GLP-1 medication -semaglutide (Ozempic or Wegovy) or a dual GLP-1/GIP medication-tirzepatide (Mounjaro or Zepbound) at Axxiums

At Axxiums AX4 Weight Loss Program, we support sustainable weight loss through personalized nutrition, exercise, and — when appropriate — pharmaceutical options. We respect that medication is not the right choice for everyone. For clients who choose a GLP-1 medication such as semaglutide (Ozempic or Wegovy) or a dual GLP-1/GIP medication like tirzepatide (Mounjaro or Zepbound), these tools can offer significant benefits for long-term weight management, especially for those who have struggled with traditional methods.

When combined with optimized nutrition and regular resistance training, clinical trials show that patients experience substantial weight loss — approximately 15% of body weight with semaglutide and up to 21% with tirzepatide — along with improved metabolic health. Used responsibly under medical supervision, these medications can help individuals regain control of their health.

Important Safety Information: Who Should Not Use These Medications

Before starting any GLP-1 or GLP-1/GIP medication, it is essential to know the following contraindications:

• Both semaglutide and tirzepatide carry an FDA boxed warning (the most serious type of warning) regarding the risk of thyroid C-cell tumors, including medullary thyroid carcinoma (MTC). These medications must not be used by anyone with a personal or family history of MTC or multiple endocrine neoplasia syndrome type 2 (MEN2).

• Semaglutide should be discontinued at least two months before a planned pregnancy, as it may cause fetal harm. The effect on breastfed infants is unknown.

• These medications should not be used in patients with a history of serious hypersensitivity to the drug.

• Semaglutide is contraindicated in severe gastroparesis.

• Caution is warranted in patients with a history of pancreatitis. If pancreatitis is suspected, the medication should be discontinued immediately and not restarted if pancreatitis is confirmed.

Common Side Effects

Semaglutide and tirzepatide are generally well-tolerated, particularly when dosed using a gradual titration ("low and slow") approach. Most side effects are mild to moderate, occur during the dose-escalation period, and tend to improve over time. In clinical trials, 4–8% of participants discontinued treatment due to adverse events.

Gastrointestinal side effects are the most common and include:

• Nausea (25–44% of patients, depending on the medication and dose)

• Diarrhea (19–30%)

• Constipation (11–24%)

• Vomiting (8–24%, more common with rapid dose increases)

• Abdominal pain (9–20%)

• Bloating, gas, and belching

• Acid reflux / GERD (5–10%)

• Difficulty tolerating large, rich, fried, or high-fat meals

Other common side effects include:

• Headache (7–14%)

• Fatigue (7–12%, usually temporary)

• Dizziness (4–8%)

• Hair loss (3–8%) — this is likely related to telogen effluvium from rapid weight loss and reduced caloric intake, rather than a direct drug effect. It is usually temporary and may be mitigated by ensuring adequate protein and micronutrient intake.

• Increased resting heart rate — semaglutide can increase heart rate by 10–19 beats per minute in a significant proportion of patients. Report any palpitations or racing heartbeat at rest to your provider.

• Injection site reactions (more common with tirzepatide)

Rare but Serious Side Effects

Although uncommon, some side effects can be more serious and require prompt medical attention. Contact your healthcare provider immediately — or seek emergency care — if you experience:

• Severe abdominal pain, especially if persistent or radiating to the back (possible pancreatitis — reported in clinical trials at low rates, but can include fatal or necrotizing forms)

• Abdominal pain radiating to the right upper abdomen or shoulder blade, especially after meals (possible gallbladder disease — a meta-analysis of 76 trials involving over 103,000 patients found a 37% increased risk of gallbladder or biliary disease with GLP-1 medications, with the risk being dose- and duration-dependent)

• A lump or swelling in the neck, difficulty swallowing, or persistent hoarseness (possible thyroid concern — seek evaluation promptly)

• Persistent vomiting or inability to keep fluids down (risk of dehydration and acute kidney injury)

• Signs of severe allergic reaction (swelling of face/throat, difficulty breathing, severe rash)

• Significant changes in vision (rare reports of optic nerve and retinal disorders have been associated with potent GLP-1 medications)

Understanding Lean Mass Loss

Any method of significant weight loss — whether through diet, surgery, or medication — results in some loss of lean body mass (muscle). With GLP-1 medications, approximately 25–39% of total weight lost is lean mass, which is broadly comparable to what occurs with intensive lifestyle interventions alone. However, because these medications produce greater total weight loss, the absolute amount of lean mass lost may be higher.

