Plan everyone on weight-loss jabs MUST know: They can leave you with malnutrition and serious illness. Now a top nutritionist reveals exactly what to eat – and keep weight off for good

It’s a story I’ve heard many times before. A woman in her mid-fifties, who we’ll call Jess, has long struggled with her weight and last year decided to start taking a revolutionary weight-loss drug.

These appetite-suppressing injections – originally an off-label use of the diabetes treatment Ozempic and later including Wegovy and Mounjaro – help patients lose up to a fifth of their bodyweight in just over a year. It can also be a massive boost to their overall health, lowering their risk of long-term conditions such as type 2 diabetes, heart disease, cancer, and Alzheimer’s.

But Jess is not seeing the dramatic weight loss she hoped for. Understandably, she is distraught. She worries that she is destined to be overweight for ever.

There is also the financial cost to consider. The NHS can currently only prescribe these drugs to the most overweight and unwell patients. Going private means paying as much as £300 a month.

For that, you would expect to see results. But, as I tell Jess, there is always hope. As dieticians and nutritionists for the healthy lifestyle coaching company Liva Healthcare, it’s our job to consider what other factors might be behind this lack of progress.

We are one of seven digitally led weight-management services recommended by health chiefs to help support patients prescribed weight-loss drugs on the NHS.

We also support those accessing these medicines privately through Boots’ online service – called Boots Online Doctor. And, in these situations, there is always one question I ask first: what are you eating?

These drugs, also known as glucagon-like peptide-1 receptor agonists (GLP-1s), trick the body into feeling full. However, while GLP-1s may cause patients to eat less, they do not make patients eat more healthily.

Many on the drugs say that, most of the day, they will go without food, but when the urge to eat strikes they turn to comfort items such as biscuits or crisps.

There are many reasons for this – it might be habit, that cooking can be time-consuming, or because such foods are just so tasty.

However, the reason these foods are so pleasing to eat is because they are packed with sugar and fat. And this means that just a few biscuits can often have as many calories as a proper meal.

It’s important to remember it’s not just about weight loss. There is also a concern that patients on GLP-1s can become malnourished. Most of us do not get enough fibre, while millions have diets deficient in vitamins and minerals such as calcium, as well as vitamins A, B, and C.

To get these nutrients, we need to eat a varied diet, which includes a spread of vegetables, fruit, pulses and – in moderate amounts – protein sources such as meat and eggs.

Studies show that, over time, malnutrition can have serious consequences, including raising the risk of bone breaks, digestive problems and serious infections.

Malnutrition can be an issue among overweight people too, because many – but not all – have poor diets. If people with full appetites struggle to get adequate nutrition, just imagine how hard it is for someone on an appetite-suppressing drug? Many patients also tell us they plan to use the drug to aid initial weight loss and then, once they’ve lost enough, they will stop the injections.

However, unless a patient ensures their diet really is healthy, they run the risk of putting the weight back on. Research shows that more than half who come off the drugs regain at least two thirds of the weight they lost.

Nearly one in five put all the weight – or more – back on.

We find that patients who focus on eating in a balanced way on the jabs put less weight back on once they stop. This is because, usually, they continue to eat like this. Of course, diet is not the only thing to consider when trying to lose weight on GLP-1s. At Liva Healthcare we also guide patients on how to create an exercise routine – another crucial factor.

So too is exploring why people eat. Do patients eat out of boredom or sadness? What can be done to change these habits?

We are able to guide people through these challenges. But diet is almost always the most important factor in weight loss.

The good news is GLP-1 drugs give patients the chance to reset their diet: some describe them as taking away the constant ‘noise’ of food. Our advice tends to follow a few simple rules. Half the plate should be made up of vegetables – and the more colourful the better. A quarter should be carbohydrates, such as potatoes or pasta; if it’s wholegrain even better.

And the final quarter should be protein, such as meat or plant-based products like tofu. Meat should be lean, such as chicken or white fish, rather than fatty red meat, pork, or processed meat.

The goal is to make each meal packed with nutrients so, even when eating small portions, patients are getting all they need. Meals should also be easy to cook and packed with flavour. If someone has a reduced appetite, they want meals to look forward to.

With all this in mind, I have created four recipes exclusively for Mail readers who are taking a weight-loss drug. For breakfast, I recommend a berry and vanilla protein parfait. This yogurt-based meal has multiple sources of

protein – crucial for building muscle in place of fat.

The berries and seeds provide plenty of fibre, which is needed for a healthy gut. It is also packed with calcium, a bone-health nutrient which many GLP-1 patients are deficient in.

Our lunch option is a green shakshuka, a twist on the classic Middle Eastern egg dish, which contains plenty of iron-rich spinach. Iron is vital for the transport of oxygen around the body, as well as maintaining healthy skin, hair and nails. The eggs and feta provide high-quality protein.

I’ve also created a snack, to graze on throughout the day. This is a roasted chickpeas, seeds and cashew mix, which contains protein, zinc and iron.

