Nutrition and Lifestyle in the GLP-1 Era, Pt. 3

Key Highlights

• Summer Kessel, RD, CSOWM explains that GLP-1 therapy helped quiet the food noise that had consumed much of her mental energy and allowed her to follow nutrition and lifestyle habits more consistently.
• She notes that GLP-1 medications can support, rather than replace, effective nutrition counseling by helping patients feel more prepared to engage with balanced meals, behavior change, and sustainable routines.
• She also encourages dietitians to become more involved in GLP-1 care because patients are actively seeking credible guidance on nutrition, appetite changes, side effects, and long-term lifestyle support.

In this episode of Nutrition 411, Lisa Jones, MA, RDN, LDN, FAND, speaks with Summer Kessel, RD, CSOWM, about the realities of using GLP-1 medications from both a personal and clinical perspective. Kessel discusses how GLP-1 therapy changed her relationship with food, helped reduce persistent food noise, and reshaped the way she counsels patients in a virtual weight management setting. She also explains why these medications should not be viewed as a replacement for nutrition and lifestyle interventions, but rather as tools that can make those changes more achievable and sustainable.

Additional Resources: Consultant360 Nutrition Resource Center

Transcript

Lisa Jones, MA, RDN, LDN, FAND: Hello and welcome to Nutrition 411, the podcast, where we communicate the information that you need to know now about the science, psychology, and strategies behind the practice of dietetics. Today's podcast is part of an ongoing miniseries on nutrition and lifestyle in the GLP-1 era featuring a Q&A with Summer Kessel.

Summer is a registered dietician nutritionist who brings both clinical expertise and lived experience to her work with patients using GLP-1 medications. Her approach integrates empathy, behavior science, and real-road strategies to help clients navigate appetite changes, mindset shifts, and sustainable lifestyle habits. I'm very excited about today's episode and we really want to hear about your personal experience using a GLP-1 and how it reshaped your perspective as a clinician, offering unique insights into what patients feel, fear, and need most during therapy. So welcome Summer to the show.

Summer Kessel, RD, CSOWM: Thank you so much for having me. I'm so excited for this conversation.

Jones: Yes, it's going to be fantastic. So, the first question I have for you is since you've personally used the GLP-1 and I believe, and you can correct me if I'm wrong, are still using it, right? Correct. Yeah. Okay. So, I guess from the start is what prompted your decision, and what did you learn firsthand about really how these medications affect appetite, energy, and mindset?

Kessel: Yeah, it's a very long story, so I'll try to be brief because I've struggled with my weight since I can remember. I was the big girl in dance class. I struggled with my weight all through high school, even though I was an athlete. I always wanted to eat well. I became intimately familiar with every nutrition documentary, nutrition book, every diet strategy you could think of through my adolescence and into my early 20s. I had lost weight twice over 100 pounds or so through diet and exercise alone and really struggled to ever keep it off for an extended amount of time. I would get married, have a baby, regain all this weight and have to go through the very difficult process of trying to manage my weight, achieve a healthy body weight through diet and exercise alone. And as I got older, it got more difficult.

And about 3 years ago now, a little more than 3 years ago now, one of my dear friends and now a colleague, Dr. Spencer, was tweeting about these GLP-1 medications, and he was talking about a patient who shared their experience of food noise, which I had never heard that term before, and how the GLP-1 medication gave them a sense of relief from that food noise so that then they could go on to do the diet and exercise routine that they so desperately wanted to be able to do consistently to lose weight. And it was something about that term food noise. I was like, "That's what I have." And that's what I have. And that relief is exactly what I was seeking because I felt like I was banging my head against the wall desperately trying to hold onto this weight loss that I had achieved but had really struggled to keep off and then never really achieved my goal.

I lose 100 pounds, but I was still technically in the obesity category as I was getting older. I had GERD and hypertension. I have PCOS. I was struggling with those symptoms. I just didn't feel great. And every time I tried to quote unquote buckle down to manage my weight in all the great amazing ways as a dietician, I knew how to do. I knew all the things. I didn't want to be too restrictive. I didn't want to dive into the diet culture disordered pathway. I wanted to do it right.

I just was hungry and I had this food noise and anytime I was in any sort of a calorie deficit, it drove me crazy. I was too hungry. So I said, "You know what? That's me. He's talking about me. I qualify.”

