Switching GLP-1s? What You NEED To Know (Ask A Weight Doctor)

Added: 2026-05-30

[00:00:00]Your fears about going up to higher doses, we'll talk about that and so many more things on today's office hours.

[00:00:06]Hello and welcome. I'm Dr. Megan. I'm a board-certified obesity medicine doctor and weight loss coach helping you cut through the pseudoscience and confusion in weight care. My approach combines evidence-based medicine with real behavioral change. So you don't just take medications, you actually transform your health. As always, I can't answer personal medical questions because I'm not your personal doctor, but if your question does lean a little personal, I'm going to change it so it's more broadly educationally applicable. And if you are interested in working with me, you've tried to schedule a consult, I'm booked out for the next 2 months. You can email this number below. Um I'm opening up some times sooner. So if you want to see me sooner, not 2 months from now, um click on that link, type consult in the email subject line, you'll get added to a list to get those updates.

[00:00:54]Also, uh there are some news that came out recently about retatrutide. I'm going to hold off on talking about it too much yet because it actually hasn't been published in a journal yet. These are This is the press release from the pharmaceutical company. I want to talk to all of you after it's gone through the rigor of a peer-reviewed study um publication. And so I will talk about it, but I'm not going to talk about it I'm not going to talk about that study in depth yet. So let's get started.

[00:01:24]Okay, first question. Um my doctor suggested moving from Zepbound 5 to Ozempic 1 mg. Do you think this is good in terms of dose equivalents? Okay. So as always, I can't answer personal medical questions, but I will tell you I will explain my thought process in terms of when I'm changing somebody from Wegovy to Zepbound or Zepbound to Wegovy, Mounjaro to Ozempic to Ozempic, you know, you get it. You get it. Um so it really, you know, there's no like perfect equivalent. In general, my rule is if someone's going from uh 2.4 of Wegovy or two of Ozempic, I will usually bring them to 7.5 of Zepbound. That's probably a little bit lower than at the equivalent dose, but also it's a different medication. And I really want to make sure that they don't have a lot of side effects, and Zepbound is quite a bit stronger.

[00:02:23]Um if they're going the reverse, if somebody's going from five of Zepbound, I'll usually it it depends on a couple things. It depends on how somebody's This goes for any dose conversion. Um whether you're you're trying to get more kind of equivalent or be a little bit more conservative. And I'm usually going to err on the side of being a little bit more conservative because I don't know how the patient is going to respond. And also, my goal is to that they're able to stay on this medication for a long time, and not that we have to do a lot of like cleaning up in terms of side effects when they change over and they hate their life and they miss a week of work and like I really try to avoid that for people. That's my goal is that transitions are easy. Maybe they're a little boring. That's as you guys know, I love I love when things are medically boring. At least in terms of side effects and things like that. So, if somebody is going from If I have a patient and they're on a Zepbound five and they're going to Wegovy or Ozempic, I'm going to think about how they've tolerated the medication so far. Is this someone who had really no side effects or one of those people who just lost weight? It's been very easy for them. They're sort of medication-wise, they've been very robust.

[00:03:43]Um versus is someone who had a lot of trouble. Are they like every time they go up on the dose, they're really having side effects? Um we've had to go up a lot slower for them. They seem to really feel those or or they their body takes a longer time to adjust. Is that this patient? Um and then second is the patient's goals. Now, some patients um are just more willing to take risks, and that's really what they want to do. And as long as we both are comfortable with that, uh you know, that's an important discussion to have, too. So, I might have someone who says, you know, maybe they had sort of an average tolerance of the medication, some mild side effects, but nothing crazy. They're like, "You know what? I'd much rather um stay at the closest equivalent dose because, you know, XYZ. And uh maybe their insurance coverage is ending, and they want to see how far they can get before they have to start paying for it. Like, there's so many other things that come into play when making these types of decisions.

[00:04:42]But maybe maybe I have a patient and they're thinking like, "I really don't want to I I really want to I'm okay with the risk of maybe having more side effects because I'd rather take a chance on um you know, less weight gain with the transition or or maybe just staying weight neutral." Versus I might have a patient, and they say, "You know what? I would rather this be really slow and easy, and I'm okay if I gain a couple pounds. I know I'm taking um two steps backward to go three steps forward eventually." So, it really depends on their comfort level as well. So, if I'm thinking about Zepbound 5, that person may, if they're feeling if I if they're more willing to take risks, I might put them at an Ozempic or Wegovy 1.

[00:05:32]If they want to be sort of more middle-of-the-road, I'll probably bring them down to an Ozempic or Wegovy 0.5. And if they really want to be conservative, I'll just bring them down to the Ozempic um or Wegovy 0.25. And at that point I will definitely let them know listen you may gain a few pounds. It's the best chance we're going to give in terms of side effect profile, but that comes at the risk of maybe regaining a small bit of weight. So there's no one right answer. The right answer is really knowing your patient, how they've tolerated the medication and also what their treatment goals are short-term and long-term. So thank you so much for what a great question. And next question. This isn't really a question. This is more of a comment, but I did want to know cuz I made a video about five don'ts of traveling and I asked you all are there things that you would add to this and this viewer had a great addition. They said one thing I'd add to the travel list is managing your injection timing across time zones. I messed this up on a trip to Europe last year and injected 18 hours late because I was confused about day of the week dosing versus actual interviews. It's worth picking a fixed hour count window rather than a calendar day so that you don't throw off your titration schedule. Okay. Um Okay, yeah. So I this is a great point.

