GLP-1 Treatment Nutritional Support Paris | English Speaking Dietitian |

Introduction: Navigating GLP-1 Treatment with Compassionate, Expert Support

If you're considering or already taking GLP-1 agonist medications (Ozempic, Wegovy, Saxenda, Mounjaro) while living in France as an expatriate, you're likely facing a unique set of questions, hopes, and perhaps concerns – compounded by navigating a foreign healthcare system in a different language.

These medications, which have revolutionized the management of type 2 diabetes and obesity, raise major nutritional challenges that deserve particular attention. And when you're far from your familiar support systems, managing these challenges in a language and medical culture that may feel foreign adds another layer of complexity.

The clinical trial numbers are impressive: average weight loss of 15-22% depending on the molecule. But behind these statistics lie complex realities. Up to 40% of this weight loss can involve muscle mass without appropriate support, and nearly two-thirds of lost weight is regained after stopping treatment without sustainable lifestyle modifications.

This is precisely where the essential role of a dietitian-nutritionist comes in – particularly one who can communicate in your language and understands both eating disorders and the expatriate experience. Not to judge your choices or impose additional restrictions, but to accompany you through this process with expertise and compassion. Because your health isn't just a number on a scale – it encompasses your vitality, muscle strength, nutritional balance, and overall wellbeing.

This article aims to provide you with a clear, scientific, and empathetic overview of what optimal dietary support during GLP-1 treatment entails, whatever your reasons for taking it, and with specific attention to the challenges you face as an international patient in Paris.

Understanding GLP-1 Treatments: More Than a Miracle Solution

What is GLP-1 and How Do These Medications Work?

GLP-1 (Glucagon-Like Peptide-1) is a hormone naturally produced by your intestine in response to food intake. This hormone acts as a metabolic conductor: it stimulates insulin secretion when your blood sugar rises, slows gastric emptying, and sends satiety signals to your brain.

GLP-1 agonists – semaglutide (Ozempic, Wegovy), liraglutide (Saxenda), tirzepatide (Mounjaro), dulaglutide (Trulicity) – are synthetic versions of this hormone, designed for prolonged action. By mimicking the effects of natural GLP-1, these medications increase feelings of fullness, reduce appetite, and help regulate blood sugar.

The mechanism is elegant: by slowing the passage of food from the stomach to the intestine and modulating appetite regulation centers in the brain, these treatments naturally reduce food intake. You feel satisfied more quickly and for longer periods.

Legitimate Medical Indications: Far Beyond "Simple" Weight Loss

It's crucial to understand that these treatments address specific, validated medical indications. Contrary to what some simplistic discourse conveys, these are not "miracle pills" for losing a few aesthetic pounds.

For Type 2 Diabetes: GLP-1 agonists are indicated when diabetes remains insufficiently controlled despite lifestyle modifications and first-line treatments (like metformin). They significantly improve HbA1c (the three-month blood sugar control marker) while promoting weight loss beneficial for insulin sensitivity.

In France, since February 2025, reimbursement of these treatments for diabetes requires the physician to specify the clinical elements justifying the prescription, to avoid misuse.

For Obesity: Certain agonists (Wegovy, Saxenda, Mounjaro) are specifically approved for obesity management in adults with:

• BMI ≥ 30 kg/m² (obesity)

• Or BMI ≥ 27 kg/m² (overweight) with at least one weight-related comorbidity (hypertension, diabetes, dyslipidemia, sleep apnea)

These prescriptions are part of comprehensive care, necessarily combining a hypocaloric diet and increased physical activity. French health authorities (ANSM and HAS) have clearly established that these medications should never be used alone.

For PCOS (Polycystic Ovary Syndrome): Although not yet an official reimbursed indication in France, many endocrinologists prescribe GLP-1 agonists off-label for PCOS patients with marked insulin resistance and associated binge eating. Improved insulin sensitivity can have beneficial effects on hormonal and metabolic PCOS symptoms.

The Suspension Effect: A Reality to Anticipate

A fundamental aspect often underestimated: the efficacy of GLP-1 agonists is termed "suspensive." This means their effects last only during treatment.

Long-term studies consistently show that after stopping medication, patients regain on average two-thirds of lost weight within the following year. In the STEP-1 study, after an average loss of 17.3% of initial weight over 68 weeks, participants regained 11.6% of their weight in the year following cessation.

This reality isn't a failure. It simply reflects that obesity is a chronic disease requiring long-term management. That's why nutritional and behavioral support is absolutely essential: it builds sustainable habits that will persist beyond treatment.

