Weight-loss strategies to protect your heart

About 40% of adults in this country have obesity, a chronic, debilitating disease that poses a serious threat to cardio­vascular health. Lifestyle changes — following a healthy diet and being more active — can help. But while such habits can nudge down the number on the scale, these people often need to lose much more weight to lower their risk of heart-related problems.

That’s now possible thanks to the GLP-1 drugs semaglutide and tirzepatide — and why these powerful weight-loss medications are now recommended as a first-line therapy for eligible people, according to an expert consensus statement published Aug. 19, 2025, in the Journal of the American College of Cardiology. But even people who are good candidates for these drugs (see “GLP-1 drugs: Current approval status”) may run into some challenges, says Dr. John Ostrominski, a fellow in cardiovascular and obesity medicine at Harvard-affiliated Brigham and Women’s Hospital.

Cost and support-related challenges

Semaglutide and tirzepatide (both of which are given by injection once a week), cost about $500 to $1,200 a month. Medicare Part D covers these drugs for people with obesity and some related health conditions but not for obesity alone. Commercial insurance coverage varies widely. “And just as people with high blood pressure generally need to stay on their medication indefinitely to prevent disease recurrence or progression, so do people taking GLP-1s,” says Dr. Ostrominski. Over the long term, the cost can be prohibitive for many people. While online sellers, spas, and clinics offer less-expensive compounded versions of the drugs, these alternative versions of the FDA-approved medications have uncertain benefits and potential harms and should be avoided, says Dr. Ostrominski.

In an ideal world, people using GLP-1s would get support from a team of experts, including a doctor experienced in prescribing the drugs and managing their side effects, as well as a dietitian, exercise coach, and behavioral therapist. Comprehensive clinics that offer such care exist, but people often face long waits — as much as six months or more — for an appointment. “A shortage of these health care professionals relative to the demand for obesity-focused care have left these clinics understaffed and overstretched,” says Dr. Ostrominski.

Steps for success

What if you’re currently taking or planning to start a GLP-1 medication and your prescribing physician doesn’t have specific expertise in obesity medicine? Creating your own care team can support your weight-loss efforts. Ask for a referral to a registered dietitian or nutritionist who can help you create a personalized eating plan that ensures you get the nutrients you need while minimizing common side effects such as nausea and constipation. Here are three key tips:

Prioritize protein. Start every meal with a heart-healthy protein (such as poultry, fish, beans, tofu, or yogurt), which will help maintain muscle mass and reduce appetite.

Fill up with fiber. Fiber-rich foods such as fruits, vegetables, whole grains, nuts, and beans can help prevent constipation.

Stay hydrated. Get eight to 12 cups of fluid a day, which can include water, unsweetened tea or coffee, or hydrating foods like lettuce, cucumbers, and melons.

It’s also a good idea to work with a physical therapist or personal trainer to help you create a sustainable, enjoyable workout routine that includes both aerobic and muscle-building exercise.

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