I started a GLP-1 medication and night and day difference within a week I just was like, “Oh, this is what those intuitive eating people are talking about. They can eat, they feel full and satisfied, they move on with their life, they're not thinking about food all the time.” I would have these moments of like, “Is this how normal people feel about food?” I would look at a cookie and be like, eh, take it or leave it. I'm like, who am I? I'm not struggling to resist impulsive food choices. And so what the medicine did for me right off the bat was allow me to eat and move my body in a way that I knew how that I wanted to, that was intentional and health promoting and had all the good principles of healthy nutrition that as a dietician I could teach anybody how to do.

And now I could do it consistently without falling into the trap of food noise or binges or temptations. I was satisfied after a meal of salmon and broccoli and rice. It was like good. I could leave a few bites behind. It was game changing. And so, you asked at the top of the call, am I still on this medication? I believe that I will be on some sort of medication therapy for obesity for the rest of my life because it is so clear to me that despite having all the education, all the tools, all the resources, all the privileges, all the childcare and support and gym access and professional access, I struggled to maintain my weight at a healthy body weight until I was able to start these medications. One of my biggest fears is losing access. So yeah, I'm obviously a big fan and so excited about these classes of medications and how they're helping people.

I started sharing about them on my social media and within a month of being on the medication, I reached back out to Dr. Spencer and I was like, "Are you guys hiring? How do I do this full-time? How do I work with people who are on these medicines?" And it's just been a total 180 career change for me as a dietician going from inpatient acute care in the hospital to working from home, virtual, connecting with people who are just like me, who need that little bit of extra support on your GLP-1 journey. And it's become a passion project for me. I've just dove right into weight management, nutrition, and science. So, I talk about it all the time and I'm thrilled to answer all of your questions and dive into those details because I'm obviously a big fan.

Jones: Oh, well, thank you for sharing that. I love many things about you, but one of the things is that you're so relatable. And it's kind of like I equate it to, I don't know if this is a good or bad analogy, but people that have a thyroid problem and they're told, "Okay, you have to take [levothyroxine] for the rest of your life or your thyroid isn't going to function appropriately." So, it's kind of like the same thing because that food noise is so real and that's one of the reasons why I became a dietician because I had a similar ... As you were talking about your pathway, I related to everything that you said and it was like, okay, well, since I'm kind of obsessed with food, might as well be a dietician. So, the fact that this is here, I think it's going to help so many people.

So I love, thank you for sharing your story. Congratulations. And it's just amazing what you're currently doing to help people.

Kessel: The analogy is fantastic. I will take it even a step further is I like to make the analogy to an antidepressant. I also take an antidepressant. I take [escitalopram], which helps with my anxiety and depression, so that I can then go to the counseling to exercise, to get sunshine, to eat healthy foods, to be calm, and assess situations logically. The medication is there to assist my brain chemistry and then allow me to go live a happier, healthier mental health life. The GLP-1 medications do exactly that for our nutrition and motivation and lifestyle and health and wellness lifestyle stuff.

A lot of people make this false dichotomy between GLP-1 medications or nutrition and lifestyle change when it's really the GLP-1 medications allow for effective nutrition and lifestyle change more easily and therefore more consistently and then people are more likely to actually follow through with these changes and stick to them for longer, which is how we know that eventually these things become more habitual and livable and sustainable.

I just think that the medications have been so wonderful for most of my clients in breaking them out of feeling like they're on a diet and now they feel like with the assistance of these medications, they can just go live a healthy, happy life with food.

Jones: Yes. And it's sustainable because we all know diets don't work. So, it goes back to, okay, how unhappy you're going to be on whatever back in the day we're like, "Let's try this diet and it's just willpowering. Come on, get out your willpower and keep going. " So, the fact that this is helpful, it's a tool. And that's one of the things that when you're talking about it that I listened to that I like how you phrase it. So, what surprises you most about talking about day-to-day realities of being on a GLP-1, whether it be physically or emotionally?

Kessel: I think for me personally, the biggest shock was just how much brain space used to consume my life around food. And I joke now sometimes that if I wasn't a dietician talking with people about food all day, how much would I even think about food now that I'm on these medicines? But like you said, I was obsessed with food. I knew every cookbook, every cookie show, every nutrition book, every podcast, every documentary that came out, I was in it. And now it's by nature of my job, I'm still kind of in it, but I'm not nearly as consumed by the thoughts about food information, but also my personal what's for dinner. I don't know. I'll figure it out when I get ... I did the groceries a week ago. I knew I had a plan. I don't remember what it was, but it'll be fine.

