Can intuitive eating and GLP-1 medications coexist?
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Yes — but only with clinical understanding of what GLP-1 does to the body’s internal signaling system, and with ongoing professional support from a weight-neutral, non-diet practitioner.

GLP-1 medications affect interoception: the body’s ability to sense hunger, fullness, and satisfaction. Research now indicates there are GLP-1 receptors on the tongue, meaning the impact extends beyond appetite suppression to include satisfaction from food and, in many cases, satisfaction with life in general. This creates a significant coaching challenge for non-diet practitioners. The very internal cues they are teaching clients to reconnect with have been pharmacologically altered. Structured eating reminders, general nutrition guidance around adequate fueling, and patience with a non-linear process all become essential components of the work.

The most important clinical distinction is between food noise as a symptom and food noise as a signal. Food noise is either genuine hunger — meaning the client is underfueling — or it is unprocessed guilt and shame around food rooted in diet culture conditioning. GLP-1 suppresses the noise quickly. It does not address the root. Practitioners who treat the medication’s muting effect as a solved problem are setting clients up for a harder re-entry when the medication is no longer present.

Body image work, belief work, and nervous system capacity building are not optional add-ons for clients on GLP-1. They are the protection. As clients do the deeper work on body acceptance and self-worth, many naturally begin to re-evaluate the role the medication is playing in their lives — not because the practitioner directed them to, but because the suffering that was driving the original decision has diminished. Practitioners who understand this are providing meaningful care regardless of what the client ultimately decides about medication. Those who do not are leaving clients without a foundation to stand on when the medication ends.

Transcript 

Stephanie: Welcome to the podcast, Miss Sam.

Sam: Thank you so much for having me.

Stephanie: I am so excited to have this conversation with you. I’m gonna let you introduce yourself for people listening to this to see who you are first, and then we’re gonna get into it.

Sam: Awesome. So my name’s Sam. I am a registered dietitian, a certified intuitive eating counselor and certified personal trainer, and the founder of Find Food Freedom, which is a virtual private practice made up of a team of — right now we have 11 registered dietitians and certified intuitive eating counselors. We offer one-on-one counseling, fully virtual, to help people repair their relationship with food and their body. And we take health insurance, which is really exciting. We started taking health insurance back in 2024. We are licensed in over 29 states and accept over 100 insurance plans. I’m really proud of that because for the longest time we didn’t accept insurance. I’ve always said I want to help as many people as possible. And I realized in order to do that, we had to make this care more accessible. It can be very hard to find providers that are weight-inclusive and intuitive eating, Health At Every Size based.

Stephanie: [00:01:00] This is why you’re here — you’re the perfect person to have this conversation with, given the size of your team. You have, as far as I know, the largest intuitive eating counselor, registered dietitian team. We want to have the conversation for other practitioners in our community about the intersection of intuitive eating and GLP-1. Nobody wants to talk about it, but we need to talk about it because it is the reality of today. You have a lot of clinical experience. We have very little research at this point — it’s clinical observation. You’re the expert on this topic as far as I’m concerned, so let’s have the conversation.

Sam: [00:02:00] I love it. And you know what, that’s kind of how it happens. The reason I’m sitting here is, like you said, we have a very large team, and the slow trickle started. Okay, in 2020, intuitive eating had its boom. I mean, it’s been around obviously since Evelyn and Elise wrote the book, but it really had this big boom in 2020. Everybody was really excited about intuitive eating. Body positivity became this trend — not really what it was, but Instagram’s whitewashed version of it. People were really excited about healing their relationship with food and body. And now these weight loss drugs are here. We just started to slowly get more questions about it, slowly get more questions, until the ball just started rolling down the hill faster and faster and faster. As a practitioner, you either have to keep up or you’re gonna get run over, frankly.

Stephanie: [00:04:00] You put out a podcast on this, I think on February 25th. I listened to it and I’m like, okay, we clearly have a lot to talk about. You said something in there — as a dietitian, it is unethical to turn away a client. You are in a position where you are there to help people and you need to figure out a way to help people within the world of intuitive eating. Is that how it comes to be for you?

Sam: Great question. I get this question a lot from younger dietitians too. They’re like, do I have to work with every single client that comes to me? And I always say: I want to support people who want to make peace with food and their body. When we look at the intuitive eating paradigm and the mission of intuitive eating, intentional weight loss is not a piece of the intuitive eating process. When people come to me and say “I wanna lose weight,” I don’t look at them and say, “Nope, sorry, next.” I would say 99.999% of our clients have a desire to be in a smaller body just due to the world that we live in and their diet cultural trauma, or eating disorder history, or whatnot. But I think there’s a very big difference between desiring weight loss and the intentional pursuit at all costs going towards weight loss.