Major Nutritional Challenges: What You Need to Know

Muscle Loss: An Underestimated but Critical Risk

One of the most important – and unfortunately often neglected – challenges of GLP-1 treatment concerns muscle mass preservation.

Weight loss is never exclusively fat. In classic low-calorie diets, approximately 20-30% of weight loss comes from lean mass (muscle, water, connective tissue). With GLP-1 agonists, this ratio can reach 40% of total loss without appropriate nutritional and physical intervention.

Why is this problematic?

Muscle mass isn't just about aesthetics. Your muscles are metabolically active organs that:

• Regulate your blood sugar by storing glucose

• Determine your basal energy expenditure

• Preserve your autonomy and mobility

• Prevent falls and fractures

• Maintain your strength and vitality

Losing muscle means reducing your capacity to burn calories at rest, weakening your metabolic balance, and accelerating aging. It also sets the stage for rapid weight regain after stopping treatment, as a slowed metabolism favors storage.

Mechanisms of muscle loss under GLP-1:

Two main factors explain this loss:

1. Drastic appetite reduction often leads to unintentional decreased protein intake, with the first weeks being particularly risky

2. Slowed gastric emptying makes consuming normal portions difficult, particularly for dense foods like meat or fish

Patients frequently report feeling "too full" after just a few bites, or experiencing nausea when faced with portions they previously consumed easily.

Nutritional Deficiencies: A Broad Spectrum to Monitor

Beyond muscle mass, the appetite-suppressing effect of GLP-1s exposes patients to risks of multiple deficiencies:

Macronutrient deficiencies:

• Protein: The recommended intake of 0.8 g/kg is absolutely insufficient during GLP-1 treatment. Studies converge toward needs of 1.2-2.0 g/kg body weight depending on age, sex, and activity level

• Fiber: Overall reduction in food intake decreases fiber intake, with consequences on transit and gut microbiota

• Essential fatty acids: Omega-3 and other quality lipids are often neglected despite being crucial for cardiovascular and cognitive health

Micronutrient deficiencies:

• Vitamin B12: Slowed gastric emptying affects B12 absorption, and reduced animal protein consumption worsens the deficit. B12 deficiency contributes to chronic fatigue reported by many patients

• Vitamin D: Already deficient in a large portion of the population, it plays a crucial role in muscle and bone health

• Calcium and magnesium: Essential for muscle function and bone density

• Iron: Particularly in women of childbearing age

• B vitamins: Involved in energy metabolism

Weight loss of 10% in 3 months or 20% in 6 months should be considered high-risk for deficiencies and requires comprehensive nutritional assessment and targeted supplementation.

Dehydration: An Often Underestimated Danger

GLP-1 agonists increase dehydration risk through several mechanisms:

• Increased diuresis (urine production)

• Reduced thirst sensation

• Nausea and vomiting that decrease fluid intake

• Frequent diarrhea in early treatment

Dehydration worsens fatigue, headaches, concentration problems, and can even precipitate acute kidney failure in vulnerable individuals. Sufficient water intake (minimum 1.5-2 liters daily) is therefore imperative.

My Role as Dietitian-Nutritionist: Far More Than a "Diet"

Support Based on Informed Consent

My support philosophy rests on a fundamental principle: informed consent. This means my role isn't to judge your decisions or impose my convictions, but to provide all necessary information for you to make informed choices that align with your values and goals.

You've decided to take GLP-1 treatment? That's your choice, and it's legitimate within the context of a validated medical indication. My role is to ensure this treatment is as safe, effective, and respectful of your overall health as possible.

I'm neither here to congratulate you blindly nor to discourage you. I'm here to accompany you through the complex reality of this treatment, with its benefits and risks, hopes and challenges.

The Nutritional Support Protocol: A Scientifically Established Necessity

It's significant that nearly all GLP-1 research protocols include systematic nutritional and dietary monitoring. This isn't by chance: it's a necessity to ensure treatment safety and efficacy.

In the STEP (Semaglutide Treatment Effect in People with obesity) and SURMOUNT (tirzepatide) studies and other major clinical trials, all participants received:

• Regular dietary support

• Personalized advice on increasing protein intake

• A structured physical activity program

• Body composition monitoring

The "miraculous" results you may have read about aren't the product of medication alone, but of comprehensive and intensive care. Removing nutritional support considerably increases risks and decreases long-term benefits.