Whereas before it was, when can I eat again, checking my watch? Has it been long enough so I can have a snack? Ooh, I wonder what they have in the cafeteria for snack. Can I go to the ... Is there any candy in the candy jar? Just constantly searching for food. And now I've since starting these medications have just opened up my ability to do more with my career and professional life, to accomplish more, to be more present with my family and my kids, to just focus that energy that used to be so focused on my personal food and nutrition and lifestyle, now I have that energy to give elsewhere. So that's been a really nice, surprising change that I just never expected. And I hear that a lot from my clients. I also from other folks who are on GLP-1s, I personally never really struggled with side effects, but a lot of people anticipate these horrible, awful, crazy side effects because that's what mainstream media has been feeding us for the past many years is that you're going to be miserable and throwing up and you're going to get gastroparesis and die if you start these medicines.

And most of my clients that are in that first month, they're like, “Is it working? I'm not nauseous. Was I supposed to be nauseous? Why am I not nauseous? I'm worried that my medicine isn't working."

And I'm like, "We have to go through these kinds of questions to figure out is it working?” Because not everybody has side effects. And I think that that's shocking to a lot of people. People almost are worried that it's not working well enough if they're not sick. And I'm like, "No, no, that's not the goal. You're not supposed to be sick.” It's very actually a small percentage of people who struggle with side effects. And even those who do, it's mild, easily managed usually only in the beginning gets better with time. There are some tips and tricks we can walk through, but otherwise no, we can jump right into thinking about what's the meal plan for next week instead of worrying so much about side effects.

Jones: Oh, that's fantastic and that's good news. And too, every day when I'm saying the daily briefs with the research, there's always something positive about GLP-1s, at least recently when I've been looking.

Kessel: Yeah, exactly shifted. In the past three years, gosh, if you told somebody you were on a GLP-1 three years ago, they looked at you like you had two heads and now people are more like, " Oh, interesting. I've heard about that. "They're more excited I think about it. There's a little less bias. I think we're making progress there. It's not gone, of course. There are a lot of dieticians and health professionals and just general population who still don't understand these medicines or how they can help people, but I think it's getting better. The news briefs are better. The research has been really cool that's coming at secondary conditions that these medications might have indications for. And I think the future generations of these medicines are exciting. They're only going to get better, stronger, less side effects, hopefully knock on wood, more affordable. And this class of medications, this concept of pharmaceutical treatment of obesity is not going away.

Jones: No, definitely not. So how about your experience with and how has it really changed the way that you counsel clients now who are using or considering GLP-1s? But you work with only those that are on them, right?

Kessel: I work in a virtual weight management clinic. There are occasionally some patients in our clinic who are unable to access GLP-1 medications are too expensive and they might be on [naltrexone/bupropion] and [phentermine and topiramate] or one of the other generations of medications. But majority of the patients that I work with are on a GLP-1. And I've been asked this question before by dieticians and reporters and these sorts of things. And it's hilarious the answer that I've come up with because literally nothing has changed about how I teach good nutrition. It is the plate method. It is the consistent carbohydrate, three balanced meals, high lean protein, fruit and veggies are the good for you. Drink your water. How much fiber are we getting? Are we doing whole grains? Or do we have healthy fats? Are we doing omega-3s? What's our saturated fats look like? Can we pull them back a little?

Where's our ... It's the basics. And now for the first time ever in my career, that's what works for weight loss. Whereas in the past, in a weight management space, that advice would be unhelpful because it didn't induce a calorie deficit all on its own. So that plate method where you give eyeball, your protein and eyeball, your starch, somebody with an insatiable appetite who's very hungry, who's a snacker, who's a grazer, who's impulsive, 3 square meals a day of super nutritious foods isn't going to be enough. They're going to be hungry. They're going to eat outside of those three basic meals. And so, when the weight management space and dietetics, we would need to induce a calorie count. We would need to introduce some sort of tracking or journaling method. We would need to provide very specific portion sizes. We would maybe need to very tightly guide them in terms of how to make a meal plan and how to navigate certain situations and how to order at restaurants.

We'd have to get really nitty-gritty with the details. Now we don't have to. It's kind of like, you can wing it 3 balanced meals a day. Here's the whole bunch of proteins that are going to be great. Here's a whole bunch of starches. Here's a whole bunch of veggies. Mix and match. Throw a sauce on it. Stop when you're full. Try not to snack in between. Try to make healthy choices more often. Cut out the liquid sugars. Those basic advice works them out. So, it's made my job as a dietician easier. The nutrition stuff is easier to teach, and folks are more willing and ... Willing is the wrong word. They're at a better level of readiness while on these medications to absorb this education, just run with it. There's less barriers, there's less resistance, they're more open and willing to try what you teach.