Sam: [00:05:00] So it’s very rare that — because our practice is so loud about what we preach — it is very rare that we get a client who comes in and says, “That intuitive eating thing sounds great, but I don’t give a crap about it. I only want to lose weight and I will do whatever it takes.” That really doesn’t happen. But if it did — the closest we get is someone saying, “The intuitive eating thing sounds great, but I really want to lose weight.” We will explain the intuitive eating process, the principles, what we can do, how we can talk about weight and weight science. But weight loss, intentional weight loss, is never going to be a tangible thing we measure or a measure of progress. And if that is what you want, you have full body autonomy to pursue it. Let’s help find a practitioner who’s gonna be a better fit, because it’s just not our team.

Sam: [00:06:00] The more I was open about sharing our beliefs about intuitive eating and anti-diet and all of these things, the more you get those clients that are looking for that. And one more thing: now people who are very rooted in intuitive eating — those GLP-1 claws are getting deeper and deeper. People who are firmly rooted in intuitive eating and body acceptance, and GLP-1 is inundating that space too. I think that’s where it gets tricky.

Stephanie: [00:08:00] Body autonomy is really centered in the conversation about GLP-1 today. People are able to choose. What we need to do as practitioners is get really clear on our marketing and how we speak. Can these two things coexist? That’s the big question of this episode. Is there an intersection between intuitive eating and GLP-1?

Sam: Great question. Yes, there is a way these two can mesh together, and I think there has to be. If someone comes to our practice and says, “I’m pursuing intuitive eating, I need help with intuitive eating, I want to make peace with food, I want to make peace with my body, and I’m taking a GLP-1, or I want to take a GLP-1” — if we turn them away as certified intuitive eating counselors, where are they going to go to learn intuitive eating? I think it’s unethical to turn someone away from that.

Sam: [00:09:00] One of the biggest disclaimers I’ll say to somebody when they are starting or on an intuitive eating journey with a GLP-1 is that your intuitive eating journey while you’re taking a GLP-1 is going to look vastly different than if you come off of that GLP-1 later. Whether it’s negative side effects, you can’t afford it, lack of access, you don’t want to be on it — whatever the reason is, if you come off the GLP-1, it’ll probably feel like starting from scratch. Because we know these medications suppress hunger, delay stomach emptying, they affect everybody vastly different. So how one client experiences this medication is going to be different from the next person. It’s going to affect how you experience hunger and fullness and satisfaction from food.

Sam: [00:10:00] While we are sifting through these principles while you’re on the medication, it’s gonna look different than if you came off of them. But I think as an intuitive eating counselor, even if you’re on a medication or not, your intuitive eating journey is always gonna look different. It’s not this linear journey. So yes, we can absolutely do both — with the understanding that it will look different if we come off of the medications.

Stephanie: [00:11:00] I see it as an onion. As life happens, you’re gonna peel the next layer. I see that in periomenopausal women because I work with an older group — they’re being re-triggered because their body’s completely changing, and we need to go back and brush off some of those principles that were well-grounded five years ago.

Stephanie: [00:12:00] So life changes, body autonomy is clear. But there’s also another angle here: people take GLP-1 for different reasons. There are people who take it to lose weight, but there’s also a growing population being prescribed GLP-1 for medical purposes — diabetes, and I’m now seeing PCOS being prescribed as well. Is a patient prescribed GLP-1 for a medical issue impacted in the same way as an intentional weight loss patient in your practice?

Sam: That’s a great question. People getting prescribed these medications where they have no interest in intentional weight loss — they’re on a body image journey with intuitive eating — to me that isn’t that different from a lot of medications because they’re clearly at a different point with their body image. When we have patients who are taking it specifically for intentional weight loss and are also interested in intuitive eating, we do set firm boundaries. We let them know the purpose of intuitive eating is not intentional weight loss. We will not be weighing you. We will not be marking your weight as a measure of progress. Yes, we can talk about weight science, we can talk about body changes — it’s not like we’re gonna slap your wrist if the word weight comes up. It’s just seen as neutral in our practice.

