GLP-1 medications in New Zealand and beyond have changed the conversation around weight, diabetes and metabolic health remarkably quickly.

Medicines such as semaglutide and tirzepatide are now widely discussed for their ability to reduce appetite and support significant weight loss. But the story is bigger than weight loss alone.

Research has shown benefits for blood glucose control and, for some medications and patient groups, cardiovascular and kidney health as well.

At the same time, these medications can substantially change how much a person eats. That raises an important question that is sometimes overlooked:

If your appetite is significantly reduced, are you still getting everything your body needs?

For people taking a GLP-1 medication, the goal shouldn’t simply be seeing a lower number on the scales. It is also about maintaining good nutrition, muscle strength, physical function and long-term health.

What are GLP-1 medications and how do they work?

GLP-1 stands for glucagon-like peptide-1, a hormone naturally produced in the body in response to eating.

GLP-1 receptor agonists mimic some of the actions of this hormone. They can:

• increase insulin release when blood glucose is elevated
• reduce glucagon secretion
• slow gastric emptying
• reduce hunger and increase feelings of fullness
• influence appetite and food-reward pathways

This combination can make it easier to eat less and, over time, lose weight.

Semaglutide is a GLP-1 receptor agonist. Tirzepatide is slightly different because it acts on both GLP-1 and GIP receptors.

These are prescription medicines and their use needs to be assessed by an appropriate medical prescriber.

Why have GLP-1 medications become so popular?

The speed at which these medications have been adopted is partly because the results are quite different from many previous approaches to weight management.

Clinical trials have demonstrated substantial weight loss, but there is also growing evidence that some GLP-1 medications can improve cardiometabolic health beyond weight alone.

The STEP trials, for example, demonstrated significant weight loss with semaglutide in people with obesity, including people without diabetes. Improvements were also seen in measures such as waist circumference, blood pressure and some metabolic markers.

The SELECT trial was particularly important because it looked at cardiovascular outcomes in more than 17,000 people with overweight or obesity and established cardiovascular disease who did not have diabetes.

In that trial, major adverse cardiovascular events occurred in 6.5% of people receiving semaglutide compared with 8.0% receiving placebo — a relative reduction of 20%.

This is one reason the conversation around these medicines has moved beyond simply asking, “How much weight will I lose?”

What are the potential health benefits?

The benefits depend on the particular medication, the person taking it and the reason it has been prescribed.

GLP-1 medications may be used in the management of:

• type 2 diabetes
• obesity and overweight with relevant health risks
• cardiovascular risk in certain patient groups
• some aspects of chronic kidney disease
• metabolic health

Research has demonstrated improvements in blood glucose control and, for some GLP-1 medications, reductions in major cardiovascular events. Kidney outcomes have also been an area of increasing research.

This is important because excess weight is only one part of metabolic health.

A person’s blood pressure, blood glucose, cholesterol, cardiovascular risk, physical function, sleep, nutrition and quality of life all matter too.

Are GLP-1 medications available in New Zealand?

In New Zealand, some GLP-1 medicines are funded for people with type 2 diabetes who meet Pharmac’s Special Authority criteria. These include dulaglutide (Trulicity) and liraglutide (Victoza). The funding criteria were widened from 1 September 2026, although eligibility still depends on meeting specific clinical requirements.

Availability and funding can change, so it is important to check current New Zealand information rather than relying on overseas websites or social media discussions.

For someone considering treatment, the first step is an appropriate medical consultation to determine whether the medication is suitable and what monitoring is required.

How much do GLP-1 medications cost in New Zealand?

Cost is an important part of the conversation.

When these medicines are used for weight management. Wegovy (semaglutide) and Mounjaro (tirzepatide) are currently not publicly funded, so people using them for weight management need to pay privately. Pharmac has assessed an application to fund Wegovy and placed it on its Options for Investment List, but there is currently no commitment about if or when funding will become available. Pharmac has also stated that it has not received an application to fund Mounjaro specifically for weight loss.

This makes cost and ongoing access an important part of the conversation for anyone considering GLP-1 treatment. The cost can vary between medicines, doses and pharmacies, so it is worth checking current pricing rather than assuming a fixed monthly cost.

GLP-1 treatment isn’t simply about whether someone can access the medication today; it also involves what happens when treatment is continued, reduced, stopped, or becomes unaffordable.

What are the side effects of GLP-1 medications?

The most commonly discussed side effects are gastrointestinal.

These can include:

• nausea
• vomiting
• diarrhoea
• constipation
• abdominal discomfort
• changes in appetite

For many people these symptoms are most noticeable when starting treatment or increasing the dose. Gradual dose escalation is commonly used to improve tolerability.

Other potential adverse effects and risks need to be considered by the prescribing clinician, including gallbladder problems, changes in heart rate and other medication-specific risks.

This is particularly important if someone has existing medical conditions or is taking other medicines.

GLP-1 medications are not appropriate for everyone, and decisions about their use need to take personal medical history and the specific medication into account.

What should you eat while taking a GLP-1 medication?

This is where nutrition becomes particularly important.

One of the intended effects of these medications is reduced appetite. Some people find that they become full very quickly and simply don’t feel like eating much.

That can be helpful for weight loss, but eating less does not automatically mean eating well.

When food intake falls substantially, there is less room for nutritional gaps.

Rather than following a rigid “GLP-1 diet”, I think it is more useful to consider the quality and nutritional value of the food you are able to eat.

Prioritise protein

Protein becomes particularly important during weight loss because maintaining muscle is an important part of maintaining strength and physical function.