Major medical societies (Endocrine Society, American Diabetes Association, HAS, ANSM) all recommend that physicians prescribing GLP-1s ensure their patients:

• Increase protein intake (minimum 1.5 g/kg)

• Consume 21-38 g of fiber daily

• Maintain nutritious eating covering vitamin and mineral needs

• Practice regular physical activity including strength training

• Benefit from long-term behavioral monitoring

Initial Assessment: Laying the Foundation

During our first consultation, I conduct a comprehensive, personalized assessment including:

Medical and nutritional history:

• Medical background (diabetes, PCOS, hypertension, etc.)

• Current treatments and potential interactions

• Weight history and previous attempts

• Recent biological assessments (blood sugar, HbA1c, kidney function, vitamins, etc.)

• Food allergies and intolerances

Body composition analysis:

• Weight (reference point, not obsessional)

• Bio-impedance analysis: precise measurement of fat mass, muscle mass, body water, basal metabolism

• Waist circumference (visceral fat marker)

• Simple muscle strength tests (chair rise, grip strength)

This initial analysis is crucial as it allows us to track evolution over months, ensuring weight loss primarily concerns fat mass rather than muscle.

Dietary habits assessment:

• Meal rhythm and food structure

• Preferences and aversions

• Cultural context and convictions (vegetarianism, etc.)

• Cooking ability and autonomy

• Professional and family constraints

• Relationship with food and eating behaviors (compulsions, restrictions, etc.)

Physical activity assessment:

• Current activity level

• Any physical limitations

• Preferences and possibilities

• Access to facilities or equipment

This comprehensive evaluation allows me to build a truly personalized nutritional plan that respects who you are, your lifestyle, and your goals.

The Personalized Nutritional Plan: Adapt, Don't Restrict

Protein strategy:

Increasing protein intake is priority number one. My goal is to help you reach 1.5-2.0 g of protein per kilogram body weight, depending on your situation:

• Elderly: higher needs (sarcopenia risk)

• Athletes: increased needs to maintain performance

• Women: particular attention to iron needs

Preferred protein sources:

• Animal proteins: lean meat, poultry, fish (salmon, mackerel, sardines rich in omega-3), eggs, dairy products (Greek yogurt, cottage cheese, cheese)

• Plant proteins: legumes (lentils, chickpeas, beans), tofu, tempeh, seitan, quinoa, seeds (chia, hemp)

Intake distribution:

Given that the satiety effect makes consuming large portions difficult, I recommend distributing proteins across several mini-meals:

• 25-30 g at breakfast (eggs, Greek yogurt, protein shake)

• 25-30 g at lunch

• 25-30 g at dinner

• 10-15 g in snacks (cottage cheese, nuts, protein bar)

When solid food becomes difficult:

Many patients report difficulty consuming solid proteins, especially in early treatment. Protein shakes then become valuable help:

• Whey, casein, or plant protein powders (pea, rice, hemp)

• Ready-to-drink protein beverages

• Homemade smoothies enriched with protein powder

While I always prioritize solid food first, these supplements are sometimes indispensable to achieve protein goals and avoid muscle loss.

Fiber and microbiota strategy:

Fiber is essential for:

• Maintaining regular transit

• Nourishing gut microbiota (which notably produces short-chain fatty acids stimulating endogenous GLP-1)

• Prolonging satiety

• Regulating blood sugar

Goal: 25-38 g fiber daily via:

• Vegetables at every meal (broccoli, spinach, carrots, zucchini)

• Whole fruits (apples, pears, berries)

• Whole grains (oats, quinoa, brown rice)

• Legumes (lentils, chickpeas)

• Seeds (flax, chia)

Optimal hydration:

A personalized hydration plan with:

• Minimum goal: 1.5-2 liters daily

• Mainly water, but also herbal teas, broths

• Monitoring dehydration signs: urine color, dry mouth, fatigue

• Increase with physical activity or heat

Quality lipids:

Contrary to popular belief, lipids shouldn't be banned. On the contrary, quality fatty acids are essential:

• Omega-3: fatty fish, flaxseed oil, walnuts, chia seeds

• Monounsaturated: olive oil, avocado, almonds

• Avoid trans fats and limit saturated fats

Vitamins and minerals:

Regular monitoring of vitamin status allows early deficiency identification and supplement adaptation:

• Vitamin B12: often necessary as supplement

• Vitamin D: nearly systematic in our latitudes

• Calcium and magnesium: according to dietary intake

• Multivitamin complex if very reduced food intake

Managing Digestive Side Effects

Gastrointestinal adverse effects are the primary cause of treatment discontinuation. My role is to help you minimize them:

Nausea:

• Split meals into small portions

• Favor cold or lukewarm foods (less odorous)

• Avoid overly fatty or spicy dishes

• Ginger (infusion, candies)

• Eat slowly and mindfully

Bloating and constipation:

• Gradually increase fiber (not abruptly)

• Sufficient hydration

• Targeted probiotics if necessary

• Light physical activity (walking)

Diarrhea:

• Identify trigger foods

• Avoid polyol-type sweeteners

• Broths to compensate losses

• Specific probiotics

Gastroesophageal reflux:

• Avoid large evening meals

• Elevate bed head

• Limit coffee, alcohol, chocolate, mint

• Wait 2-3 hours before lying down after dinner

Physical Activity: The Indispensable Partner

Nutrition alone isn't enough to preserve muscle mass. Exercise, particularly strength training, is absolutely essential.