Sam: [00:15:00] We focus on those non-scale victories: less obsession with food, more variety of foods, more satisfaction from meals, feeling nourished, feeling energized, hydrating, finding pleasure from food, being able to go out on a date night and order dessert and enjoy it without freaking out after, our relationship with movement, our relationship with our body. We do a lot of digging into why — why do you want to be in a smaller body? Is it genuinely for health? Because there are many things we can do that will have a positive impact on health outcomes that are completely uncoupled from body change. Or is it for confidence? Then we’re going down the body image path, the anti-fat bias path, the body image trauma path. We hold space for them. I have so much empathy for clients navigating this.

Stephanie: [00:17:00] So the majority of intentional weight loss patients will eventually come off — that’s just the reality. Very few will take it for a lifetime. Are you seeing the first wave come off?

Sam: We are seeing the first wave come off. And it’s what I said earlier — it feels like starting from scratch. Because when people talk about the food noise going away while on the medication, if we just turned it off with the flip of a switch — the drug — now the drug’s not there, and now we need to address what was never addressed. It’s like pushing a beach ball underwater. You can only push it down for so long and then it pops up. And the further you push it down, the further it’s gonna fly up. We’re definitely seeing that — whether it’s people wanting to come off because they feel ready, or because of negative side effects like gastroparesis, throwing up, diarrhea, GI discomfort. The first wave has started.

Stephanie: [00:21:00] Let’s go through the principles and see how you are coaching your team to adapt them for GLP-1. If we take the eating cues — hunger, fullness, satisfaction — we do know through research that hunger and fullness are affected through GLP-1. I also read something before this interview that there are GLP-1 receptors on the tongue, which means there’s an impact on satisfaction as well. How do you coach someone on GLP-1 through those three principles?

Sam: [00:22:00] For hunger, it’s very similar to some of our clients with extreme restriction — in the beginning they have to have a lot of structure around food because without structure, they will simply not eat. So it could be setting alarms in your phone, structured mealtimes, because if you’re not getting the proper cues from your body, you need to remind yourself to eat. For fullness — a lot of people experience feeling fuller much quicker, so we talk about what a generally adequate amount of food looks like, to make sure we’re not underfueling. We know 1,200 calories is the need of a two-year-old, yet diet culture has pushed that as the baseline for human beings forever. So we make sure we’re getting enough calories for organs to function, enough for any activity level.

Sam: [00:24:00] When we talk about satisfaction — how we said food just isn’t fun anymore for some people — that happens with intuitive eating all the time without GLP-1s, because food is not forbidden anymore. Once you make peace with food and you don’t have things that are off limits, it’s just food. And for years before GLP-1s were a big thing, a big part of our practice has been overcoming food boredom and how to bring fun and pleasure back into food. Now I would say that conversation is front and center because GLP-1s have been shown to decrease satisfaction — not only of food, but of life in general. So we have a keen eye for ensuring our clients are not too numbed out on life, because what is the fun of life if we’re just going through it without satisfaction?

Stephanie: [00:25:00] What you’re describing is what I call functional eating — where sometimes you just have to structure your eating. I think a lot of us in our niche have pulled away from that sometimes too much, and GLP-1 must bring that back because people will end up undereating. And nutritional deficiency is probably going to become a big problem in the future, though we have very little research on it yet.

Stephanie: Let’s talk about food noise — the diet mentality, the thoughts we have about food. We know GLP-1 turns this down. But I heard someone say last week that it turns it down too much — “I don’t think about food enough anymore.” Is that what you’re seeing?

Sam: [00:26:00] It’s so individualized. Medications are affecting everybody differently. I saw someone’s video where she was talking about her vacation on a GLP-1, and she was like, “Vacations are so different now. I don’t wake up thinking about food all the time. I go sit on the beach and watch the sunrise, enjoy my coffee, eat foods that make me feel pleasant, and move my body in ways I enjoy.” And as she’s going on, I’m thinking: this is what intuitive eating does. This is intuitive eating. I stitched that video and got tons of comments from people saying, “When I was on intuitive eating, I just ate everything in sight.” And that often comes from people who stopped dieting and think that that’s intuitive eating — but it’s an evidence-based practice with ten defined principles.

Sam: [00:28:00] There are so many parallels with intuitive eating and coming off GLP-1s around food noise, because that’s what we do in intuitive eating — we address those voices in our head and figure out where they came from. We were not born into this world thinking we’re bad people for eating food. We were not born with guilt for eating certain amounts. So we challenge those beliefs, we have exposure to food, we use food habituation. And GLP-1 is putting a bandaid on it. It will quiet the food noise quickly. But if we come off the medications and we didn’t address why the food noise is there in the first place — because food noise is usually two things: you’re either genuinely hungry, or once we rule that out, there’s guilt and shame in the relationship with food. We could take the medication and work on intuitive eating simultaneously, or we could do it with intuitive eating alone. But the medication looks a lot sexier because it’s a lot quicker.