Good sources can include:

• eggs
• dairy products
• fish
• chicken and other lean meats
• tofu and other soy foods
• legumes
• nuts and seeds
• other protein-rich foods that suit your diet

The amount needed varies between individuals, so there isn’t one protein target that is appropriate for everyone.

If your appetite is very low, it can be useful to think about protein first rather than filling up on foods that provide relatively little nutritional value.

Don’t forget fibre

Fibre supports digestive health and is also important for cardiovascular and metabolic health.

Vegetables, fruit, legumes, wholegrains, nuts and seeds can all contribute.

However, increasing fibre very quickly can make bloating or gastrointestinal symptoms worse — particularly when a medication is already slowing gastric emptying.

For some people, gradually increasing fibre and paying attention to how their digestive system responds will be more appropriate than simply aiming for a high number.

Focus on nutrient density

When portions become smaller, food quality matters.

A smaller meal can still provide a good amount of protein, vegetables or fruit, healthy fats and other important nutrients.

This is one reason I would rather talk about nutrient-dense eating than simply “eating less”.

And don’t forget fluids

Reduced food intake, nausea, vomiting or diarrhoea can all affect hydration.

Regular fluid intake is therefore particularly important, especially if gastrointestinal symptoms are occurring.

Can you lose muscle while taking a GLP-1 medication?

Weight loss doesn’t consist entirely of body fat.

Some lean mass can be lost during significant weight reduction, and this is an important consideration with any intervention that produces rapid weight loss.

The aim isn’t simply to become lighter. It is to become healthier while maintaining as much strength and physical function as possible.

This is where protein and resistance exercise become particularly important.

Research suggests that combining resistance training with adequate protein is a useful strategy for supporting lean mass during GLP-1-associated weight loss.

Why is exercise important during GLP-1 treatment?

Exercise provides benefits that medication cannot replace.

Walking and other aerobic activities support cardiovascular fitness, while resistance exercise helps maintain strength and muscle.

Resistance training doesn’t have to mean going to a gym. Depending on your circumstances, it might involve:

• weights
• resistance bands
• body-weight exercises
• gym machines
• other forms of progressive resistance exercise

For someone who is new to resistance training, getting appropriate instruction can be helpful.

The important point is that exercise shouldn’t disappear simply because a medication is helping with weight loss.

In fact, maintaining physical activity may become even more important.

What happens when you stop taking a GLP-1 medication?

This is one of the most important long-term questions.

GLP-1 medications work while they are being taken, and stopping treatment can be followed by significant weight regain.

Research following people after semaglutide treatment has demonstrated that substantial amounts of lost weight can return after treatment is discontinued.

This doesn’t mean the medication has “failed”.

It highlights an important reality: for many people, obesity and metabolic disease are chronic conditions, and treatment may need to be considered over the longer term.

It also means that the question shouldn’t only be:

“How much weight can I lose?”

It should also be:

“How do I want my health to look over the next 5, 10 or 20 years?”

What should the long-term goal be?

Weight can be one useful measure, but it isn’t the whole picture.

Long-term health might also mean:

• maintaining muscle and strength
• improving blood glucose control
• supporting cardiovascular health
• maintaining healthy blood pressure and cholesterol
• improving physical fitness
• eating a nutritionally adequate diet
• sleeping well
• being able to participate in the activities you enjoy
• reducing the risk of future health problems
• improving quality of life

For some people, medication will be an important part of achieving these goals.

For others, medication may not be appropriate.

Either way, the broader health picture still matters.

GLP-1 medications are a medical treatment — not a replacement for healthy living

There is sometimes an unnecessary divide between medication and lifestyle.

It doesn’t have to be one or the other.

The evidence supports GLP-1 medications as an important medical treatment for appropriate patients. At the same time, nutrition, exercise and other lifestyle factors remain important components of long-term health.

A medication can reduce appetite.

It cannot go for a walk for you.

It can improve blood glucose.

It cannot build muscle.

It can help you lose weight.

It cannot decide what you eat when you do have an appetite.

That is why I think the most useful approach is to look at the whole picture.

Where can nutrition and naturopathic care fit?

If you are taking a GLP-1 medication, your medical prescriber remains responsible for the medication itself, including prescribing, dose adjustments, monitoring and managing medication-related concerns.

My role as a naturopath is different.

A consultation can provide an opportunity to look at the broader health picture and consider how nutrition, lifestyle and appropriate supplements may fit alongside your existing medical care.

For someone taking a GLP-1 medication, that might include looking at:

• whether you are eating enough protein
• the nutritional quality of your meals
• fibre and digestive health
• hydration
• energy levels
• sleep
• exercise and strength
• other medications and supplements you are taking
• your longer-term health goals

It isn’t about trying to replace the medication.

And it isn’t about adding a long list of supplements.

It is about making sure that losing weight doesn’t become the only measure of success.

Looking beyond the scales

GLP-1 medications represent a significant development in the treatment of obesity, type 2 diabetes and cardiometabolic disease.

The research is continuing to evolve, but we already know that these medicines can produce meaningful weight loss and, for some medications and patient groups, important cardiovascular and metabolic benefits.

We also know that treatment raises new questions around nutrition, muscle, exercise, affordability, long-term use and what happens when treatment stops.

For me, that makes the most useful question a little broader than:

“How much weight can I lose?”

It is:

“How can I use this treatment, if it is appropriate for me, as part of a longer-term plan for better health?”

That is where nutrition, movement, strength, sleep and sustainable lifestyle habits still have an important place.

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