Strength training (2-3 times weekly):

• Target all major muscle groups

• Free weights, machines, resistance bands, bodyweight

• Progressive intensity increase

• Examples: squats, lunges, push-ups, pull-ups, deadlifts

Cardiovascular exercise (150 min weekly):

• Brisk walking, cycling, swimming, dancing

• Improves cardiovascular health

• Promotes insulin sensitivity

• Complement, but doesn't replace strength training

Adapted physical activity: If you're starting from zero or have limitations, we work together to build a progressive, safe program. The key is regularity, not heroic intensity.

I can coordinate with a physiotherapist or specialized sports coach to support you in this crucial treatment dimension.

Strategies for Short, Medium, and Long Term

Phase 1: First Three Months (Short Term) – Stabilization and Adaptation

Priority objectives:

• Manage digestive side effects

• Establish split eating routine

• Achieve protein goals despite early satiety

• Initiate or maintain physical activity

• Prevent dehydration

Follow-up frequency:

• Complete initial consultation

• Follow-up at 2 weeks (rapid adjustments)

• Follow-up at 1 month

• Follow-up at 3 months with bio-impedance

Monitoring:

• Weight evolution (indicative, not obsessional)

• Body composition: maintaining or improving muscle mass?

• Digestive tolerance and progressive adaptation

• Biological assessment at 3 months: blood sugar, HbA1c, kidney function, vitamins B12 and D

Phase 2: Months 4-12 (Medium Term) – Optimization and Personalization

Priority objectives:

• Optimize fat mass loss while preserving muscle

• Refine nutritional strategy according to results

• Strengthen sustainable habits (empowerment)

• Work on eating behaviors in depth

• Psychologically prepare stabilization phase

Follow-up frequency:

• Monthly or bimonthly according to needs

• Bio-impedance every 2-3 months

• Biological assessments at 6 and 12 months

Adjustments:

• If muscle loss: increased proteins, intensified strengthening

• If plateau: reassessment of intake, stress, sleep

• If persistent side effects: specific nutritional strategies

• If return of compulsions: deepened behavioral work, coordination with psychologist

Phase 3: After 12 Months (Long Term) – Consolidation and Relapse Prevention

Priority objectives:

• Stabilize achieved weight

• Consolidate eating and physical activity habits

• Prepare potential treatment cessation (if planned)

• Anticipate and manage weight regain

• Maintain body composition vigilance

Maintenance strategy:

Obesity is a chronic disease. Even if you stop GLP-1, nutritional and behavioral monitoring should continue long-term (potentially lifelong).

If treatment cessation planned:

• Psychological preparation several months beforehand

• Very progressive increase in physical activity

• Strengthening appetite management strategies (mindfulness, stress management)

• Close monitoring first 6 months post-cessation (monthly)

• Re-intervention threshold: if regain > 2-5% of weight, intensive readjustments

If long-term treatment continued:

• Quarterly or semi-annual monitoring according to stability

• Vigilance on long-term deficiencies

• Annual comprehensive biological assessments

• Regular benefit/risk reassessment with prescribing physician

The Expatriate Factor: Additional Challenges You May Face

Navigating the French Healthcare System

Managing GLP-1 treatment in France as an international patient presents unique challenges:

Language barriers in medical contexts: Even if you speak French conversationally, medical terminology and nuanced health discussions can be challenging. Miscommunication about side effects, nutritional instructions, or treatment concerns can compromise your care quality.

Different healthcare structure: The French "carte vitale" system, specialist referrals, prescription procedures, and pharmacy access may differ significantly from what you're used to. Understanding medication reimbursement rules (or lack thereof for obesity-indicated GLP-1s) can be confusing.

Prescription and follow-up: Since February 2025, French regulations require specific documentation for GLP-1 prescriptions in diabetes. For obesity indications (Wegovy, Mounjaro, Saxenda), these medications aren't reimbursed and cost 200-400€ monthly, which may differ from pricing in your home country.