Stephanie: [00:30:00] As a practitioner, if you find yourself not knowing how to help people with food noise — not equipped to do the mental and emotional work — that’s the piece that’s missing with just reading the intuitive eating book. How do you actually do that work? Because what I hear you say is that you’re doing mindset work — looking at thoughts, beliefs, emotions — actually doing the deep work so people can permanently address the food noise.

Sam: Yes. And it’s not easy work. It’s very emotional. It can be traumatic to bring up — a lot of bad things happen to people. Abuse, bullying, so many things. But it is some of the most rewarding work when it pays off. And I don’t blame people for wanting to choose the quicker fix, whether that’s a fad diet or an injectable — if we don’t feel comfortable being uncomfortable, I understand completely.

Sam: [00:32:00] As a provider, you have to be able to sit in the discomfort. We are not the authority pointing the finger. We sit there with our clients and we’re in it with them — in the suck, as Bri Campos says. That took time for my team. As dietitians, we don’t have body image continuing education or credentials built into our training. So it’s very important to get additional support — which I know takes money and privilege to do so.

Stephanie: [00:33:00] And that’s the solution for the food noise that GLP-1 gives. Because we’re going to come to the last bit of principles — the relationship to the body and the habits of movement. That is not something we learn in nutrition from an intellectual knowledge standpoint. It’s all behavior, mindset, and coaching. So let’s talk about body image. How do we help someone who is on GLP-1 for intentional weight loss with their body image work?

Sam: [00:34:00] It’s so sticky. A lot of the exercises, reflections, and modalities we would do for body image work with someone not on a GLP-1, we would still do with clients on a GLP-1. It’s just that we know they are not as far into the anti-diet, Health At Every Size, intuitive eating work — because they are still holding onto intentional weight loss. So it’s going back to: tell me why. I want to gather as much as I can from the client. “Tell me more. Why do you want to lose weight? Okay, you want to love yourself more. Tell me why. When is a time you didn’t feel loved because of your body?” You’re creating this web.

Sam: [00:35:00] Marcy Evans and Fiona Sutherland have a body image story reflection exercise I’ve never forgotten — body image is like a tree. The roots are the foundation: what were the primary messages you were given about body image and how have they impacted how you think about your body and bodies in general? The trunk is your current relationship with your body. The leaves and branches are where you want that relationship to go and what an ideal relationship would look like. Unpacking that takes many, many sessions and brings up a lot. And it’s been really interesting to see that as people become more accepting and neutral with their body, some eventually come off of the GLP-1. Not because we’re sitting there saying they should. We’re holding space for them regardless of what they decide.

Stephanie: [00:37:00] That makes sense because if we have a patient on GLP-1 for intentional weight loss and you keep doing the body image work, unpacking the core belief — the emotional suffering lessens and lessens. And the cost of being on GLP-1, the symptoms, the financial cost, the burden — becomes greater than the burden of being in their body. So we’re lessening the suffering that was driving the decision, not pushing them off the medication. The medication just becomes less attractive on its own.

Sam: Yes. Because if they start to accept their body, they’re more neutral in their body, they’re making positive changes for physical, mental, and emotional health — and then they’re like, “Oh wait, I don’t have to be on this to impact my health in a positive way.” And they’re starting to have all these behavior changes. It makes total sense.

Stephanie: [00:39:00] Let’s talk about health-promoting behaviors. Part of our work is helping people build health-promoting behaviors outside of intentional weight loss. Is there a specific approach for people on GLP-1 or is it the same health behavior approach?

Sam: When we’re meeting with clients, it’s always: what is your biggest obstacle, how can we help you? We’re looking at variety of foods, consistent fuel and nourishment throughout the day, hydration, stress management, sleep hygiene, movement that they enjoy, and rest. We take a full whole-person approach. And for each client it’s about what they need in that moment. I like to think of each client as a puzzle — I’m always looking for the corner pieces first. What are those cornerstones we want to prioritize? A lot of times clients already know, and we’re there to help prompt them along.

Stephanie: And we help them build the skillset — so that when life after GLP-1 happens, they can take those skills and apply them.

Stephanie: [00:41:00] What about rejecting the diet mentality — principle one? Taking it for intentional weight loss does not align with that principle. How do you hold that?