And they're like, okay, well, I've only ever lost weight by cutting out carbs and counting 1,200 calories. And I'm like, " Hey, you're on a new medicine. Let's try something new. Let's eat some carbs and let's forget about tracking that app and let's use the plate method and see what happens. And then if we need to adjust, if we need to get more detailed, we'll do that on the follow-up but let it be easy. "And we talk a lot about just general routine and shopping and planning and more big concepts in nutrition. We don't get hung up on the little details as much anymore. So I love that about nutrition counseling for people on GLP-1s because with that, without having to focus on so many details, we can go to that next level stuff and get into the motivational interviewing and get into the behavior change and the patterns and the thoughts and the feelings and the mindset and the future thinking and the sustainability and what's it going to look like in a year We can have that conversation because we're not so stressed about what we're going to eat next week

Jones: Or next meal or the next-

Kessel: If it was effective, it's made for very effective nutrition counseling relationships. Whereas before folks would get frustrated and they'd come in having gained a pound and you'd spend 15 minutes of that session trying to figure out why they gained weight. And now it's like, no, they're just losing weight. They're doing well. They feel good. We can kind of breeze through that and get right into the more interesting stuff.

Jones: Wow, I love that. I think it sounds like a breath of fresh air really because it's hard to follow with 1,200 calorie diet. You're like, okay, if you're not budgeting that right, you're done by after lunch snack.

Kessel: Or you would have folks who are trying hard to budget so they undereat in the first half of the day and then they end up overeating and sticking into the night and then we didn't need a calorie count at all in the first place. Most of the time I'm working out with people on making sure they're eating enough. Most of my interventions I'm recommending are like, okay, how do we make breakfast bigger so that you are actually feeling that satiety so you can make it all the way to lunch with good energy and good digestion and you feel good and you don't get snacky in the office. We're usually adding food in nutrition counseling with people on GLP-1s. Very rarely are we giving folks and in dietetics in general, we try not to do this for any patient, but specifically in weight management, we would need to say, okay, you got to cut out X, Y, Z.

It's just not serving you. These are the quote unquote the better for your foods and these are the foods you should avoid because they're super high calorie dense, for example. Well, now a cookie, they're only going to eat one of them, whereas before they would eat six. So who cares if they have one cookie? It makes for an actually a very beautiful evolution of people's relationships with food. It's why I wish some of these intuitive eating dieticians would come join the GLP-1 club because there's this potentially amazing collaboration that could happen between anti-obesity medications and intuitive eating skills and counseling practices because that is essentially what we're teaching and helping people implement. They just happen to be people living with obesity who are trying for intentional weight loss. And I know that that intentional weight loss bit hangs up a lot of the intuitive eating health at every size a bit.

But beyond that, we agree on more than we disagree on. And I think that patients would really benefit from that shift away from traditional dieting and towards more that eating mindset, which is achievable now when they have a GLP-1 medication on board because now they have that internal perception of hunger and fullness cues. Now they can do that work to say, how am I feeling checking in with my body? What am I craving? Those skills are possible now. Whereas before GLP-1, it was, I'm just starving all the time. What do you mean there's nuance to my hunger and fullness cues? I don't know that. I'm just hungry. And so, the GLP-1s make it possible to navigate that space with more nuance and be in that gray area and patients really love that they don't have to diet so intensely anymore to see positive health outcomes.

And I think that that has been a wonderful thing for just weight management and dietetics in general.

Jones: Yes. Yes, that sounds fantastic. I appreciate everything that you've said in this episode to help fellow dieticians help really with blending personal insights with their professional boundaries when they're supporting clients that are on similar journeys. So, thank you so much.

Kessel: Thank you for having me. I appreciate the opportunity to share, especially to an audience of nutrition professionals because we are dieticians and folks in this space have so many skills that patients with on GLP-1s are searching for. They're looking for answers, they're looking for information, they're looking for guidance, they're going to the internet, they're going to TikTok, they're reading on, they're listening to the news. And I think that there's a way for dieticians to be way more involved and to elevate our profession and be part of this GLP-1 movement because it's not going away. The patients need us. They love us. They are fun to work with, and I wish more dieticians would get on board.

Jones: Yes, get on board. I second what some are saying. Thank you. Thank you for being on.

Kessel: Thanks for having me.

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