Modern Metabolic Health with Dr. Lindsay Ogle, MD

Health Risks of Rapid Weight Loss

• Lindsay Ogle, MD • Episode 8

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Chasing quick results can feel rewarding, but rapid weight loss on GLP-1 medications comes with trade-offs that can quietly erode health. We dig into what “too fast” really means, why a threshold of more than two pounds per week raises concern, and how weight change is inherently nonlinear. The real aim is metabolic health—treating adipose tissue dysfunction—not a race to the lowest number, and we share a practical framework to keep progress steady without compromising safety.

We walk through the biggest red flags: severe nausea, vomiting, diarrhea, dehydration, and signs of disordered eating like extreme restriction or urges to purge. We also spotlight medical conditions that can masquerade as “great progress,” from malignancy and chronic infections to inflammatory and malabsorptive GI disease such as Crohn’s, ulcerative colitis, and celiac. Once the serious causes are ruled out, we map out how to navigate hyper-response to GLP-1s with dose adjustments, tighter monitoring, and nutrition strategies that protect muscle, bone, and energy.

Expect clear, actionable guidance: protein-forward meals to safeguard lean mass, hydration and fiber to support digestion, multivitamins as a bridge when intake dips, and resistance training to preserve strength. We explain why rapid loss increases the risk of gallstones and delayed hair shedding, and how chronic restriction can depress resting metabolic rate, making long-term maintenance harder. With a team-based approach—physician, dietitian, and trainer—you can align medication benefits with sustainable habits and keep health at the center.

If this resonates, follow the show, share it with someone focused on metabolic health, and leave a review to help others find it. What’s one metric beyond the scale you’ll track this week?

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Dr. Lindsay Ogle:

