First—you’re not doing anything wrong, and you don’t need to push through feeling unwell.

GLP-1 medications (like Zepbound® and Mounjaro®) work by slowing digestion and changing appetite signals. For some people, especially early on or after a dose increase, this can lead to side effects such as nausea, stomach upset, reflux, fatigue, constipation, or diarrhea.

The good news: most side effects can be improved with simple adjustments.

Step 1: Do not increase your dose

If you’re feeling unwell:

• Do not move up to the next dose

• Stay at your current dose, or

• If symptoms are significant, your provider may recommend dropping back to the previous dose

Many people do better by slowing down the dose progression.

Step 2: Adjust how, when and what you’re eating

Because digestion is slower on GLP-1 medications, portion size and food choice matter more than ever.

Helpful strategies include:

• Eat smaller meals, more often if needed

• Stop eating at the first sign of fullness

• Avoid large, heavy, greasy, or very fatty meals

• Limit alcohol (especially early on or after dose changes)

• Eat slowly and chew well

• Avoid eating late at night or within 2 hours of bedtime

Overeating—even unintentionally—can worsen nausea and discomfort.

Step 3: Support digestion

These small habits often help:

• Stay well hydrated, but avoid chugging fluids with meals

• Separate food and fluids when possible

• Sit upright after eating

• Gentle movement (like walking) can help digestion

• For constipation: adequate fluids, fibre from food, and regular meals matter

Step 4: Give your body time

Side effects often improve:

• Within a few days to a couple of weeks

• As your body adapts to the medication

This is one reason we use slow, flexible dosing schedules—your body sets the pace.

When should I contact my care team?

Please reach out if:

• Side effects are persistent, worsening, or interfering with daily life

• You’re vomiting, unable to eat, or becoming dehydrated

• You’re unsure whether to stay at your dose or go down

We can help adjust the plan—this may include holding the dose longer, reducing the dose, or pausing briefly if needed.

A final reminder

The goal is not to tolerate the highest dose.
The goal is to find the lowest dose that helps your appetite and metabolic health while still allowing you to feel well.

Feeling miserable is not a requirement for success.

Obesity medications:

Wegovy DIN 02528509

Saxenda DIN 02437899

Zepbound DINs all doses needed

• 02557509: Zepbound Kwikpen 2.5 mg

• 02557517: Zepbound Kwikpen 5 mg

• 02557525: Zepbound Kwikpen 7.5 mg

• 02557533: Zepbound Kwikpen 10 mg

• 02557541: Zepbound Kwikpen 15 mg

Diabetes medications:

Ozempic DIN 02471469

Mounjaro DINs all doses needed

• 02551950: Mounjaro KwikPen 2.5 mg

• 02541068: Mounjaro 5 mg

• 02541076: Mounjaro 7.5 mg

• 02541084: Mounjaro 10mg

• 02541092: Mounjaro 12.5 mg

• 02541106: Mounjaro 15 mg

If you’re having side effects like nausea, reflux, fatigue, or appetite suppression that feels too strong, your provider may recommend temporarily lowering your dose using a method called click counting. This can help your body adjust more comfortably rather than stopping the medication altogether.

What is click counting?

Ozempic and Wegovy pens increase the dose in small increments (“clicks”) as you turn the dial. Each click delivers a tiny, consistent amount of medication. By stopping before the full dose, you can take a partial dose.

Approximate Dose - Number of Clicks - This applies to the Ozempic 1mg and Wegovy 1mg pens:

0.25 mg = 18 clicks

0.375 mg = 27 clicks

0.5 mg = 36 clicks

0.75 mg = 54 clicks

1.0 mg (full) = 72 clicks

Click charts are available online for Wegovy pens and can be found by searching on Google.

More instructions on HOW TO TAKE OZEMPIC are found here.

More instructions on HOW TO TAKE WEGOVY are found here.

How Zepbound® and Mounjaro® Dosing Works

Zepbound® and Mounjaro® are injectable medications that come in fixed-dose pens. This means each pen delivers one specific dose—you can’t adjust the amount within the pen itself.