[00:06:58]If you have let's say you're traveling to you know from uh the US to Singapore or you're going from you know Boston to Hawaii. These are good windows that can also factor into the timing of your medication. So thank you so much for that. That is an excellent addition. And now if I had a patient like that, let's say I have a patient and they are they are going somewhere really far. Like let's say they're let's say they are let's say they're going from Boston to Singapore or Japan. I'm going to have them start to think about uh you know even before they leave start mentally being in the place where they're where they're going to. So, if it's 10:00 a.m. in Boston, it's going to be 10:00 p.m. same day in Singapore, and so start living at that 10:00 p.m. time and when they're thinking about their injections, so that by the time they get to Singapore, they're already on that schedule. And personally, I like to do that for myself, too, if I'm traveling somewhere really far. I like to start um you know, usually before I travel is kind of mentally preparing myself to be in that time zone. So, that's just personal life hack that has served me well. Anyway, that is one way to that I would think about with a patient in terms of if they really had some significant um time differences for their travel, how could we make that as easy as possible. Next question. All right, this is This is really a response to I had asked a question about um being concerned some I've noticed some people are concerned about going up to higher doses. And one viewer wrote in, "For me, the fear of being at a higher dose, currently at 10 of Zepbound, uh is that the medication will stop working for me before I get to my goal. I'm only losing 1 lb a week and have 80 left to lose and I'm already at 10 mg after three 13 weeks. No side effects, but no big like whooshes either." I think they mean about like a lot of weight coming off at once. "So, while I look forward to moving up to see if the efficacy improves for me, the same time I'm very aware that there are only two notches higher I can go, and then what?" And I think that's a very good point. But also, there's really not much you can do about that. You can't really change um whether you're somebody who responds quite a lot or or you know, more of an average weight loss or very little, you know, or below average. And so, while it is worth seeing how far you can get on each dose, not everybody's going to lose all the weight they need to lose on Zepbound 2.5 or 5. And so, what I mean, also important to think about is when you get to the maximum dose, it's not the end of the road. The medications don't do everything, right?

[00:09:54]If it's one thing that if you've been watching my channel for a while, that I say over and over and over is the medications are a tool, they are one component. And so, if somebody gets to that maximum dose, we really feel like their weight has gotten them to their new their medication has gotten their weight to the new normal, it's probably not going to go too much further than where it is, then we're thinking about other things like other medications we can add, other lifestyle changes that we can make. And for some patients also, if bariatric surgery is an important thing to add.

[00:10:26]So, if you're on the top dose, and you're not at your goal, talk to your doctor about what your other options are. It doesn't mean it's the end of the road. It really doesn't, but um you just may need to explore adding things to what you're already doing. And thank you so much for sharing that.

[00:10:44]Okay, next question. If someone is only consuming 1,200 to 1,300 calories daily, protein and hydration is good, and they strength train four times a week, their weight loss has slowed down less than 1 lb a week. What good does raising the dosage of Zepbound do? Current dose is 2.5. No side effects, no food noise.

[00:11:04]Well, it's probably going to help that person lose more weight. Um so, they're going to have increased food satiety.

[00:11:11]They're more likely going to eat less, but also the the where their fat storage and fat burning um is controlled in their brain, it's going to make it slightly more easy for them to lose more weight. So, again, it's not just about how the GLP-1 medications change your behavior, but also how they affect the energy regulation in your brain. And so, raising this the dose of Zepbound for a person who wants to lose more weight um is probably going to help a lot um in addition to all the great lifestyle changes they're doing. And of course, I also um I always like to encourage people to really take this as an opportunity to move away from calorie counting and more towards, you know, listening to your body and appreciating the fullness and the hunger signals.

[00:12:02]Um of course, if you're somebody whose appetite is extremely suppressed, talk to your doctor because sometimes these signals can be less accurate, but for a lot people a lot of people, the signals get uh stronger and better. So, they really can rely on their body a lot more and not so much on these external metrics that sort of diet culture has taught them to use. And of course, if you like calorie counting and it works for you, go for it. But for a lot of people, they don't love it, it's pretty burdensome. So, um think about how to really tune into your bodily cues. And again, I work with people on this all the time because it can be a little tricky, especially if your doses are changing. And I'll leave all that info at the end, but um start to learn to listen to your bodily cues.

[00:12:51]Um and then the the increasing the dose is going to help weight loss in a couple of different ways, not only improving those signals, but also that energy balance regulation in the brain is going to be affected as well. Thank you so much for all those questions. As always, these questions come from the community.

[00:13:08]So, if you have a question, leave it on this video, leave it on another video, and I will add it to the list. If you want to work with me directly, I do work one-on-one with people. If your food situation is very chaotic, if your food habits, if your eating patterns are not helping your medication work to its best potential, we should definitely talk.

[00:13:27]You can click on the link below, schedule a console. I would love to tell you how I help people just like you.

[00:13:32]Thank you so much for watching and please be well.