Cultural Differences in Food and Eating

French food culture specifics:

• Emphasis on multi-course meals and dining rituals

• Cultural importance of cheese, bread, wine

• Later dinner times (8-9 PM typical)

• Smaller portion sizes than Anglo-Saxon countries

• Different breakfast culture (lighter, often sweet)

These cultural norms can interact with GLP-1 side effects in complex ways. The French emphasis on pleasure in eating may intensify the psychological difficulty of reduced appetite. The later dinner culture combined with slowed gastric emptying may worsen reflux symptoms.

Restaurant and social situations: French social life heavily revolves around food. Declining portions or experiencing nausea at a dinner party can feel more culturally awkward than in countries with more flexible eating norms. You may feel pressure to conform to French dining rituals even when your body is saying "stop."

Ingredient and product availability: Certain products recommended for GLP-1 nutritional support (specific protein powders, certain supplements, Greek yogurt varieties) may be less available or more expensive in France. Conversely, you have access to excellent fresh produce, quality proteins, and whole grains that support healthy eating.

Isolation and Lack of Support Network

Distance from familiar support: When managing a significant medical treatment like GLP-1, being far from family, longtime friends, and familiar healthcare providers can feel particularly isolating. You can't just call your mom for advice or drop by your regular doctor's office.

Language-appropriate mental health support: If you're experiencing body image challenges, relationship difficulties with food, or emotional responses to dramatic weight changes, finding a therapist who can work in your language and understand both eating disorders and expatriate experiences is crucial.

Professional network coordination: Building a healthcare team (endocrinologist, dietitian, therapist, personal trainer) who can communicate effectively with each other and with you in English requires extra effort.

My Approach: Culturally-Sensitive, English-Speaking Care

English-language consultations: No language barriers during sensitive discussions about your eating habits, body image, treatment side effects, or health goals. Medical terminology explained clearly in your native language.

Cultural adaptation: I understand that your relationship with food may be rooted in different cultural contexts (American, British, Australian, etc.). I adapt nutritional recommendations to respect your food culture while integrating beneficial aspects of French dietary patterns.

Navigation support: I can help you understand French nutritional labeling, find appropriate products in French supermarkets, communicate with French pharmacies about supplements, and coordinate with your French-speaking medical team.

Expatriate-specific strategies:

• Managing travel back to your home country while on treatment

• Dealing with jet lag effects on eating schedules

• Navigating weight-related conversations across different cultural contexts

• Finding English-speaking exercise classes or trainers

• Building social connections that don't revolve exclusively around food

Professional network: I maintain connections with English-speaking therapists, psychiatrists, and other healthcare providers in Paris who understand both eating disorders and expatriate challenges. I can coordinate your care effectively across this network.

Special Situations and Specific Populations

GLP-1 and PCOS: A Promising Indication

For PCOS patients with insulin resistance and binge eating, GLP-1s can have multiple benefits:

• Improved insulin sensitivity

• Reduced food compulsions linked to glycemic fluctuations

• Moderate weight loss beneficial for hormonal balance

• Potential improvement in ovulation and fertility

My support in this context integrates:

• Specific insulin resistance management (glycemic index, carbohydrate distribution)

• Attention to deficiencies in inositol, vitamin D, chromium

• Coordination with gynecologist or endocrinologist

• Cycle and hormonal symptom monitoring

GLP-1 and Neurodiversity (ASD, ADHD)

Neurodivergent individuals may face specific GLP-1 challenges:

• Difficulties with eating routine changes

• Sensory hypersensitivities to textures (difficulty with protein shakes)

• Forgetting meals or hydration (ADHD)

• Cognitive rigidity facing necessary adjustments

My adapted approach:

• Highly structured and predictable routines

• Reminders and alarms for hydration and food intake

• Food choices compatible with sensory sensitivities

• Flexibility in strategies (respecting restricted food preferences)

• Coordination with psychiatrist or psychologist

GLP-1 and Eating Disorders

This is particularly delicate terrain. GLP-1s can be prescribed for patients with binge eating disorder history, but require close monitoring.

Risks:

• Potential worsening of restrictive behaviors (anorexigenic effect)

• Transfer to other compulsions

• Reinforcement of weight and control focus

Specialized support:

• Close collaboration with eating disorder specialized psychologist

• Focus on metabolic health, not weight

• Vigilance on internal restrictive discourse

• Body acceptance work in parallel

• Regular reassessment: is treatment genuinely helping or worsening relationship with food?

For patients with anorexia nervosa or severe restriction, GLP-1s are contraindicated.

