Holiday season means food—and a lot of it, from work events to social gatherings with friends and family.
“When I talk to my patients, instead of calling it the most beautiful time of year, I call it the most challenging time of the year,” says Dr. Andres Acosta, a physician in the division of gastroenterology and hepatology at Mayo Clinic.
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For the 12% of adults in the U.S. now taking a weight-loss medication that targets the GLP-1 and/or GIP hormones to restrict appetite or treat diabetes—think Ozempic, Wegovy, Mounjaro, and Zepbound—the season is even more complicated.
“We’ve heard of people not skipping their injections but pushing them back,” says Michelle Cardel, chief nutrition officer at WeightWatchers. “So if they normally inject on Wednesday, and Thanksgiving is on Thursday, they might give themselves their injection on Friday instead, so they can have a little more room to enjoy the holiday foods and are less likely to experience unwanted side effects if they overeat.” Others stop the medications for longer periods during the holiday months, doctors say.
In general, doctors don’t recommend changing anything about your injection schedule. Unlike most previous anti-obesity medications, drugs like Wegovy and Zepbound work in part on the brain to dampen hunger signals and reduce appetite so you don’t feel like eating. In order to achieve that effect with the fewest side effects, the dose of the injections that people give themselves once a week have to be ramped up gradually over 16 weeks before people reach the maximum dose that they then maintain. Generally each injection can successfully control hunger signals for about a week, and just as its effect starts to wane, you give yourself another injection.
Skipping or shifting injections has a domino effect. For those moving from a Wednesday dose to a Friday dose, for example, their future doses will now occur on Friday. And people skipping doses should be prepared to experience the same side effects that they felt when they first start their doses—such as nausea, vomiting, diarrhea and other gastrointestinal symptoms—when they restart their doses.
“I advise my patients against stopping their medication because we are managing chronic obesity,” Acosta says, and changing an established dosing schedule can have additional consequences. If patients stop their injections for more than one week, they have to return to lower doses and work their way back up to the dose they achieved before they stopped, which further pushes back any weight-loss goals they might have set.
Read More: How to Add More Protein to Your Thanksgiving Recipes
Dr. Andre Teixeira, medical director of the Orlando Health Weight Loss and Bariatric Surgery Institute, has seen some serious examples of these spillover effects among his patients. “Some people can’t work back up to the dose where they were before,” he says. Because these are hormone-based medications, he likens the effect to what some women experience on different types of birth control; certain brands are associated with more extreme side effects that make the pills intolerable for some.
And of course, any time patients stop taking Wegovy or Zepbound, their weight eventually goes back up. “I tell my patients that we don’t want to burn all the effort they have put in to lose weight over the whole year over the six weeks of the holidays,” says Acosta.
Instead of messing with their medication, Acosta advises people to plan ahead with dietary and fitness adjustments. On Thanksgiving or Christmas Day, for example, don’t eat large meals earlier in the day. “You don’t need to have a big breakfast or a massive lunch,” Acosta says. “Go exercise that morning—everybody benefits from a long walk or a hike. We’re super good at planning meals and dinners with loved ones; we should also plan to go for a walk in the park with our loved ones. And if the weather isn’t nice, then go the mall. Do something that requires physical activity so you burn some calories.”
He also reminds patients about the consequences of overeating while on the medications, and advises them not to overdo it, even if they might feel pressure to at a family gathering. You might consider letting loved ones know about your situation. Since these drugs are discussed openly on social media and gaining popularity, “it’s become a little more acceptable to share that you are trying to lose weight and using anti-obesity medications.”
And it’s not just navigating food—but alcohol as well—that might be a challenge for people taking the medications. Many experience nausea, vomiting, and other GI issues if they drink while on the medications. WeightWatchers conducted a study to chronicle how anti-obesity medications affected alcohol consumption and found that 45% to 51% of people taking GLP-1 and GIP drugs decreased the amount of alcohol they drank. It wasn’t clear from the study whether people made this change because they wanted to avoid side effects or if they just decided to drink less as part of their overall desire to be healthier. But, says Cardel, “my guess is that it’s a combination of both.”
What’s most important for navigating the holidays is to plan ahead so that if you are taking one of these medications, you can find ways to maximize your enjoyment of long-standing family traditions while still staying on track with your dosing schedule.
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