If you’re taking semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), certain food-focused holidays like Thanksgiving and Christmas are probably very different for you now. After all, these powerful appetite-suppressing drugs can make indulging in rich foods an uncomfortable experience.
You may be tempted to skip or delay a dose in advance of a special occasion, whether it’s a big holiday meal, an expensive birthday or anniversary dinner, or another celebration. Or maybe you’re planning a vacation and considering missing a dose to really get your money’s worth from an all-inclusive resort.
An informal review of social media forums dedicated to the use of injectables for weight loss suggests that people are very divided on the issue of skipping doses. Some report that they happily delayed or missed doses for holidays and vacations and do it again. Others have tried the technique and had poor results. Some people reject the idea entirely.
So, is it really safe to skip a dose every now and then? And is it a good idea?
The new weight loss drugs significantly reduce your interest in eating
The new injectables for weight loss, dubbed GLP-1, mimic the actions of hormones that the body naturally releases after meals, resulting in complex metabolic effects that work together to curb hunger.
They have become a global phenomenon for one big reason: they are extraordinarily effective appetite suppressants. A 12-week study, for example, found that semaglutide users consumed 24 percent fewer calories and enjoyed additional benefits such as fewer food cravings and enhanced self-control during eating. Participants also had a decreased interest in fatty foods.
That’s great news for weight loss and diabetes management. But using these drugs means learning to navigate celebrations that involve being surrounded by loved ones feasting on delicious food.
Does skipping doses work?
Katherine Saunders, MD, assistant professor and obesity specialist at Weill Cornell Medicine in New York City and co-founder of Intellihealth, says that while missing the occasional dose of weight-loss medication is “technically safe,” she doubts it will allow patients to enjoy. a great meal.
Dr. Saunders has seen patients underestimate how slowly these drugs leave their system. “People can get into trouble with this habit given the long half-life of semaglutide and tirzepatide,” he says. “If someone skips medication for a week to eat larger portions, they might get sick if they assume the medication is out of their system and eat more than they can handle.”
He explains that even if the appetite seems to return after a delayed or skipped dose, large meals can still cause punitive side effects: “Eating heavy food or large portions while on semaglutide or tirzepatide can lead to heartburn, nausea and vomiting. Sometimes people feel fine while eating and even after for a while, but then they vomit out of nowhere several hours later,” he says.
Andrew Kraftson, MD, the director of the weight management program at Michigan Medicine in Ann Arbor, agrees. “Just because you skipped a dose does not mean that you are not at risk of side effects. Individuals should always be advised to chew very well, eat slowly, and moderate their portions to avoid getting into trouble,” he says.
Dr. Kraftson speculates that people who routinely experience gastrointestinal side effects from their medications may be “at higher risk of having more pronounced symptoms if they skip a dose.”
Delaying a shot by a day or 2 may be “totally reasonable”
Kraftson adds that while delaying a dose to create hunger may be unwise, there are other valid reasons to change your injection schedule around the holidays or a trip.
Many people experience their worst digestive problems during the first day or two after their weekly injection, and have learned to delay their shot on days when vomiting or diarrhea would be particularly inconvenient, such as during job interviews, air travel, or holiday parties. Kraftson calls these short delays “totally reasonable.”
If your usual injection is scheduled to take place immediately before a big holiday meal, it’s probably safe to wait a day or two – it could reduce the risk of spending too much of the party in the bathroom.
Skipping doses can set you up for failure in the long run
Sean Hashmi, MD, the regional director of clinical nutrition and weight management for Kaiser Permanente Southern California and a medical reviewer for Everyday Health, says that delaying or skipping a single dose of your medication is medically harmless — in the short term. . But be careful with the practice for a second reason. Dr. Hashmi is concerned that overindulging while on a “medication vacation” can do profound damage to the habits that GLP-1s help you build — habits that will be critical to weight maintenance if you need to. discontinue the medication.