GLP-1 and Vegetarianism/Veganism

Achieving protein goals can be more complex but is entirely possible:

• Diversifying sources: legumes, tofu, tempeh, seitan, pea/rice/hemp proteins

• Systematic B12 supplementation

• Attention to iron (plant sources + vitamin C for absorption)

• Possibility of vegan protein powders

• Food combinations for complete amino acids

My PEACE method (Benevolence, Equilibrium, Authenticity, Coherence, Evolution) applies particularly well to these situations.

GLP-1 and Older Adults

Seniors are particularly vulnerable to sarcopenia (age-related muscle loss):

• Higher protein needs (minimum 1.2-1.5 g/kg)

• Fall and fracture risk if muscle loss

• Close kidney function monitoring

• Attention to polypharmacy and interactions

• Maximum progressivity in weight loss (no more than 0.5 kg/week)

Warning Points and Contraindications

When GLP-1s Are Not Appropriate

GLP-1 agonists aren't suitable for everyone. Here are the main contraindications:

Absolute contraindications:

• Hypersensitivity to active substance

• Personal or family history of medullary thyroid cancer

• Multiple endocrine neoplasia syndrome type 2

• Pregnancy and breastfeeding (insufficient data, treatment should be stopped at least 2 months before conception)

• Eating disorders like anorexia or severe restriction

Precautions and reinforced vigilance:

• Severe kidney failure

• History of acute pancreatitis

• Active inflammatory bowel disease

• Pre-existing gastroparesis

• Severe depression or suicidal ideation (close monitoring)

Potential Serious Side Effects

Although rare, certain serious adverse effects require monitoring:

Acute pancreatitis: Intense, persistent abdominal pain radiating to the back, accompanied by nausea and vomiting. If these symptoms occur: immediate treatment cessation and urgent consultation.

Gallstones: Rapid weight loss increases gallstone risk. Upper right abdominal pain, nausea, jaundice. Control ultrasound may be recommended.

Hypoglycemia: Primarily in diabetic patients on insulin or sulfonylureas. Symptoms: sweating, trembling, confusion, intense hunger. Requires insulin dose adjustment by physician.

Ischemic optic neuropathy: Very rare but serious adverse effect potentially causing vision loss. Any sudden visual disturbance should lead to emergency ophthalmological consultation and treatment cessation.

Impaired contraceptive efficacy: Pregnancies have been reported in women on oral contraception and semaglutide. Complementary barrier contraception is recommended, especially in early treatment.

The Question of Reimbursement and Cost

In France, GLP-1 reimbursement is strictly regulated:

• Ozempic, Victoza, Trulicity: reimbursed only for type 2 diabetes according to specific criteria

• Wegovy, Mounjaro, Saxenda: NOT reimbursed for obesity indication (cost 200-400€/month depending on molecule)

This reimbursement difference has led to Ozempic diversions (prescribed off-indication) creating shortages for diabetic patients. Since February 2025, the prescription system strictly frames this use.

The high cost of anti-obesity treatments raises equity of access questions. My role isn't to judge these economic choices, but to support you whatever your financial situation, and help you implement nutritional strategies that will maximize treatment efficacy if you have access.

The Importance of Informed Consent: Your Health, Your Choices

Moving Beyond Simplistic Discourse

Public debate around GLP-1s is often polarized between two extremes:

• On one side, enthusiastic discourse making them "miracle pills" without risk

• On the other, moralizing criticism accusing patients of "taking the easy way out"

Reality is infinitely more nuanced. GLP-1s are powerful medical tools, with real benefits and risks to manage. They're neither magical solutions nor cheating.

My role as dietitian-nutritionist is to help you navigate this complexity with lucidity and benevolence.

Essential Questions to Ask Yourself

Before starting or continuing GLP-1 treatment, I invite you to reflect on these questions:

On your motivations:

• Why do I want to take this treatment? (metabolic health, mobility, joint pain, fertility, etc.)

• Are my motivations aligned with my deep values?

• What pressure (internal or external) do I feel concerning my weight?

On your expectations:

• What results do I expect from this treatment?

• Are my expectations realistic given scientific data?

• How will I manage plateau phases or side effects?

• Am I ready to invest in necessary nutritional support and physical activity?

On the long term:

• Am I ready to take this treatment for several years?

• How will I manage eventual cessation and possible weight regain?

• What sustainable habits am I ready to implement now?

On your overall health:

• Do I prioritize my metabolic health or the number on the scale?

• How does this treatment fit into my overall health approach?

