The FDA-approved prescribing information for Wegovy and Zepbound lists nausea, vomiting, diarrhoea and constipation among common adverse reactions, and warns about acute kidney injury associated with dehydration from severe GI reactions. They also carry warnings about pancreatitis and gallbladder disease.

A coach reading those lines should hear: GI distress plus poor fluid intake is a medical escalation path, not a willpower issue.

NIAAA describes drinking patterns and risks on its moderate and binge drinking overview. For someone already nauseated or eating very little on a GLP-1 medicine, alcohol can crowd out protein and fluids. Coaches can:

• Ask what usually happens after one drink (nausea, reflux, next-day under-eating).
• Practise a default order (zero-alcohol beer, soda water) before the client is standing at a bar.
• Plan protein before any social drink so the evening is not liquid calories only.
• Refer to the prescriber if the client reports vomiting, blackouts, escalating intake, or using alcohol to manage anxiety or appetite.

Coaches must not invent a medical "allowed units on semaglutide" number.

The 2025 joint advisory from ACLM, ASN, OMA and TOS supports nutrient-dense eating, adequate protein, smaller meals and slower eating for people on obesity medications (Mozaffarian et al., 2025). Practical coaching moves:

1. Protein first. Name the protein before sides.
2. Half-portion plan. Ask for a box at the start, or split an entrée.
3. Pace. Put the fork down between bites; stop at comfortable fullness, not empty-plate rules.
4. Next-morning protein. Protect breakfast after a late dinner so under-eating does not stack with lean-mass risk (Neeland et al., 2024).
5. Strength still happens. Restaurant weeks are when people skip the gym. Keep two short sessions on the calendar (Physical Activity Guidelines).

• Confirm the venue and whether a protein-forward option exists.
• Agree the drink default before arriving.
• Agree a stop signal (comfortable fullness, not a calorie target the coach invents).
• Agree what "unwell" looks like and who the client calls (prescriber / urgent care).

Same-day / urgent referral cues: repeated vomiting, inability to keep fluids down, severe abdominal pain, fainting, chest pain, blood in vomit or stool, or any symptom that frightens the client.

Also refer if restaurant restriction looks like an eating-disorder pattern (rigid rules, fear of all social meals, compensatory behaviour). Coaches are not ED therapists.

• Suggest skipping a dose before a wedding or tasting menu.
• Recommend alcohol as an appetite tool.
• Promise that a restaurant protocol replaces medical follow-up.
• Source medicines or "research" peptides for clients who want a cheaper workaround.

Scope: NBHWC.

• "How many drinks are safe on Wegovy?" "I can't set a medical alcohol limit. Let's look at how you feel after one, keep protein and fluids up, and ask your prescriber."
• "I'll just not eat so I can drink." "That pattern can worsen dehydration and under-eating. Let's reverse it — food and fluid first — and loop in your clinician if nausea is bad."
• "Can I pause my dose for vacation?" "Dose changes are your prescriber's decision only."

Level 1 free. Level 3–5 cover GLP-1 lifestyle modules, GI/alcohol/eating-out scripts and case practice. /coach. No income promises.

High-stakes meals are when clients ask to skip a dose. Rehearse the meal plan; never rehearse a dose change. Agree protein-first ordering, a drink default, a stop signal and a next-morning protein breakfast. If nausea is already severe that week, the client contacts the prescriber before the event — not after vomiting through it.

Airport and hotel food can wipe out protein for two days. Pack a backup option, choose the protein item first, and keep strength sessions on the calendar even if they are 20 minutes in a hotel gym.

Note what the client agreed for the meal, what symptoms they reported, and when you referred. Do not chart a medical alcohol limit or a clinical assessment of pancreatitis risk.

Education only. Not medical advice.