Weight loss injection preparation

For most people, a healthy balanced diet means having the following.

• Three main meals a day.
• Include a portion of protein, carbohydrate, fat and plenty of fruits and vegetables in each meal.
• Adequate fluid intake.

A balanced meal for weight loss looks like this:

Protein

Protein is essential for maintaining muscle mass whilst losing weight.

It is important to maintain your muscle mass so that your metabolism stays high and you maintain your strength and ability to do your usual daily activities.

Protein foods also keep you fuller for longer. If you eat plenty of protein with your meals this can reduce the need for snacks in between.

 Aim for 70g to 100g of protein per day. Include at least one portion of protein at every meal.

Examples of foods high in protein include:

• fish, seafood
• meat
• eggs
• tofu, tempeh
• beans, lentils, peas, chickpeas
• yoghurt, cheese.

Further sources of protein are listed in the Guide to the protein content of some everyday foods section at the end of this leaflet.

If you have snacks between meals, include a source of protein here too. Some protein rich snack ideas are:

• 1 tablespoon of nuts such as almonds, with some fruit.
• 1 tablespoon of reduced fat houmous, with some carrot sticks.
• 1 hardboiled egg, with some tomatoes.
• 2 tablespoons of low fat cottage cheese with a rye cracker.
• 1 small pot of fat free Greek yogurt.
• 1 teaspoon peanut butter, with some apple.

Starchy carbohydrates

 Choose starchy carbohydrates that are high in fibre.  

Examples of starchy carbohydrates include wholegrains and brown carbohydrates like brown bread and brown rice. They help you feel fuller for longer and provide you with longer lasting energy. These carbohydrates also help improve your digestion by providing plenty of fibre.

Examples of high fibre starchy carbohydrate foods include:

• brown rice
• brown pasta or noodles
• bulgar wheat
• wholegrain couscous
• brown bread
• sweet potatoes
• white potatoes with their skins on
• oats
• quinoa‍.

Healthy fats

 Include healthy fats with your meals.

These healthy fats are called ‘unsaturated fats’. They are beneficial for our overall health, providing essential nutrients, reducing inflammation levels and reducing your risk of heart disease.

Examples of healthy fats include:

• olive oil
• rapeseed oil
• avocado
• nuts and seeds
• oily fish, such as salmon and mackerel (these are classed as protein sources but they also contain healthy fats).

When using oils in cooking or on your foods, use small amounts as oils are high in calories.  We recommend a maximum of about 1 teaspoon per meal.

Try and limit less healthy ‘saturated fats’ such as butter, ghee, coconut oil, lard, palm oil. These are also found in foods such as pastries, biscuits, cakes, fast food and takeaways and fatty or processed meats (such as salami, bacon, sausages).

Fruit and vegetables

Include a variety of fruits and vegetables, with your meals and in between as snacks. Aim to have at least 5 portions of vegetables or fruit per day.

Fruit and vegetables provide essential vitamins, minerals, antioxidants and fibre to support your immune system, help avoid constipation and improve your overall health.

Try and eat a variety of fruits and vegetables across a week, aiming for different colours and types.

All fruit is ok to have including fresh, frozen, dried or tinned in juice.

Aim to include 2 to 3 portions of low fat dairy per day.

Dairy foods are a good source of protein and calcium which is important for strong bones and teeth.

If you prefer to use dairy alternatives, make sure they are fortified with calcium and ideally other nutrients such as iodine and vitamin B12.

Fluids

Stay hydratedby drinking plenty of water throughout the day. Adequate hydration supports digestion, overall wellbeing and can help to manage potential side effects of weight loss injections.

Signs and symptoms of dehydration to watch out for include decreased urine, dark coloured urine, dizziness, headaches, lack of concentration, dry mouth or lips.

Aim for at least 2 litres of fluid per day.

• Water and sugar free drinks all count towards your fluid intake.
• Alcohol does not count and can increase the risk of dehydration.
• Limit fruit juice and smoothies to a total of 150ml a day as these contain a lot of sugar.