• What health indicators really matter to me? (energy, sleep, mobility, biological markers, psychological wellbeing)

Respecting All Choices, Including Not to Treat

It's equally legitimate to choose not to take GLP-1, even if you meet medical criteria.

You may prefer to:

• First work on lifestyle modifications alone

• Explore other approaches (behavioral therapy, stress management, sleep)

• Refuse lifelong treatment for personal reasons

• Accept your current weight in a body acceptance approach (Health At Every Size)

My role is to respect these choices and accompany you on the path you choose, providing nutritional tools adapted to your situation, with or without medication.

Toward a Peaceful Relationship: Beyond the Scale

Health Isn't Just a Number

One of the most important messages I want to share: your health isn't reducible to your weight.

GLP-1s can induce impressive weight losses, but if this loss is accompanied by:

• Massive muscle loss

• Nutritional deficiencies

• Chronic fatigue

• Worsening of an obsessive relationship with food

• Social isolation (avoiding convivial meals)

...then the net benefit to your health is questionable.

Conversely, more modest weight loss (5-10%) but with:

• Muscle mass preservation

• Improved metabolic markers (blood sugar, lipids, blood pressure)

• Increased energy and mobility

• More serene relationship with food

• Maintained social life

...represents major therapeutic success.

The Real Health Indicators

Throughout our support, we'll track together indicators far more relevant than weight alone:

Metabolic markers:

• HbA1c (3-month glycemic balance)

• Fasting and postprandial blood sugar

• Lipid profile (total cholesterol, LDL, HDL, triglycerides)

• Blood pressure

• Liver and kidney function

Body composition:

• Fat mass evolution (absolute and percentage)

• Muscle mass preservation or gain

• Muscle mass/fat mass ratio

• Basal metabolism

Functional capacities:

• Muscle strength (chair rise test, grip strength)

• Cardiorespiratory endurance

• Mobility and flexibility

• Sleep quality

• Daily energy level

Psychological wellbeing:

• Relationship with food (compulsions, restrictions)

• Body image

• Self-confidence

• Social life and participation in convivial meals

• Overall quality of life

Supporting Without Judging, Informing Without Imposing

My support philosophy rests on a few cardinal principles:

Radical benevolence: You're not "weak" because you take medication for obesity, any more than a diabetic is weak for taking insulin. Obesity is a chronic multifactorial disease, not a moral failing.

Non-restrictive approach: My goal is never to add prohibitions or guilt. On the contrary, I seek to free you from rigid rules and restore a more flexible and serene relationship with food, even in the context of GLP-1 treatment.

Empowerment: I give you tools and knowledge to become autonomous. My goal is that you eventually won't need me anymore, that you can navigate your food and health choices with confidence.

Holistic approach: We don't just work on food, but on all dimensions of your health: sleep, stress, physical activity, social relationships, mental health.

Professional humility: I don't claim to have all the answers. Obesity and GLP-1 science is constantly evolving. I commit to staying informed of the latest data and adjusting my recommendations accordingly.

Conclusion: Together, Let's Build Your Health Journey

GLP-1 agonist treatments represent a major medical advance in managing type 2 diabetes and obesity. Their effects on weight loss and glycemic control are undeniable and can transform lives.

But – and this is a crucial "but" – these treatments aren't autonomous miracle solutions. Without appropriate nutritional support, they expose patients to significant risks: muscle loss, deficiencies, massive weight regain after cessation, and perpetuation of a dysfunctional relationship with food and body.

That's precisely why research protocols systematically include intensive dietary monitoring. That's why medical societies insistently recommend this support. And that's why I'm here.

My role isn't to sell you a diet or impose my convictions. My role is to accompany you in your journey, whatever it may be, with expertise, empathy, and respect for your autonomy. I'm here to maximize your treatment benefits, minimize risks, and help you build sustainable habits that will persist beyond treatment.

Because your health isn't reducible to a number on a scale. Because you deserve to be fit, energetic, strong, and at peace with yourself. Because your health journey belongs to you, and you have the right to be fully informed and supported in your choices.

As an English-speaking dietitian specializing in eating disorders and with deep understanding of expatriate challenges, I can provide support in your language, respecting your cultural context while helping you navigate French healthcare and food culture.

If you're considering or already taking GLP-1 treatment, don't hesitate to contact me. Together, we can make this journey a genuine investment in your long-term health.

Lighten your relationship with food and free yourself from what hinders you!

