Eliana Witchell RD - Evidence-Based Nutrition
Case Study

GLP-1 Medication Support: Optimizing Weight Loss While Preserving Muscle

"I started Wegovy and the weight is coming off, but I'm worried I'm losing muscle too. I'm exhausted, can't eat enough protein, and don't know if I'm doing this right."

— Female, early 40s, on Wegovy (semaglutide 2.4mg), managing weight loss and muscle preservation

Key Clinical Outcomes

Weight Loss
35 lbs
Lean mass preserved
Protein Intake
45 → 95g
Daily protein doubled
Side Effects
Managed
Strategic meal timing

Clinical Presentation

Chief Complaint

42-year-old female 8 weeks into Wegovy therapy (titrated to 1.7mg weekly, target 2.4mg). Significant weight loss (18 lbs in 8 weeks) but concerns regarding muscle loss, extreme appetite suppression limiting protein intake, persistent nausea, and fatigue affecting daily function. Seeking nutrition guidance specific to GLP-1 medication use.

Medical History

  • Obesity (BMI 36.2, weight 220 lbs, height 5'6")
  • Wegovy initiated 8 weeks prior (current dose 1.7mg weekly)
  • Previous multiple failed diet attempts
  • Sedentary lifestyle, desk job
  • No significant medical comorbidities
  • Strong motivation for weight loss success

Baseline Assessment

  • Weight: 202 lbs at nutrition consultation (18 lbs lost on Wegovy prior to consult)
  • Protein intake: Approximately 45g/day (well below needs)
  • Activity: Minimal structured exercise
  • Side effects: Moderate nausea (especially mornings), extreme appetite suppression, food aversions (particularly to meat)

Nutrition Therapy Intervention

Therapeutic Approach

Evidence-based nutrition therapy specifically designed for GLP-1 medication use. Primary goals: optimize protein intake to preserve lean muscle mass during rapid weight loss, manage medication side effects through strategic food choices and timing, support energy levels through adequate nutrition despite appetite suppression.

Nutrition Protocol

  • Protein target: 95-110g/day (0.7-0.8g/lb current weight), prioritizing high-quality sources
  • Protein timing: Small, frequent protein servings throughout day (5-6 mini-meals)
  • Protein forms: Variety of textures and preparations to work around food aversions
  • Nausea management: Strategic meal timing (avoid eating within 2 hours of medication), cold/room temp proteins, ginger supplementation
  • Hydration: 80+ oz daily, electrolyte supplementation
  • Resistance training: 2-3x/week progressive program to preserve muscle

Specific Strategies

  • Protein shakes: 2-3 daily (easier to consume than solid food)
  • Greek yogurt: High protein, cold, easier to tolerate with nausea
  • Eggs: Multiple preparations to prevent aversion
  • Chicken/turkey: Cold preparations (less aversion than hot meat)
  • Cottage cheese: High protein density in small volume
  • Timing: Front-load protein early in day when appetite slightly better

Clinical Results Timeline

Month 1

  • Protein intake: 45g → 75g/day (significant improvement)
  • Weight: 202 → 196 lbs (6 lbs loss, slower than pre-nutrition intervention)
  • Nausea management strategies effective
  • Initiated resistance training 2x/week with trainer
  • Energy levels beginning to improve

Month 3

  • Protein intake: Consistently achieving 90-95g/day
  • Weight: 189 lbs (total 31 lbs lost from starting weight)
  • Wegovy titrated to full 2.4mg dose with minimal side effects
  • Resistance training 3x/week, noticeable strength gains
  • Energy substantially improved
  • Body composition scan: Preserved lean mass, fat loss primary

Month 6 (Current)

  • Weight: 185 lbs (35 lbs total loss)
  • BMI: 29.9 (from 36.2 initially)
  • Protein intake: 95g/day average, well-established habits
  • DEXA scan: Lean muscle mass maintained within 2% of baseline
  • Patient reports feeling strongest she's felt in years
  • No longer experiencing significant nausea
  • Plans to continue Wegovy per prescriber with ongoing nutrition support

Clinical Discussion

Key Learning Points

  1. Muscle preservation is achievable on GLP-1s: With adequate protein and resistance training, lean mass can be maintained during rapid weight loss.
  2. Protein strategies must adapt to appetite suppression: Liquid proteins, cold preparations, and small frequent servings work better than traditional meal patterns.
  3. Side effect management improves adherence: Strategic timing and food choices minimized nausea without requiring medication discontinuation.
  4. Resistance training is non-negotiable: Exercise stimulus critical for maintaining muscle mass during caloric deficit.
  5. Specialized nutrition support enhances GLP-1 outcomes: Most patients receive minimal dietary guidance from prescribers; targeted RD support optimized results.

Taking a GLP-1 Medication?

Specialized nutrition support can help you maximize weight loss while preserving muscle mass and managing side effects. Learn how a personalized approach could optimize your GLP-1 results.

Schedule GLP-1 Nutrition Consult →View More Case Studies

Important Disclaimer: This program is for educational purposes only and does not replace individualized Medical Nutrition Therapy or medical care.

Personalized nutrition therapy services are available only in jurisdictions where Eliana Witchell, RD, CDE holds active licensure. Always consult with your healthcare provider before making changes to your diet, exercise, or medication regimen.