Sam: That one is very conflicted, because that is what intuitive eating is all about. And a GLP-1 for intentional weight loss does not align with it. So it’s going back to those boundaries from the beginning — we are not measuring progress through weight loss. One thing I would add, specific to GLP-1: if a client does start to lose weight and they start getting comments about their body, I think talking about what that brings up for them is really important. I’ve had many clients lose weight on intuitive eating journeys — bodies change, and we treat that as neutral. But then clients get comments from loved ones like “Oh my God, you look so great, what are you doing?” — and they feel uncomfortable. So on the flip side, what does it mean for you if you’re getting compliments about a smaller body? How does that make you feel? That’s a lot of self-worth work.

Stephanie: [00:43:00] And setting up an environment where commenting on my body is not something I’ll allow — on GLP-1 or not — because there is an impact to that. Learning to set those boundaries is just a life skill.

Stephanie: What about people coming off? Is there a specific approach when people are transitioning off GLP-1?

Sam: [00:44:00] It’s so individualized. The difference is that you should be getting professional support — whether you are on the medications, thinking about getting on them, or transitioning off. Especially transitioning off, because it is impacting your body physically, mentally, and emotionally. We don’t have strict protocols of “you will do this, then that,” but as you are on an intuitive eating journey you are building introspective awareness and connection with your body. Making sure we are really checking in — are we nourishing consistently? Are we hydrating? Being aware of negative thoughts as they enter, being aware of how we are speaking to our body, putting that curiosity cap on, staying in conversation with our clients.

Sam: [00:45:00] We have a HIPAA-compliant platform where clients can message us similar to texting. Knowing they have support is so helpful, because it’s such a tricky time — they open their phone and see GLP-1 ads everywhere and think, “Am I doing the right thing? Should I stay on?” All that dissonance enters. So it’s about being there for them and knowing that whatever struggle they have, we’re in it with them.

Stephanie: And revisiting the principles of intuitive eating in the aftermath of the GLP-1, triggering those conversations so they’re not left behind.

Sam: Yes. And knowing it’s okay if the food noise comes rushing back. I think setting expectations that it’s okay if things change, it’s okay if this happens, nothing is final. So much of life — when we’re stressed — feels permanent. Let’s just take a breath. Whatever you’re going through in this moment is not permanent, and we can work through it together.

Stephanie: [00:46:00] People want permanency because they want relief from suffering. So the best skill we can teach our clients is how to deal with suffering — so the illusion of being done and never suffering again can be normalized. And then bring it on — something will change and I’ll be able to cope with it.

Sam: Yes. Because diet culture just sells that idea — “If I just lose the weight, then I’ll be happy and things will be great.” Even though the majority of our clients, even those on GLP-1, have existed in a smaller body at some point throughout their diet cycle. And I’ll ask them, “Were you happy?” And it’s like, no, it was never enough. Maybe I got external validation that felt good. But I didn’t love myself. I wasn’t happy. And so if we weren’t happy then in a smaller body, what makes us believe this is it? It just proves how insidious diet culture is and how deeply, deeply it is entrenched in our society.

Stephanie: [00:47:00] So as we close the podcast — can intuitive eating coexist with GLP-1? What is the answer?

Sam: Yes, and. Yes — and everything we just talked about. It is so nuanced, so individualized, it will not look the same as if you come off the GLP-1. But yes, you can do it. And it is very important to get professional support who can help you and hold space for you along that journey, no matter what happens, from a fair, unbiased place.

Stephanie: I’ll answer it two ways. Yes, it can coexist — based on why you’re taking the GLP-1 first of all. Let’s separate the two categories. And then: I believe GLP-1 and intuitive eating can coexist for the benefit of the patient or the client. We have to find a way to support people instead of just shutting the door. We need to be flexible as practitioners and work on whatever we can work with them while they’re with us, so that they can be better long term.

Sam: I love that, Stephanie.

Stephanie: So where can we find you, Sammy?

Sam: [00:48:00] Instagram is the easiest place — and that has all the links, including where you can get your insurance benefits checked. Pop in your state and your insurance plan and see how much coverage we have.

Stephanie: And you do mentoring for professionals as well.

Sam: Yes. I’m always happy to talk with new dietitians or dietitians in the field who want support because it’s tricky and we’re always learning and growing.

Stephanie: Okay. We’ll put the link to your website and also to the episode that got me to invite you to this podcast. Thank you so much, Sam.

Sam: Thank you so much, Stephanie.