📚 Further Reading

Complementary articles on the website:

• Understanding binge eating disorder

• PCOS and nutrition: a compassionate approach

• Nutritional rehabilitation protocols

• Eating disorders and neurodiversity

• Eating disorders resources for international patients in Paris

📞 Contact and Appointments

Alexis Alliel Registered Dietitian-Nutritionist Specialized in Eating Disorders RPPS: 10007258733 | N° ADELI: 75 95 0878 1

📍 My Offices in Paris and Île-de-France:

• Paris 6th: 59 rue de Seine (Tuesday, Wednesday) - SOS Anor

• Paris 20th: 11 Rue Saint Blaise (Monday) - LIONNES Feminist Cabinet

• Le Raincy (93): Appointments available

• Video consultations: available throughout France and internationally

📞 Phone: +33 6 22 41 55 21

🗓️ Book an Appointment: Book on Doctolib

🌐 Website: www.alexis-alliel-dn.fr/en

Professional Affiliations:

• French Federation for Anorexia and Bulimia (FFAB)

• Eating Disorders Network Ile-de-France (RTCAidf)

• LION.NES Feminist and Queer-Friendly Cabinet

Scientific and Official References

Major Clinical Studies:

1. Wilding JPH, et al. (2021). "Once-Weekly Semaglutide in Adults with Overweight or Obesity." New England Journal of Medicine, 384:989. DOI: 10.1056/NEJMoa2032183

   • STEP-1 study: Average weight loss 14.9% with semaglutide vs 2.4% with placebo over 68 weeks

2. Gasoyan H, et al. (2025). "Changes in weight and glycemic control following obesity treatment with semaglutide or tirzepatide by discontinuation status." Obesity (Silver Spring), 33(9):1657-1667

   • Real-world conditions: 7.7% loss with semaglutide, 12.4% with tirzepatide (vs 14.9% and 22.5% in clinical trials)

3. Rodriguez PJ, et al. (2025). "Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists Among US Adults." JAMA Network Open, 8(1):e2457349

   • High discontinuation rates in real-world practice compared to clinical trials

4. Almandoz JP, et al. (2024). "Nutritional considerations with antiobesity medications." Obesity (Silver Spring), 32(9):1613-1631

   • Specific nutritional recommendations for patients on GLP-1

Official Recommendations:

5. ANSM (French National Agency for Medicines Safety). "GLP-1 analogues for obesity treatment: evolution of prescription conditions." June 2025.

   • https://ansm.sante.fr/actualites/analogues-du-glp-1-indiques-dans-le-traitement-de-lobesite

6. HAS (French High Authority for Health). "Pharmacological management of obesity." 2024.

   • Prescription and monitoring conditions for GLP-1 agonists

7. Geneva University Hospitals (HUG). "Procedures and advice for using GLP-1 agonists in obesity." 2024.

   • Detailed surveillance and multidisciplinary support protocols

Nutrition and Muscle Preservation:

8. Wolfe RR, et al. (2017). "Protein and muscle health in humans." American Journal of Clinical Nutrition

   • Optimal protein needs for muscle mass preservation during weight loss

9. Phillips SM, et al. (2016). "Protein requirements for weight loss and body composition changes." Journal of Nutrition

   • Recommendations 1.2-1.6 g/kg during caloric restriction

10. InBodyCanada (2025). "GLP-1 weight loss: Why body composition matters more than ever."

    • FDA recommends body composition measures as clinical evaluation criteria (January 2025)

11. Landi F, et al. (2019). "Sarcopenia and nutrition." Current Opinion in Clinical Nutrition & Metabolic Care

    • Sarcopenia prevention in elderly during weight loss treatment

Deficiencies and Micronutrition:

12. Medscape France (2024). "Five essential nutrients for patients on GLP-1 analogues."

    • Vitamin B12, protein, fiber, vitamin D, iron: monitoring and supplementation

13. RNPC (French National Network for Obesity Prevention and Management). "Anti-obesity GLP-1 medications: RNPC support." September 2025.

    • https://www.rnpc.fr/glp-1-les-medicaments-anti-obesite/

Medical Societies:

14. Endocrine Society. "Clinical Practice Guidelines for Obesity Management." 2023.

    • Recommendations for protein intake 1.5 g/kg, fiber 21-38g/day

15. American Diabetes Association (ADA). "Standards of Care in Diabetes – 2025."

    • GLP-1 place in type 2 diabetes therapeutic strategy

Other Resources:

16. Qare. "GLP-1 prescription: functioning, indications, monitoring." July 2025.

    • https://www.qare.fr/sante/glp-1-prescription/

17. DoktorABC. "Losing weight with new medications: GLP-1 agonists, a revolution?" January 2025.

18. Santé sur le Net. "Obesity: GLP-1 analogues can be prescribed by all physicians." July 2025.