Starting Dose

Everyone starts at a low dose of 2.5 mg once weekly.
This starting dose is not meant for full effect—it’s designed to help your body adjust and reduce side effects.

Dose Increases

If you’re tolerating the medication well, the dose can be increased:

• Doses typically increase every 4 weeks

• Each increase is by 2.5 mg at a time (for example: 2.5 → 5 → 7.5 → 10 mg, etc.)

This gradual approach helps balance effectiveness and tolerability.

Why Your Prescription Has Multiple Refills at the Same Dose

You may notice that your prescription is written with multiple refills at each dose level. This is intentional.

It gives you flexibility.

Rather than forcing you to increase the dose on a strict schedule, this approach allows you to:

• Stay at your current dose longer if it’s working well

• Delay increasing if you’re having side effects

• Increase when ready, based on both symptom control and how you’re feeling

In other words, you are not required to increase the dose every 4 weeks.

How to Decide Whether to Increase or Stay the Same

When deciding whether to move up to the next dose, we consider two things:

1. Response

   • Appetite control

   • Reduction in food noise or cravings

   • Feeling satisfied with smaller amounts of food

2. Side Effects

   • Nausea, vomiting, diarrhea, constipation

   • Fatigue or other symptoms

If you’re getting good benefit and side effects are minimal, staying at the same dose may be the best option.
If benefits are wearing off and side effects are manageable, increasing the dose may help.

The Goal Is the Lowest Effective Dose

More is not always better.
Our goal is to find the lowest dose that gives you meaningful benefit with tolerable or minimal side effects.

Weight loss and metabolic improvement do not require reaching the highest dose for everyone.

Always Check In If You’re Unsure

If you’re uncertain about whether to increase your dose—or if side effects are concerning—please reach out to your care team reminding you don’t need to “push through” discomfort to be successful on this medication.

More instructions on HOW TO TAKE MOUNJARO are found here.

Approximate out-of-pocket costs (without insurance) in Ontario (2025):

• Ozempic: ~$230 per month (prescribed off-label for weight loss, access ozempic.ca for manufacturer discount)

• Wegovy: ~$450 per month

• Zepbound: ~$300–$480+ per month (depending on the dose, discount card required from myzepbound.ca)

• Saxenda: ~$475 per month

• Contrave: $199 per month

Prices are subject to change. Generic semaglutide is expected to come to the Canadian market in mid-2026 which will add pricing pressure to other GLP1 medications.

Tracking Body Composition in Your Care

In your care, we focus on metabolic health and body composition—not just the number on the scale. A standard scale cannot tell the difference between fat loss and muscle loss, which is especially important during weight-loss treatment and GLP-1 therapy.

Our Recommended Method: BIA Scales at Home

For regular tracking, we recommend using a BIA (bioelectrical impedance analysis) scale—a safe, affordable, and repeatable way to monitor meaningful changes over time.

Recommended At-Home Scale Options (Amazon.ca)

1. 8-electrode BIA scale (higher accuracy)
Measures arms, legs, and trunk separately for more precise data

2. Standard foot-to-foot BIA scale (more affordable)
Still effective for tracking overall trends

Both options are acceptable. The most important factor is consistency—using the same scale over time.

Important Notes

• Do not follow calorie or nutrition advice from the scale’s app. Please rely on our Registered Dietitians for nutrition guidance.

• Focus on trends over time, not single readings

• Individual results can vary based on hydration, time of day, and recent activity

• Our clinical team will interpret your results in the context of your overall health and treatment plan

Please be prepared to share weight, % body fat, and % muscle at each physician visit.

DEXA Scans (Optional)

If you would like a more detailed body composition assessment, you may choose to get a DEXA scan through a local fitness centre or private clinic that offers DEXA body composition testing in your city.

• DEXA is a highly accurate method for measuring fat mass, lean mass, and bone density

• These scans are typically not covered by OHIP

• Availability and pricing vary by location

• DEXA can be helpful for occasional baseline or progress checks, but is not required

The medical research gold standard for body composition is MRI, but this is generally used only in research settings and is not practical for routine clinical monitoring.

Our Goal

Our goal is healthy, sustainable fat loss while preserving muscle and supporting long-term metabolic health—not just weight loss.