A quieter appetite is the treatment working. But "less" has a floor, and this chapter is about noticing when you are approaching it — calmly, and early, while it is still an easy conversation.

Under-fueling rarely announces itself. It shows up sideways: energy that fades earlier each day, workouts or stairs that feel heavier, feeling cold, hair shedding more than usual, or realizing at dinner that today held only a few hundred bites' worth of food. None of these proves a problem on its own. A pattern of them, across a week or two, is worth reporting rather than pushing through.

Where the line sits

Use three levels, in plain language.

Three contact levels in rising urgency. Worth raising at your next visit: food variety keeps narrowing, meals skipped without noticing, quiet pride in how little you need. Contact your care team within days: far less than usual for more than a few days, weakness progressing, dizziness that keeps returning. Worth a call the same day: cannot keep fluids down, vomiting that will not stop, or signs of dehydration — dizziness on standing, very little urine, dry mouth. — Three levels of contact, in rising urgency — calling is part of the treatment.

Worth raising at your next visit: your food variety keeps narrowing, meals are being skipped without you noticing, or you are quietly proud of how little you need. Bring it up even if you feel fine.

Worth contacting your care team within days: you have eaten far less than usual for more than a few days despite the adjustments in Chapter 5, weakness is progressing, or dizziness keeps returning.

Worth a call the same day: you cannot keep fluids down, vomiting will not stop, or you have signs of dehydration — dizziness on standing, very little urine, a dry mouth that will not resolve. These same-day signs are covered in depth in the safety book; the point here is simple — do not try to eat your way through them at home.

You will not be wasting anyone's time. Adjusting the plan when intake falls is part of the treatment, not an interruption of it.

Two situations that need a coordinated plan

Diabetes treatment. If you use insulin, a sulfonylurea, or another glucose-lowering medication, eating substantially less changes the math of those medications, and low blood sugar becomes a real concern — shakiness, sweating, confusion, or falling readings deserve prompt contact. Coordinate any major change in how much you eat with the prescriber who manages your glucose. Do not adjust doses yourself. This coordination is a core reason supervised GLP-1 care is built around monitoring rather than refills.

Your relationship with food. For some people, eating less starts to feel like winning — rules multiply, fear attaches to foods, guilt follows normal meals. Research on GLP-1 medications in people with eating disorders is too limited for confident conclusions in either direction, which is precisely why this deserves a professional conversation, not self-diagnosis. If any of this sounds familiar, say it out loud to your clinician. It is treatable, and you will be met with help, not judgment.

What about supplements and blood tests? Individually useful, universally unproven. The evidence that this treatment routinely causes specific deficiencies is incomplete, so the right supplements or labs — if any — follow your risks, your intake, and your clinician's review, not a standard checklist from the internet.

The takeaway. Less is expected; too little is a signal. Know the three levels, coordinate early if you use glucose-lowering treatment, and let no one — including you — grade your health by how little you eat.