Your modifications

A. On a GLP-1 medicine

The idea: your medication is excellent at one thing, reducing appetite. It is not designed to protect your muscle, and studies show a meaningful share of the weight lost on these medicines is lean tissue unless you actively defend it [22] [23] [24]. This overlay is the defense. It is a modifier, not a gate; the program works with your medication, on purpose.

• Protein gets eaten first at every meal. With a smaller appetite, whatever you eat first is what you actually finish. Aim for the top of your range; four societies' guidance is at least 1.2 g/kg spread evenly, plus lifting [25] [26].
• Lifting is non-negotiable. Exercise changed what the medicine took off: fat-free mass kept, fat loss doubled [27]. Skipping lifting on a GLP-1 is how people arrive at their goal weight weaker than they started.
• Small meals, planned, rather than grazing. Three or four protein anchors a day, from the plan, not from hunger. Do not skip meals. Do not let the medicine overshoot into a crash diet.
• Hydrate deliberately. Thirst quiets down along with hunger. Two litres a day, scheduled.
• Fiber to 25 g and a daily walk keep digestion moving; psyllium if needed [89].
• Side effects: nausea likes small, bland, low-fat meals, stopping at "no longer hungry", and staying upright after eating. Greasy food is the top trigger. Heartburn: last meal 2 to 3 hours before bed.
• Never adjust, skip or stack doses yourself. Severe or persistent belly pain, vomiting you cannot keep fluids down through, or dizziness and dark urine are call-now problems.
• Tell your prescriber you are doing this program. Lifting plus a protein target is exactly what clinicians want alongside these medicines. It is a good conversation, not a confession.

B. Vegetarian and vegan

You can hit these numbers. At matched protein, plant eaters gained the same muscle and strength from lifting as omnivores [44]. Per gram, plant proteins are a little less effective, so the fix is to aim higher and choose well.

• Aim for the top of your range.
• Soy is the workhorse: tofu, tempeh, edamame, soy milk. Whey and soy are the highest-quality proteins on the score dietitians use; pea is close; wheat, rice and oats are lower [45].
• Lentils, beans and chickpeas at most meals. A pea or blended plant powder (pea plus rice, or soy) is a reasonable fourth meal.
• Vegetarians: Greek yogurt, cottage cheese and eggs make 30 grams easy.
• Vegans: check vitamin B12 and consider creatine; plant eaters carry the lowest stores [51].

C. Kidney disease, or reduced kidney function

The protein number on this site is the rule for healthy adults, where high intakes have been studied and found safe [39]. With chronic kidney disease the guidance is different and lower, about 0.8 g/kg, with intakes above 1.3 g/kg avoided [41]. Your nephrologist sets your number. Take this site to that appointment. The plate habit, the sleep, the walking and the lifting are still yours. Skip creatine.

D. Diabetes on insulin, a sulfonylurea, or a meglitinide

Eating less carbohydrate, which the plate habit and the swaps do, lowers blood sugar. On these medicines that can mean lows unless the doses change. Talk to your prescriber before week 3. Treat shakiness, sweating, confusion or dizziness as a check-your-sugar event. Keep carbohydrate consistent from day to day rather than swinging, and keep protein and vegetables first on the fork; eating them before the starch blunts the after-meal rise [74]. Low-carbohydrate eating has real evidence for diabetes remission at six months [69]; it is a legitimate route here, with your doctor adjusting the medicine as you go.

E. After a joint replacement, or before one

• Protein at the top of your range in the weeks before and after surgery. Your surgical team's instructions win over anything here.
• Do not crash-diet before surgery. If weight needs to come down first, slow loss with protein and lifting, coordinated with the team.
• Constipation with pain medicine: fiber, water, walking, psyllium.
• Rehab first. Your therapy plan comes before anything in Unlock Strong; ask before you add to it.
• For a sore knee that is not being replaced yet: each pound lost takes about four pounds of load off the joint with every step, and losing 10% of body weight gave the biggest pain relief in the trials [85] [86].

F. A history of an eating disorder

Dietary restraint and daily numbers are the strongest predictors of relapse, so your plan leaves off the calorie ballpark and the daily weigh-in on purpose. What is safe and useful: protein at every meal, half the plate plants, real food most of the time, sleep, and lifting. Please loop in whoever treated you before starting, and if any part of this program starts to feel like the old rules, stop and talk to them.

G. After bariatric surgery

Your surgical team's protein target and supplement list win. Most programs set 60 to 80 g of protein a day with lifelong vitamins, and set protein per kilogram of ideal weight, the same basis we use [54]. Use this site for the habits, the plate and the challenges, not for the numbers.

H. Pregnant or breastfeeding

The protein and plate habits are good for you. The fat-loss plan is not for now; use Hold steady. Skip creatine and any supplement not cleared by your obstetric team.

I. Heart failure or a fluid restriction

Skip the water-before-meals habit and follow the limit your cardiologist gave you. Sodium under 1,500 mg matters more for you than for most; cooking at home does the work [80].

Every overlay ends with the same rule: modifications are for familiar, nuisance-level situations. New symptoms that are severe, worsening week over week, or frightening are a see-your-doctor problem, not a modify-your-plan problem.