Tips to keep hydrated:

• Sip water regularly through the day.
• Carry a reusable water bottle with you when you go out.
• Set a timer on your phone to remind you to have a drink.
• Drink more fluids than usual in hot weather or when you are active.
• If you do not like to drink plain water, some fresh fruit and mint in the water can add flavour.

Fibre

Keep fibre intake high.

A diet rich in fibre can help ease constipation which you may experience with weight loss injections. Fibre also helps promote feelings of fullness and has been shown to reduce the risk of some illnesses such as heart disease.

Examples of high fibre foods include:

• Oats and higher fibre breakfast cereal. Look for the ones labelled as ‘wholegrains’.
• Wholemeal or granary breads, or higher fibre white bread.
• Wholegrain crackers such as rye crackers and oatcakes.
• Wholewheat pasta, bulgur wheat or brown rice.
• Potatoes with their skins on, such as a baked potato or boiled new potatoes. 
• Beans, lentils and other legumes such as chickpeas.
• Vegetables. Fresh, frozen or tinned (without added salt) are all good choices.
• Fruit. Fresh, frozen, dried or tinned (in juice rather than syrup).
• Nuts and seeds.

Processed foods

Avoid eating a lot of processed foods. 

There are a few foods we recommend you limit eating. This does not mean you can never eat these foods, but try to eat them less and in small portions.

Do your best to minimise your intake of processed foods. They are often low in fibre and high in saturated fat, sugar, salt and calories that do not help to improve your health.

Examples of these types of food to limit include:

• pre made microwaveable foods and meals
• sugarcoated cereals
• cakes and biscuits
• pastries
• fast food and takeaways
• crisps
• sweets
• fizzy drinks.

Added sugar

Do your best to reduce the amount of foods with added sugars, such as sweets and chocolate, desserts and sugary yogurts, cakes, pastries and biscuits.

Watch out for drinks that contain a lot of sugar and calories. These should also be limited. Drinks to limit include:

• fizzy drinks
• fruit juice
• milkshakes
• some coffees and hot drinks flavoured with syrups.

Extreme dieting

There is no need to cut out entire food groups or follow extreme diets while you are on weight loss injections.  Examples of extreme diets include shake diets, cutting out carbohydrates completely, keto or intermittent fasting.

Instead, focus on balanced, nutritious meals that nourish your body and support your health improvement goals.

As you will be consuming less food and fewer calories than before, there is a slight increased risk of developing nutrient deficiencies which can lead to malnutrition over a longer period.

You can reduce this risk by following a balanced diet with regular fruits and vegetables, protein, and some healthy fats.

We recommend you take a complete A to Z multivitamin and mineral supplement, particularly if your appetite is significantly reduced.

The most common side effects of GLP 1RA medicines include:

• nausea
• vomiting
• burping
• constipation
• diarrhoea
• dizziness
• tiredness
• gastrointestinal (stomach) discomfort
• reflux (stomach acid travels out of the stomach back into the oesophagus or food pipe)
• hypoglycaemia (low blood sugar) when used in combination with some diabetes medicines such as insulin or sulfonylureas.

Other less common but serious side effects include:

• gallstones
• pancreatitis (inflamed pancreas)
• increased heart rate
• altered taste
• changes in vision.

Some weight loss medicines have also been associated with thyroid lumps and cancer, particularly medullary thyroid cancer. These risks are based on studies in rodents (rats and mice) but have not been seen in studies of primates (eg monkeys and apes) or humans.

Tell your hospital doctor or GP if you develop a lump or swelling in the neck, hoarseness, trouble swallowing or shortness of breath whilst using weight loss injections.

For most people the side effects are mild and reduce over time.

Contact the KHWC team or come to Kingston Hospital Emergency Department (A&E) if symptoms persist or become severe.

Severe symptoms include:

• severe abdominal pain that will not go away
• vomiting or diarrhoea that does not stop
• yellowing of the skin or eyes
• pale grey or light coloured stools (poo)
• changes in your vision.

As with most medicines, weight loss injections can cause an allergic reaction in some people.

Symptoms can be mild or serious and include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe.

