Expert Diet and Weight Loss Solutions

If youre taking semaglutide (Ozempic, Wegovy) or tirzepatide (Mounjaro, Zepbound), certain food-focused holidays like Thanksgiving and Christmas are probably very different for you now. After all, these powerful appetite-suppressing drugs can make indulging in rich foods an uncomfortable experience.

You might be tempted to skip or delay a dose in advance of a special occasion, whether thats a big holiday meal, an expensive anniversary or birthday dinner, or some other celebration. Or maybe youre planning a vacation and considering missing a dose in order to really get your moneys worth from an all-inclusive resort.

An informal review of social media forums dedicated to the use of weight loss injectables suggests that people are very much split on the issue of skipping doses. Some report they have happily delayed or missed doses for holidays and vacations and will do so again. Others have tried the technique and experienced poor results. Some people reject the idea entirely.

So, is it really safe to skip a dose once in a while? And is it a good idea?

The new weight loss injectables, nicknamed GLP-1s, mimic the actions of hormones that the body naturally releases after meals, resulting in complex metabolic effects that work together to curb hunger.

Theyve become a global phenomenon for one big reason: They are extraordinarily effective appetite suppressants. A 12-week study, for example, found that semaglutide users consumed 24 percent fewer calories and enjoyed additional benefits like fewer food cravings and enhanced self-control during eating. Participants even had a diminished interest in fatty foods.

Thats great news for weight loss and diabetes management. But using these drugs means learning how to navigate celebrations that involve being surrounded by loved ones deliriously gorging themselves on delicious foods.

Katherine Saunders, MD, an assistant professor and obesity specialist at Weill Cornell Medicine in New York City and a cofounder of Intellihealth, says that while missing the occasional dose of weight loss medication is technically safe, she doubts it will allow patients to enjoy a large meal.

Dr. Saunders has seen patients underestimate how slowly these drugs leave their system. People can get into trouble with this habit given semaglutide and tirzepatides long half-lives, she says. If someone skips medication for one week in order to eat larger portions, they might get sick if they assume the medication is out of their system and they eat more than they can handle.

She explains that even if appetite seems to return after a delayed or skipped dose, big meals can still provoke punishing side effects: Eating heavy foods or large portions while on semaglutide or tirzepatide can lead to heartburn, nausea, and vomiting. Sometimes people feel fine while theyre eating and even afterwards for a while, but then they vomit out of nowhere several hours later, she says.

Andrew Kraftson, MD, the director of the weight navigation program at Michigan Medicine in Ann Arbor, agrees. Just because you skipped a dose doesnt mean you arent at any risk of side effects. Individuals should still be counseled to chew very thoroughly, eat slowly, and moderate their portions to avoid getting into trouble, he says.

Dr. Kraftson speculates that people who routinely experience gastrointestinal side effects from their medications may be at higher risk of having more pronounced symptoms if they skip a dose.

Kraftson adds that while delaying a dose to create hunger may be unwise, there are other valid reasons for changing your injection schedule around the holidays or a trip.

Many people experience their worst digestive issues during the first day or two after their weekly injection, and have learned to delay their shot on days when vomiting or diarrhea would be particularly inconvenient, such as during job interviews, air travel, or holiday parties. Kraftson calls these short delays totally reasonable.

If your usual injection is scheduled to occur immediately before a big holiday meal, its probably safe to wait a day or two it could reduce the risk that you spend too much of the party in the bathroom.

Sean Hashmi, MD, the regional director of clinical nutrition and weight management for Kaiser Permanente Southern California and a medical reviewer for Everyday Health, says that delaying or skipping a single dose of your medication is medically harmless in the short term. But he strongly cautions against the practice for a second reason. Dr. Hashmi is concerned that overindulging while on a medication vacation can do deep damage to the habits that GLP-1s help you build habits that will be critical for weight maintenance if you ever need to discontinue the medication.

This concept that we can stop this medicine to do something that we know isnt good for us, it sets us up for failure in the long run, says Hashmi. From a medical perspective its fine, but just remember that if you were an alcoholic, I wouldnt tell you to go have a drink every Saturday night.

In the online weight loss community, theres a contingent that agrees wholeheartedly with Hashmis perspective, and plans to stick to their regular dosing schedules throughout the holiday season. Some users are proud to enjoy only small portions of holiday fare and know that theyre keeping their health on track. And more than a few voices online have reported that when weight loss drugs quiet their food noise, it just makes it easier to appreciate everything else the holidays stand for.

Experts agree that the best strategy for people on weight loss drugs is to manage your expectations about what and how much you can eat, rather than skipping your doses.

Saunders suggests three simple tips for those still interested in partaking in rich foods now and then:

If youre considering making a temporary change to your dosing schedule, the manufacturers of semaglutide and tirzepatide provide official guidelines:

For short delays, there is no need to worry about dosage strength. If its only a week or two, you go right back to the original dose, says Hashmi.

Longer pauses may be more difficult to accommodate. There are no official guidelines on how to restart your GLP-1 drug regimen after missing two or more weeks. Nobody really knows yet, because the data is still coming out on varied practice patterns, says Hashmi.

The big question is whether or not you can go back to the dosage you were previously using, or if you need to step back down to a smaller dose.

New users of GLP-1 drugs always begin with small starter doses before gradually titrating up (increasing) their dosage. It takes the body some time to adjust to these potent medications, and those infamous gastrointestinal side effects tend to be at their very worst in the first few days of a new higher dose. With longer pauses, the worry is that your body might lose some of the tolerance that originally allowed you to step up your dosage. Going back to a high dose after a wait of several weeks could be more than your body is ready to handle, resulting in extremely uncomfortable side effects.

In the absence of clear guidance, Hashmi says that his clinic has taken a conservative approach: When we stop patients for a month or so, we will restart them at a lower dose for safety reasons and then quickly ramp them back up. We do that to avoid any nasty side effects of nausea, vomiting, diarrhea, or constipation. But at the moment that protocol is based only on educated guesswork. Thats not evidence-informed. Right now, we just dont have the expert opinion.

Saunders takes a similarly cautious strategy with her patients. When our patients are off medication for an extended period, we generally recommend starting back at the lowest dose and titrating up gradually.

If youve missed more than two regular doses, it might be unwise to start back on your prior dosage. Call your healthcare provider, who can provide a recommendation based on your unique situation.

Skipping or delaying one dose of your weight loss medication is unlikely to let you truly indulge in rich foods. These potent drugs stay in your system for longer than one week, and even if your hunger seems to return, large fatty meals can still result in ugly gastrointestinal side effects.

Longer medication breaks skipping doses for two weeks or more raise new issues to deal with, as you may need to go back to a lower starter dose in order to comfortably transition back to your current level.

The better plan is to manage expectations around special meals and vacations. Embrace your diminished appetite, and if you want to partake in heavy foods, do so in moderation.

Read more:
Is It Safe to Skip an Ozempic Shot Before a Special Meal or Trip? - Everyday Health