Healthwise: Same Table, Smaller Plate

Navigating holiday meals on GLP-1s

Thanksgiving is known for heaping plates of turkey and button-busting fullness. But for people taking GLP-1 medications such as Wegovy, Zepbound or Ozempic, holiday dinners present a new hurdle in their weight loss journey. It’s likely their appetite has changed even if the menu hasn’t.  

These medications help people lose weight because they mimic a naturally occurring gut hormone that helps regulate blood sugar, slows stomach emptying and reduces hunger and increases the feeling of fullness. Many patients on GLP-1s say they are surprised by how little they actually want to eat, even when presented with their favorite treats, according to Dr. Robert Catania, director of metabolic and bariatric surgery at Southern New Hampshire Health. 

“The interesting thing about those medications is, not only do they help patients eat less, but they actually take away a lot of the cravings and desires for eating,” he says. “Oftentimes, it’s really not as hard as one would expect.”

Trying to eat the way you did before starting the medication; however, can lead to gastric distress. To avoid feeling unwell, Catania recommends approaching an upcoming holiday meal with a plan in place. He also advises against skipping a GLP-1 dose simply to make more room for holiday dinner.

“Remember why you started taking the medication; you didn’t take it just to control your eating. You took it because you wanted to be healthier. You wanted to lose weight and keep weight off permanently. And so really, once you make that commitment to yourself, I think it’s best if you honor it,” Catania says.

Setting the Table: Dr. Catania’s Tips for GLP-1 Users

There are ways to enjoy holiday dinners without taking a diet detour. By using a smaller plate, GLP-1 users can sample multiple dishes while naturally reducing the amount of food that fits on their plate. 

“Instead of grabbing the big plate, grab a smaller plate, and you can still put a little of everything on the plate, but it’s just smaller and you’re just not going to be able to fill it as much,” Catania says. “The other thing it does is help your eyes adjust to the right portion size.”

Desserts that GLP-1 users once looked forward to indulging in may no longer provide the same pleasure they once did. Eating more isn’t likely to improve your enjoyment of sweets, either.

“People who aren’t on GLP-1s may eat that cookie and then get a little bit of a sugar rush and a little bit of a high, and it makes you feel good, which is why we eat them. You may not get that same reaction on a GLP-1, because part of what it does is it blunts some of those signals in the brain,” he says. “If you find yourself with a cookie or a piece of cake in your hand, and you take one bite and it doesn’t light up your life, it’s OK to put it down or throw it away.” 

For similar reasons, many people on GLP-1 medications enjoy alcohol less, tend to drink less and may be shocked at how much their alcohol tolerance has plummeted since they first started taking their GLP-1.

“You want to be a little careful that you don’t overdo it and then realize, ‘Hey, I haven’t had this much to drink in six months or a year,’ and find yourself being escorted to the couch,” Catania says.

The emotional piece of eating less during the holidays may be even harder to navigate than adjusting your food intake. Families often equate food with love and may wonder why you’re not eating their famous pumpkin pie, or why your plate looks sparser than it did last year. 

Catania suggests patients, before they attend an event, to prepare how they will answer questions about smaller portion sizes or their weight loss journey. They should also decide beforehand how much information they feel comfortable sharing.

“If you’re willing to tell people you can’t eat because you’re on a GLP-1, that’s one problem solved, right? It’s a very easy thing to say, but not everybody wants to do that,” he says. “If you don’t want to share that you’re on a medication that’s preventing you from eating, you can say ‘My stomach felt a little off this morning, so I really don’t have room,’ or ‘I already ate a lot before I got here and I’m full right now.’ Just have a little backup plan that you’re going to stick with, because you’re going to get questioned 10 times.”