the GLP-1s. I love that.

James Hill:
Now, Holly, a little bit of a teaser. This is kind of like a bookend episode because we've looked at what happens to diet on GLP-1s. Our next episode is going to look at physical activity. What happens to physical activity when you take GLP-1 meds? So stay tuned because together, these are going to maybe raise some questions that might surprise you.

Holly Wyatt:
Yeah. So our next episode, Jim, is along the same lines, if people lose weight, they feel better. And if movement gets easier, I mean, surely they're going to move more.

James Hill:
Are they out there joining gyms and buying a ton of shoes and so forth?

Holly Wyatt:
Your joints feel better. You're going to move more, right?

James Hill:
We'll see.

Holly Wyatt:
We'll see.

James Hill:
So join us next time on Weight Loss And.

Holly Wyatt:
Bye, everybody.

James Hill:
Bye. And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:
We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at weightlossand.com. Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:
And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.