General tips

• Try to inject yourself with the medicine at the same time and day each week so your body has a regular interval between each dose.
• Stay hydrated. Sip water through the day if you experience nausea, vomiting or diarrhoea.
• It may also help to eat smaller meals more regularly, eat slowly and avoid anything that smells or tastes too strong.
• Avoid eating late at night as this can worsen symptoms such as reflux, nausea and bloating.

Nausea, vomiting and heartburn

• eat small, plain meals
• avoid greasy, fatty, and spicy foods
• drink ginger tea or eat foods containing ginger
• eat slowly
• avoid strong smelling foods
• stay hydrated
• sip cold water or other clear fluids (such as squash)
• avoid fizzy or caffeinated drinks and alcohol
• get plenty of fresh air
• sit upright after eating and avoid eating just before bedtime
• an over the counter antacid medicine can also help.

Good hydration is key to these and other symptoms. If your urine turns a dark colour, or you feel lightheaded, this may be a sign that you are dehydrated and need to drink more fluids.

Call NHS 111 for advice if you are not able to drink more fluids or you are worried about your condition.

Diarrhoea

• Keep hydrated by drinking plenty of clear fluids (such as water or squash).
• Make sure you get enough rest.
• Eat small amounts regularly.
• Avoid greasy, fatty, and spicy foods.
• A simple pain reliever like paracetamol can help if you are in discomfort.
• Consider taking oral rehydration salts. Speak with your local pharmacist about these.

Call NHS 111 for advice if diarrhoea persists over a few days, or you are unable to tolerate any fluids, or you have bloody diarrhoea or there is bleeding from your bottom.

Constipation

• Gradually increase your fibre intake by including more fruits and vegetables, wholegrains, beans and pulses.
• Try eating fruits that are high in sorbitol, such as pear, peach, plums or prunes.
• Include some linseeds (available in most supermarkets) or psyllium husk (available from health food shops) in your diet. Start with a small amount mixed into foods or drinks, and gradually increase the amount over several days, up to 1 to 2 tablespoons per day. Make sure you take these with an extra glass of water.
• Make sure you move regularly throughout the day. Get regular activity, for example short walks.

Headaches

• Drink plenty of water.
• Take a simple pain relief medicine, such as paracetamol.
• Rest in a quiet place with dim lighting.
• Try relaxation strategies such as meditation, focusing on your breathing.
• Try gentle exercise.
• Apply hot or cold compresses to your head, neck.
• Ensure you are getting enough sleep.

Injection site reactions

These reactions can include redness, bruising, itching, swelling and pain. These tend to settle as your body gets used to the medicine. Until then you may wish to try a non drowsy antihistamine tablet or a local antihistamine cream which you can get from your local pharmacist.

Stop using the medicines and seek help from your GP, endocrinologist, NHS 111 or your nearest Emergency Department (A&E) if your rash gets worse, spreads, becomes redder or the pain is not tolerable. 

Include exercise in your daily life in the following ways:

• Design a realistic exercise plan. It must fit with your lifestyle. If it does not, you will find it difficult to keep it going.
• Pick an activity you enjoy or try a new one.
• If you have not done regular activity before, start with gentle exercise and increase it slowly.
• Get support from a friend or partner who will encourage you and exercise with you.
• Use a step counter app or smart watch to track your activity and see if you can gradually increase the amount you are doing.
• If you have never enjoyed exercise, start by reducing your inactive time. For example you can spend less time watching television or using the computer. You can also use stairs instead of lifts or get off the bus 1 or 2 stops earlier than you need to.
• If you prefer to walk rather than go to the gym, you can try walking more quickly or gradually walking further and faster.
• For an outdoor activity, have a backup type of exercise that you can do when the weather is wet or cold.
• If mobility is difficult, try chair based, seated exercises (see More information below).

There are lots of free resources online that you can use for ideas or support (see More information below). You can also look for local clubs that run activities in your area.

Some GPs may be able to refer you to a local health centre for subsidised exercise sessions. These offer support from a personal trainer or gym instructor until you have the confidence to continue on your own.

Ask your GP for details of subsidised exercise sessions.