This is not an acute emergency, but it is an important consideration for long-term health — particularly for older adults or those at risk for sarcopenia. The most effective strategy to preserve muscle during weight loss is consistent resistance training combined with adequate protein intake. Emerging research also shows that GLP-1 medications may improve muscle quality by reducing fat infiltration within muscle tissue, even as total muscle volume decreases.

At Axxiums, we emphasize resistance training as a core component of the AX4 program for this reason.

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Perioperative Considerations

If you are scheduled for any surgery or procedure requiring anesthesia or deep sedation, inform your surgical and anesthesia team that you are taking a GLP-1 medication. These medications delay gastric emptying, which may increase the risk of retained stomach contents during anesthesia. The FDA has added a warning about the possibility of pulmonary aspiration to all GLP-1 medication labels.

Current guidance from the American Diabetes Association recommends a personalized approach: patients with gastrointestinal symptoms may benefit from a 24-hour liquid diet before the procedure, and point-of-care gastric ultrasound may be considered. Discuss the plan with your surgical team well in advance.

Managing and Minimizing Side Effects

Many side effects can be reduced or avoided with proper strategies:

• Stay well hydrated — aim for more than 2–3 liters of water daily. Electrolyte supplements can help, especially during the early weeks.

• Eat smaller, protein-rich meals — focus on lean proteins (poultry, fish, eggs, legumes) and aim for adequate daily protein intake (typically 100–120 grams per day, individualized to your needs). Avoid large or heavy meals.

• Increase fiber gradually — high-fiber foods and supplements can help with constipation, but increase slowly to avoid worsening bloating or gas.

• Follow "low and slow" dosing — do not increase your dose if side effects are still present at the current dose.

• Maintain a consistent resistance training routine — this is the most effective strategy to preserve muscle mass during weight loss.

• Adjust diet as needed — many patients naturally prefer simpler, less fatty foods while on these medications. This is expected and can be embraced.

• For nausea — avoid fried foods and carbonated beverages; ginger or peppermint tea may help.

• For acid reflux — eat smaller portions, avoid lying down for 2–3 hours after meals, and limit high-fat and spicy foods.

If side effects persist, contact our office before making dosage changes.

Frequently Asked Questions

Q: What are the most common side effects?

A: Nausea, diarrhea, constipation, vomiting, bloating, acid reflux, headache, and temporary fatigue. Not everyone experiences side effects, and they are most common during dose escalation.

Q: Do side effects last the entire time you're on the medication?

A: Most side effects improve or resolve within weeks as your body adjusts. Gastrointestinal side effects are most common during the first few weeks and during dose increases.

Q: How can I reduce side effects?

A: Stay hydrated (2–3+ liters daily with electrolytes), eat smaller high-protein meals, increase fiber intake gradually, and exercise regularly. Starting at a low dose and titrating slowly is key.

Q: Should I lower my dose if I have side effects?

A: Do not increase the dose until side effects have resolved. If side effects are significant at your current dose, contact our team for guidance — a temporary dose reduction may be appropriate.

Q: Can side effects be serious?

A: While rare, serious side effects can occur, including pancreatitis, gallbladder disease, and severe allergic reactions. Seek immediate medical care if you experience any of the severe symptoms listed above.

Q: Will the medication stop working over time?

A: Some patients notice reduced appetite suppression over time. Plateaus can often be managed with dietary adjustments, lifestyle optimization, or — under medical guidance — switching to another medication. Obesity is a chronic condition, and weight regain after discontinuation is expected, which is why long-term lifestyle modifications are essential.

Q: Will I lose my hair?

A: Hair thinning (telogen effluvium) occurs in approximately 3–8% of patients in clinical trials and is likely related to rapid weight loss and reduced caloric intake rather than a direct drug effect. It is usually temporary. Ensuring adequate protein and micronutrient intake may help.

Q: What about surgery or procedures?

A: Always inform your surgical and anesthesia team that you are taking a GLP-1 medication. These medications can delay stomach emptying, which may require special preparation before procedures involving anesthesia.

Important: Always discuss any concerning or persistent side effects with your healthcare provider.

Questions about our AX4 Weight Loss Program in Frederick, MD?

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This information is for educational purposes and does not replace personalized medical advice. Always consult your healthcare provider before starting, stopping, or changing any medication.

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