A few months ago a patient came to my clinic with a box of Ozempic in her bag and many unanswered questions. Her doctor had prescribed the drug. He had explained how to inject herself. And he had told her to return in three months. Nothing about what to eat. Nothing about when to eat. Nothing about exercise, protein, side effects, muscle loss, or what would happen when she stopped. Because Ozempic is prescribed, but it often arrives with a lack of professional support.
What struck me most was not the negligence, which exists as well, but that this patient was not aware of everything she needed to learn. She believed that was everything. That the drug would do the job by itself. The one who was alone was her.
An extraordinary drug with a contextual problem
GLP-1 analogs — Ozempic, Mounjaro, Wegovy, Rybelsus — are a real medical revolution. They reduce appetite, improve glycemic control, decrease cardiovascular risk and have demonstrated results that no conventional diet had sustainably achieved in patients with obesity.
I’m not here to question them, on the contrary. I’m here to talk about what happens around them.
The drug reduces appetite, but it does not teach anyone to eat. It does not build habits. It does not move the body. It does not work on the relationship with food that has been broken for years. And it does not prepare the person for when the treatment ends or is interrupted. The drug is a great tool, but without information and training, it is nothing more than a temporary patch.
The dreaded rebound effect
With GLP-1 and without nutritional guidance, many women eat very little, because the drug suppresses appetite. The little they eat does not meet their needs for protein, iron, vitamin D, zinc or B12.
The body, in deficit, begins to pull from muscle as an energy source. The muscle lost during treatment without support is one of the factors that most contribute to the rebound effect when the drug is withdrawn. A meta-analysis published in The BMJ in 2026 with more than 9,300 patients found that those who discontinue the treatment regain the weight lost at an average of 0.4 kg per month.
It’s not a failure of the drug, but the result of using it without nutritional and physical education behind it.
The doctor prescribes, but only Google accompanies
It would be easy to blame doctors, but it is fair to do so. Primary care and endocrinology professionals are overwhelmed. They do not have time in consultations to provide individualized nutritional education, to monitor body composition, or to coordinate with a dietitian-nutritionist. The system is not designed for that, nor in this aspect nor in others, such as mental health or the chronic use of medications that, in principle, should be short-term.
The problem is not willingness: it is structural.
In Spain, the dietitian or nutritionist is not systematically part of primary care teams. There is no mandatory protocol for nutritional referral when a GLP-1 is prescribed. And most of the women who start Ozempic or Mounjaro do so alone, turning to the Internet or asking AI—with the dangers of misinformation and biases that entails—and hoping that it will work.
And sometimes it works, but without the proper foundations, results rarely last.
Multidisciplinary teams that do not exist
A GLP-1 treatment should include, from day one, a referral to a dietitian or nutritionist who specializes and works in parallel with the prescribing physician. Not as an optional complement, but as part of the protocol. It would also be advisable to integrate into those teams professionals with formal sports qualifications, who understand the importance of physical activity in this process and adapt it in a progressive and kind way for patients who, in many cases, have never stepped foot in a gym, do not know how to hold a dumbbell, and may have conflicts with their bodies.
We need those coordinated professionals (and not a tutorial pulled from social networks) to explain to that patient what to eat when she hardly has any appetite, how to distribute protein throughout the day, what to do about nausea, why muscle matters now more than ever…
But also, what will happen when the drug is withdrawn.
It’s not asking too much: it’s the minimum indispensable for the treatment to be worthwhile and the results to consolidate over time. Because the goal should not be the chronification of the use of these medications — nor of any other — when it is not necessary.
Success is only for those with comfortable wallets
All of the above is what should happen and does not. But the system won’t change overnight and there are women who start these treatments every week without anyone explaining anything to them. Abandoned with their Ozempic and an absolute lack of professional support.
We health professionals are many who try to fill that void from private practice, with all that entails: that only those who can afford it come, those who know this specialization exists, those who are lucky or have the resources to look beyond what the system offers.
That is also an inequality. And it deserves to be named.
Seila Sánchez
Online dietitian specializing in women over 40, GLP-1 and GIP treatments (Ozempic, Mounjaro, Wegovy) and lipedema. Works from a behavioral and non-restrictive approach, guiding women who have had years without results to understand what is happening in their bodies.
