What happens when medications that suppress appetite meet a holiday centered on eating?
Twelve percent of Americans report having used weight-loss drugs like Ozempic.1 Originally developed to treat diabetes, these medicines help to control blood sugar and promote weight loss by slowing gastric emptying and reducing appetite, helping people feel full sooner and for longer. The medicines improve blood pressure and cholesterol and can reduce the risk of major cardiovascular events.
For some, continuing weight-loss medication over Pesach is a relief. These medications quiet the “food noise” that can make Pesach feel overwhelming. Food becomes less tempting; small portions become sufficient.
Others prefer to pause the medications in order to enjoy traditional holiday foods. This both restores their appetites and allows them to avoid the gastrointestinal discomfort that the medicines cause people who eat larger portions or rich meals. Another concern is being able to fulfill the mitzvot of the Seder, as these medicines can make it difficult to consume the minimum shiurim required for wine or matzah, let alone the larger, preferred quantities of these mitzvot, without discomfort. Mishnah Berurah (476:6) writes that one who eats the afikomen while so full that the food becomes repulsive fails to fulfill the mitzvah.
Is temporarily stopping the medication safe? For diabetics, even short-term discontinuation can be dangerous; it can impair blood glucose control and increase the risk of hyperglycemia. For people taking medications just for obesity, one expert believes that the risks of a pause of up to two weeks are limited, but the issue needs more study.2
So, should someone pause the medication so as to facilitate mitzvah observance at the Seder? And what about doing so in order to observe the mitzvot at the highest level?
To answer these questions, I consulted Rabbi Yosef Zvi Rimon and Rabbi Professor Avraham Steinberg. According to Rabbi Rimon, diabetics should not discontinue the medication. Those taking it for obesity alone should continue if they can fulfill the minimum shiurim (measurements). According to Rabbi Rimon, the minimum shiurim are at least half of a matzah for achilat matzah, one-third of a matzah for korech and afikomen, and melo lugmav for each of the four cups. And one may use grape juice lechatchilah for the four cups (wine represents a hiddur—a preferred fulfillment of the mitzvah).3 (One should ask their rabbi or see the OU Guide to Pesach for what minimum shiurim they should adhere to: https://oukosher.org/passover/download-passover-guide-signup/.) Those who cannot fulfill the preferred shiurim should continue the medication and settle for the minimum amounts. This approach reflects the lack of data establishing the safety of pausing the medicine, and the fact that venishmartem (the obligation to promote health) is biblical. The minimum shiurim are also biblical; fulfilling the mitzvot with the larger amounts is rabbinic, but a rabbinic obligation does not override a biblical obligation, especially at a potential risk to one’s health.4
Rabbi Steinberg believes that if a pause poses little risk for those who take the medicine for obesity alone, they should stop in order to eat the larger amounts at the Seder. Even if doing this leads to some weight gain, the break does not meet the halachic threshold of sakanah (danger), and resuming the medicine should correct the situation. However, if discontinuing it could worsen a diabetic’s glycemic control, he may rely on the minimal required amounts.5 Given the variability in individual tolerance to weight-loss medications and their side effects, those concerned about fulfilling the Seder mitzvot should consult with their physicians and halachic authorities to develop a personalized, informed plan for navigating the Seder.
Especially for those who continue the medication, experts recommend enjoying limited portions of holiday foods and not eating past the point of fullness. Spiritual engagement, mindful eating, walks with family, and time with people we love can make Pesach meaningful, enjoyable and healthy for everyone. Those who pause should remember that one week is unlikely to undo a year’s worth of healthy habits. The challenge is to approach food with balance and intention, preserving our health and the meaning and joy of the holiday.
Pesach food does more than sustain us; it creates a spiritual connection. As Rabbi Joseph B. Soloveitchik explains, “Matzah symbolizes the trust . . . that the Jews placed in G-d on that night in Egypt. Matzah represents an act of . . . unconditional commitment to G-d . . . .”6
On this Festival of Freedom, we must remember that we were freed from slavery to serve G-d. Each person must decide how best to do this; for some, continuing weight-loss medications creates a sense of freedom in their relationship with eating, while others might choose to pause the medications.
As we celebrate Pesach, may we merit to be masters of our bodies—thoughtful about what we put into them and how we care for them—in order to preserve our health and live as free people, servants of the Holy One, as the Torah teaches (Vayikra 25:55): “My servants and not servants to servants.”
Notes
1. https://www.kff.org/public-opinion/poll-1-in-8-adults-say-they-are-currently-taking-a-glp-1-drug-for-weight-loss-diabetes-or-another-condition-even-as-half-say-the-drugs-are-difficult-to-afford.
2. Personal communication with Jody Dushay, MD, MMSC, assistant professor of medicine at Harvard Medical School and attending physician in the Division of Endocrinology and Metabolism at Beth Israel Deaconess Medical Center, March 2026.
3. Regarding Rabbi Rimon’s shiurim, a person who is uncertain whether he can eat this amount for the afikomen may rely on the opinion of the Ba’al Hachinuch and eat less.
4. Personal communication with Rabbi Yosef Zvi Rimon, March 2026.
5. Personal communication with Rabbi Professor Avraham Steinberg, March 2026.
6. Joseph B. Soloveitchik, Festival of Freedom: Essays on Pesah and the Haggadah (New York: Ktav Publishing House, 2006), 63–66.
Sharon Grossman, MD, MPH, is a Harvard-trained radiation oncologist with a master’s degree in Public Health. She is the author of a forthcoming book, The Cure before the Illness: Disease Prevention in Jewish Law (Maggid Books), written through the Kitvuni fellowship at Matan.