Finally, for dinner, I’ve suggested a chipotle-lime chicken bowl. The smoky chipotle flavour enhances the taste, the pickled onions help digestion and the avocado provides healthy fats for energy. The chicken is the protein that should keep patients satiated until the morning.

I’m not saying you should consume only these, but it gives a flavour of the tasty and healthy meals it’s possible to eat while losing weight.

Berry and Vanilla Protein Parfait 

Ingredients

• 200g Greek yogurt 
• 20g vanilla protein powder 
• A dash of vanilla extract 
• 150g mixed berries (fresh or frozen) 
• 2 tbsp chia seeds
• 1 tbsp water 
• 100g rolled oats 
• 40g sliced almonds 
• 20g pumpkin seeds 
• 15g sunflower seeds 
• 15g chia seeds 
• 2 tbsp coconut oil 
• 1 tbsp almond butter  
• 1 tbsp maple syrup 
• 1 egg white
• 1 tsp cinnamon 
• Pinch of salt

Method

1. Preheat oven to 150C (300F).
2.  Mix dry ingredients in large bowl.
3. Whisk wet ingredients including egg white in a small bowl. 
4. Combine wet and dry mixtures. 
5. Spread on a lined baking sheet. 
6. Bake 20-25 minutes. 
7.  Cool completely for clusters to form (this makes 2-3 servings of granola).
8. Heat berries in a small pan until they release juices. 
9. Add chia seeds and water. 
10.  Simmer for 5 minutes until thickened.
11. Cool completely then assemble the parfait in a glass tumbler or bowl. 
12. Put the yogurt mix as the bottom layer, topping with the compote and a third of granola mix. 

Roasted Chickpeas, Seeds and Cashews

Ingredients (makes three servings)

• 100g chickpeas 
• 30g pumpkin seeds
• 20g sunflower seeds
• 30g cashews 
• 1 tbsp olive oil
• 1 tsp smoked paprika 
• ½ tsp garlic granules
• ½ tsp onion granules
• ½ tsp cumin seeds
• Large pinch black pepper   
• Small pinch salt

Method

1. Heat oven to 180°C (350°F). 
2. Mix chickpeas with half the olive oil and all seasonings except salt.
3. Roast on a baking sheet for 25-30 minutes, shaking halfway through. 
4. In a bowl, mix seeds and cashews with remaining olive oil and salt. 
5. Add to baking sheet for final 5-6 minutes of roasting.
6. When cool, combine well in a large bowl. 
7. Store in an airtight container at room temperature for up to two weeks.

Green Shakshuka 

Ingredients

• 2 large eggs 
• 120g fresh spinach (about half a standard bag)
• 1 small courgette, grated
• ½ medium white onion, thinly sliced
• 1 clove garlic, minced 
• 50g frozen peas 
• 30g feta cheese 
• ½ tsp za’atar 
• ½ green chilli, thinly sliced (optional) 
• ½ tbsp olive oil 
• salt and pepper

Method

1. Heat the olive oil in a medium-sized frying pan. 
2. Add the sliced onion and cook for 5-7 minutes until it develops a golden colour. 
3. Add the garlic and grated courgette. 
4. Cook for 5 minutes, stirring occasionally. 
5. Add the spinach in batches, allowing each handful to wilt slightly before adding more.
6. Add the peas. 
7. Season with salt and pepper, remembering that feta will add extra saltiness. 
8. Create two small wells in the vegetable mixture for your eggs. 
9. Crack the eggs into these spaces and crumble the feta around them. The steam from the vegetables will help cook the eggs gently.
10. Cover with a lid and cook for about 5-6 minutes, or until the egg whites are set but the yolks remain slightly runny. 
11. Finish with a sprinkle of za’atar and sliced chillis, if using, before serving.

Chipotle-Lime Chicken Bowl

Ingredients

• 120g chicken breast 
• 1 tbsp chipotle paste 
• 2 limes 
• 1 clove garlic, minced 
• ½ tsp ground cumin 
• ½ tsp smoked paprika
• pinch of oregano 
• 40g brown rice 
• handful of shredded lettuce
• 1 corn on the cob 
• 50g red pepper, sliced 
• 50g courgette, sliced diagonally 
• 40g red onion, thinly sliced 
• ¼ avocado, sliced
• 2 tbsp Greek yogurt
• fresh coriander

Method

1. Combine chipotle paste, juice of one lime, garlic and spices.
2. Coat chicken and marinade for 30 minutes. 
3. Make quick pickled onions: combine red onion with the juice of ½ lime and salt, set aside.
4. Cook brown rice according to package instructions. 
5. Heat a griddle pan until hot. 
6. Cook the corn, peppers, and courgette until tender and charred. 
7. In the same pan, cook chicken until charred and cooked through.
8. Place rice, lettuce, charred vegetables (cut off the corn from the cob if desired), pickled onions and avocado into a bowl, adding the charred chicken on top. 
9. Garnish with coriander, a good dollop of Greek yogurt and a lime wedge.