“This concept that we can stop this medicine to do something that we know is not good for us, sets us up for failure in the long run,” says Hashmi. “From a medical perspective, that’s fine, but just remember that if you’re an alcoholic, I’m not going to tell you to go drinking every Saturday night.”
In the online weight loss community, there’s a contingent who wholeheartedly agree with Hashmi’s perspective, and plan to stick to their regular dosing schedules during the holiday season. Some users are proud to enjoy only small portions of holiday fare and know that they are keeping their health on track. And more than a few voices online have reported that when weight loss drugs silence their “food noise”, it just makes it easier to appreciate everything the holidays are about.
Tips on how to enjoy special meals while taking Ozempic or other weight loss drugs
Experts agree that the best strategy for people on weight loss drugs is to manage your expectations about what and how much you can eat, instead of skipping your doses.
Saunders suggests three simple tips for those interested in indulging in rich foods from time to time:
- Take small portions, especially if the food is very rich.
- Eat more slowly.
- Stop eating before you feel too full.
Official guidelines for late and missed doses
If you are considering making a temporary change to your dosing schedule, the manufacturers of semaglutide and tirzepatide provide official guidelines:
- Users of Semaglutide (Ozempic, Wegovy) are advised to take a missed dose “as soon as possible within five days after the missed dose.” If more than five days have passed, users should skip the weekly dose entirely and resume their regularly scheduled injections.
- Semaglutide users should never administer two doses within 48 hours of each other.
- Users of Tirzepatide (Mounjaro, Zepbound) are advised to take a missed dose “as soon as possible within four days (96 hours) after the missed dose.” If more than four days have passed, users should skip the entire week and resume their regularly scheduled injections.
- Tirzepatide users should never administer two doses within 72 hours of each other.
Long medication breaks may mean returning to smaller doses
For short delays, there is no need to worry about the dose strength. “If it’s only a week or two, go right back to the original dose,” says Hashmi.
Longer breaks can be more difficult to accommodate. There is no official guidance on how to restart your GLP-1 drug regimen after missing two or more weeks. “No one really knows, because the data is still coming out on varied practice patterns,” says Hashmi.
The big question is if you can go back to the dose you used before, or if you need to go back to a smaller dose.
New users of GLP-1 drugs always start with small starter doses before gradually titrating (increasing) their dose. It takes the body some time to adjust to these powerful medications, and those infamous gastrointestinal side effects tend to be the worst in the first few days of a new, higher dose. With longer breaks, the concern is that your body might lose some of the tolerance that originally allowed you to step up your dose. Returning to a high dose after a wait of several weeks could be more than your body is ready to handle, resulting in extremely uncomfortable side effects.
In the absence of clear guidance, Hashmi says his clinic has taken a conservative approach: “When we stop patients for a month or more, we’ll restart them at a lower dose for safety reasons and then quickly send them back. We do that to avoid any negative side effects of nausea, vomiting, diarrhea or constipation.” But at the moment the protocol is based only on educated guesses. “It is not informed evidence. Now, we do not have only the opinion of experts.”
Saunders takes a similarly cautious strategy with his patients. “When our patients are off medication for an extended period, we generally recommend starting at the lowest dose and titrating it down gradually.”
If you have missed more than two regular doses, it might be unwise to start again on your first dose. Call your healthcare provider, who can provide a recommendation based on your unique situation.
The bottom line on skipping or delaying doses of weight loss drugs
Skipping or delaying a dose of your weight loss medication is unlikely to allow you to actually indulge in rich foods. These powerful drugs stay in your system for more than a week, and even if your hunger seems to return, large fatty meals can still result in negative gastrointestinal effects.
Longer medication breaks—skipping doses for two weeks or more—raise new problems to deal with, as you may need to return to a lower starting dose to comfortably return to your current level.
The best plan is to manage expectations around special meals and holidays. Embrace your decreased appetite, and if you want to partake in heavy foods, do so in moderation.
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