Welcome to the Modern Metabolic Health Podcast with your host, Dr. Lindsay Ogle, Board Certified Family Medicine and Obesity Medicine Physician. Here we learn how we can treat and prevent modern metabolic conditions such as diabetes, PCOS, fatty liver disease, metabolic syndrome, sleep apnea, and more. We focus on optimizing lifestyle while utilizing safe and effective medical treatments. Please remember that while I am a physician, I am not your physician. Everything discussed here is provided as general medical knowledge and not direct medical advice. Please talk to your doctor about what is best for you. When someone starts a GLP1 medication like Setbound or Vigovi for the treatment of their obesity, they are looking for weight loss. What happens when there is too much weight loss or it happens too quickly? We're gonna talk about that today. I often utilize GLP 1 medications in my telehealth practice, Missouri Metabolic Health, where I see adult patients in the state of Missouri for the treatment of obesity and metabolic conditions. And I say this often, but everybody responds to GLP 1 medications differently. I have patients who respond very well at the initial dose and do not need to go to higher doses. I have others who are not responding or getting the positive benefits until we get to higher doses. And at that first dose, I don't really feel much of anything, and I see everything in between. And so all of this is general medical knowledge and not direct medical advice. And I want you to take this information and bring it back to your doctor so you can have the best individualized care available. But today we're gonna talk about that rapid weight loss when utilizing GLP1 medications. Let's start with the definition. What would be that cutoff for rapid weight loss? And typically in obesity medicine, we say anything greater than two pounds per week. And for some people, that might even be a little bit too high. I typically like to see a half a pound to a pound a week, and then sometimes that a little bit more, but if I see more than two pounds loss per week, that's when I start to get worried about rapid weight loss, and we'll talk about why I would be worried. Before we talk about the complications, I want to also highlight the fact that weight loss is not a linear process. If you lost consistently a pound to two pounds a week while you're on a GLP1, eventually you would get to zero pounds if you were going to continue it indefinitely. And of course that's not what we want. We want you to still be a human. We want you to be alive and to be functional in your body. The whole goal of obesity medicine is to help patients achieve and maintain their health by treating the underlying condition, which is adipose tissue dysfunction. And these medications help utilize that. The weight loss is a part of that process, but it is not the overall main goal. The main goal is health. And so we monitor weight loss as an indicator of progress, but also as something to monitor for side effects. And today we're talking about the side effect concern with weight loss. So what might happen if you are losing weight too quickly? First, let's talk about why you might be losing weight too quickly. One would be you're having intolerable side effects of your medication. If you are so nauseous that you are unable to eat or drink throughout the day, if you are vomiting, if you are having diarrhoea, if you are not able to maintain adequate nutrition and hydration, that is an absolute red flag. You have to tell your doctor about this right away because that is very concerning, and we need to find out why that's happening and adjust accordingly. Another thing that could be happening would be that there is an underlying eating disorder that was either not diagnosed or managed previously or has developed, and people of all sizes can have anorexia and bulimia. And the goal of these medications is not to allow that um restrictive process or the purging process to be easier, it's quite the opposite. And so if you are taking a GLP1 medication and your brain is telling you that either you should not eat anything throughout the day or severely restrict, or that you need to purge after eating, then please talk to your doctor and seek additional guidance and treatment because that is of course not healthy weight loss and needs to be addressed right away. I just released an interview with dietitian Isabelle about atypical anorexia, and this is a great one to go back and listen to if you're having any of these thoughts or concerns, and you can learn more about atypical anorexia with that conversation. And in general, when we see rapid weight loss in medicine, it's a red flag that something bad is happening in the body, something dangerous is happening that we need to figure out why. Um, two other fairly common reasons for rapid weight loss can be a cancer or malignancies. So make sure that you are up to date on your cancer screenings, just everybody in general, but especially if you are experiencing rapid weight loss, and then infectious causes like HIV, but other infections and other inflammatory conditions like rheumatologic conditions can also lead to weight loss. I would also say some GI conditions like Crohn's or ulcerative colitis and um celiac disease. If you have inflammation in your bowels and you're not absorbing nutrients, then that will lead to weight loss as well. So rapid weight loss, not the goal. It could indicate that there is something serious underlying that needs to be diagnosed and addressed, or that your medication is not working for you, or we need to address those side effects to help make it work for you. So if we've ruled out those scary underlying causes and you're not having terrible side effects like that constant nausea vomiting that I mentioned, and we're not worried about an eating disorder, then you may be one of those people who are hyper responders to GLP1 medications, which is okay. And there are strategies that we can utilize to kind of mitigate that rapid weight loss, and I'll talk about that at the end, but I want to address why we want to avoid that rapid weight loss because there are complications that could occur. Some notable complications include nutritional deficiencies. So if you're not able to keep that food down or get enough nutrient nutrients in throughout the day, you could be low on vitamins and minerals. Um so, in general, you could consider adding a multivitamin if you're on a GLP1. It is best to get these nutrients through your food and your diet. But if that is difficult for you at any point, um you can add on a multivitamin. But alongside those nutritional deficiencies and inadequate nutrition, it can lead to fatigue and headaches. Um, it can contribute to upset stomach and constipation. Also, it essentially sends the body into fight or flight and a shock response. And what that can do is it can lead to hair loss that is seen about three months after this shock occurrence. Um so this might not be something that you notice in that moment in time. But if you're not getting the adequate nutrition and you're losing weight too rapidly, about three months on the line, you might expect to see some hair loss that is temporary but um can be distressing to many people if they're not expecting it. Rapid weight loss can also lead to gallstone formation and gallbladder concerns. So if you have a gallbladder, um, this may be something that would develop with rapid weight loss. So if you have any pain in your stomach, especially after eating, especially on the right side, right under your rib cage, talk to your doctor, give them a call, let them know what's going on, and you should probably be evaluated for gallstone development. If that pain occurs and it is not going away and getting worse, go to the emergency room because it could be something more urgent going on, um, like an infection in your gallbladder. So do not ignore some stomach pain um if you are having that while on a GLP1, especially with rapid weight loss. And a couple things that we worry about if this rapid weight loss occurs over a longer period of time, so for weeks and months, this could contribute to slowing of your metabolism. This was seen in the Biggest Loser study when patients lost weight very rapidly with caloric restriction and increased exercise. Long term, years, decades after their participation in the Biggest Loser show, they continue to have decreased metabolism compared to people of similar body sizes. And so um, I don't want this to happen to you. It makes weight maintenance much more difficult if your metabolism decreases because of excessive restriction and rapid weight loss. So that's something to consider. We also worry about decreased muscle mass and decreased bone mass. Your body needs those nutrients, it needs protein and vitamins and minerals to build and maintain your muscle and bone. And so if you are excessively restricted and your body is needing to, you know, conserve energy and bring it to its vital organs like the brain and the heart and the kidneys, it's not able to give extra nutrients in the protein building blocks to maintain your muscles and your bone. And so those will weaken over time and lead to significant um complications, decreased mobility as you get older, and increased risk of fractures, which can be absolutely devastating. So this is something to be really cognizant about. Goal of obesity medicine is not to get everybody to a normal quote unquote BMI. The goal is to help patients achieve and maintain their health, and we never want to sacrifice our health in the name of weight loss. We are wanting to optimize our health, and using GLP1s is a great way to do that for many people. But for some people, it's not a good fit, or some people need additional support with a board-certified obesity medicine physician, oftentimes also a nutritionist or dietitian or a personal trainer. Build a team around you to ensure that you are successful and that you are maintaining your health and keeping health at the front of mind. So if you've been worried that maybe you're not losing weight fast enough, I hope this is reassuring to you that you are doing this in a sustainable way. I hope this reassures you that you are approaching weight management in a sustainable and healthy way. And if you are one of those people who are losing more than two pounds a week, review this um video or this podcast and think about where along that path you might be. Is this something that is underlying that you need evaluated by a doctor? Is this uh possibly an eating disorder? Are you having side effects from your GLP1 medication? And then take that information and talk to your doctor and you can adjust your plan. This does not mean that you will no longer qualify for treatment. This just means that we need to pivot and get you back on track with that health focus. If you found this helpful, please like and subscribe and share with somebody in your life who is wanting to improve their metabolic health. And I can't wait to see you next week for our next topic. Take care. Thank you for listening and learning how you can improve your metabolic health in this modern world. If you found this information helpful, please share with a friend, family member, or colleague. We need to do all we can to combat the dangerous misinformation that is out there. Please subscribe and write a review. This will help others find the podcast so they may also improve their metabolic health. I look forward to our conversation next week.