It’s impossible to scroll through social media or watch TV without seeing ads for a glucagon-like peptide-1, better known by the acronym GLP-1. Sold under brand names like Ozempic® and Wegovy®, these medications mimic a natural gut hormone that boosts insulin release, slows digestion, and curbs appetite.
Originally developed to treat type 2 diabetes, GLP-1s are now widely prescribed for weight loss. But GLP-1s have also ushered in an era of thinness-chasing, with doctors raising concerns about rapid muscle loss while on the medication and potential misuse by people with eating disorders.
Rough Draft Atlanta spoke to two area physicians on how GLP-1s work, why strength training and other lifestyle habits can support successful results, and who should take these drugs – or avoid them altogether.
What is a GLP-1?
According to board-certified physician Sharon Bergquist, M.D., GLP-1 is a hormone the body produces naturally. Released when people eat, it lowers blood sugar, boosts insulin production, slows digestion, and signals feelings of fullness to the brain.
While naturally-occurring GLP-1 survives in the bloodstream for only a few minutes, GLP-1 medications produce the same effects for several hours, or even days.
“These medications work on the brain itself, which actually leads to decreased cravings and appetite, so people aren’t as hungry or thinking about food all the time,” said Alicia Shelly, M.D., a specialist in internal and obesity medicine at Wellstar.
This is particularly helpful for people who experience “food noise,” or persistent, intrusive thoughts about food, Shelly explained. GLP-1s can also be useful for people in perimenopause and menopause, as the drugs can help reduce insulin levels, allowing the body to burn fat instead of storing it.
Supporting medications with lifestyle changes
With the “Ozempic chic” look seemingly fashionable among celebrities and social media influencers, Shelly is finding that many people are turning to GLP-1s for a quick fix.
“A common misconception is that a GLP-1 is a magic pill,” Shelly said. “I’ve actually had patients who gained weight because they were emotionally eating. We had to tackle the stress management part so that we could see the benefit of the GLP-1.”
Bergquist said GLP-1s work best when incorporated alongside lifestyle habits like regular exercise and a healthy diet.
“They are an incredibly powerful tool in the toolkit for developing and maintaining good habits, but [GLP-1s] work best when they support, rather than replace, the habits that build long-term health,” Bergquist cautioned.
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Strength training
One of the best ways to build long-term health is to strength train.
According to Bergquist, 20-38% of all weight lost on GLP-1s is lean body mass, or muscle and bone. This loss is especially risky for post-menopausal people and adults over the age of 65.
“After menopause, the loss of estrogen accelerates muscle and bone loss, and adults over age 65 are already losing about 1–2% of their muscle mass each year as part of normal aging,” said Bergquist.
As people age, muscles become less responsive to exercise and dietary protein. So additional muscle loss due to taking a GLP-1 can increase risk for falls, fractures, and other complications.
Bergquist and Shelly both recommend that adults using these medications do structured resistance training two to three days a week, in addition to 150 minutes of weekly cardiovascular activity.
Increasing protein intake to up to 1.3 grams per kilogram of body weight per day can also help prevent muscle loss. So can getting adequate sleep and managing daily stress, whether that’s through meditation, talk therapy, journaling, or deep breathing exercises.
Risks and precautions
GLP-1s have become a successful tools for many people struggling with weight management and chronic conditions such as diabetes. But they’re not appropriate for everyone.
Shelly and Bergquist stress that people with thyroid cancers, pancreatitis, several gastrointestinal disorders, gallbladder disease, or who are actively breastfeeding or pregnant should avoid these medications altogether due to potential complications. And because these drugs suppress appetite and can cause rapid weight loss, GLP-1s can be dangerous for people with eating disorders.
Bergquist advises against using a GLP-1 for anyone with active anorexia or bulimia nervosa, as the medications may exacerbate restrictive eating behaviors. However, for people with a history of binge eating disorders or food preoccupation, a GLP-1 can help reduce hunger and manage cravings, especially if used in consultation with a qualified physician and professional support from psychologists and nutritionists.
“Don’t listen to social media. Don’t let someone else’s experience persuade you one way or another when it comes to your medical care,” said Shelly. “Always talk to your doctor about what might work for you.”
“GLP-1 medications don’t replace healthy habits, but they help people overcome some of the biological barriers that make healthy habits difficult to sustain,” said Bergquist.
Disclaimer: Because GLP-1s can suppress appetite and cause rapid weight loss, patients with a history of disordered eating should carefully consult with a doctor, therapist, and/or dietitian before starting these medications.
