Doctors used to tell me, “Most people aren’t interested in changing their habits. They’re searching for a magic pill!”

Now, we actually have it. We have this so-called magic pill in the form of GLP-1s.

GLP-1 drugs have emerged as a revolutionary tool in the realm of weight management and fitness. Their ability to regulate appetite and improve metabolic function has positioned them as a potential game-changer for individuals pursuing a healthier lifestyle. However, their popularity also prompts critical discussions about their suitability, potential risks, and the role they should play in a comprehensive health strategy.

Today, I want to talk about them—all about them. I want to pull back the veil, debunk some myths, and show everyone how we can help them at BFP whether they are using a GLP-1 or not.

The truth is this: GLP-1s are here to stay. More people are using them than you think, and if you are working with a coach who is “against them” or doesn’t understand their risks and benefits, then you probably aren’t working with the right coach. It’s our job to understand innovations like this when they come along. It’s the literal magic pill that everyone has been searching for.

No matter how much that goes against our nature as coaches, we can either “help first” or remain ignorant and pretend they will go away. So, let’s dive in.

What are they?

GLP-1 RA: Glucagon-like peptide-1 receptor agonists

The most popular GLP-1s for weight loss are semaglutide, tirzepatide, and liraglutide. You may know them under the names Wegovy, Zepbound, and Saxenda.

Overview of GLP-1 Drugs

GLP-1 drugs were originally created to help people with type 2 diabetes manage their blood sugar. The combined effects not only improve blood sugar levels but also help with weight loss by making people feel full and eat less.

How They Work

GLP-1 drugs target specific receptors in the body, including receptors in the brain and pancreas. When these receptors are activated, they help control appetite. These drugs also aid slowing down how fast your stomach empties. Basically, you generally feel full and satisfied and aren’t hungry.

How Effective Are They?

Two common GLP-1 drugs, liraglutide and semaglutide, are approved for weight management. Studies have shown that they can help both diabetic and non-diabetic individuals lose a significant amount of weight. Semaglutide, in particular, has been especially promising in ongoing research.

Are They Safe?

GLP-1 drugs are generally safe, though some people experience mild side effects like nausea or diarrhea, which often go away over time. They are generally considered safe for long term use but there are some studies that show mixed results. We really don't have a lot of long term data when being used for weight loss.

As of June 2024, it’s estimated that over 12% of US adults have used a GLP-1 to aid in weight loss.

Weight loss associated with GLP-1 agonists like semaglutide can lead to significant improvements in various health parameters. Clinical trials have shown that semaglutide, or Wegovy, can result in substantial weight loss when used as a supplement to lifestyle modifications.

The benefits of weight loss with GLP-1 agonists are the same as benefits without taking the medication:

Reduction in body weight: Semaglutide has been shown to lead to clinically significant weight loss in overweight or obese individuals.

Improved glycemic control: GLP-1 agonists can help improve hyperglycemia (high blood sugar) and insulin sensitivity (your ability to lower blood sugar when needed).

Cardio-metabolic protection: Weight loss with GLP-1 agonists may contribute to better cardiovascular and metabolic health.

Renal protection: GLP-1 agonists may have a positive impact on renal function and protection. This is observed mostly in diabetic folks.

Sustained weight loss: GLP-1 agonists like semaglutide have demonstrated the ability to maintain weight loss over time, leading to long-lasting benefits like the ones above.

The important thing to understand in all of this is that the benefits are coming from weight loss. Not the drug specifically. The drug is helping with weight loss or actually, causing it. But the benefits are from the weight loss. I make this point because although I am sharing the benefits, I want to make clear that the same benefits can be had from traditional weight loss measures including exercise and more importantly, solid nutrition habits, managing stress (because it’s always present), and being as active as possible all day outside of exercise.

Side Effects?

Semaglutide, can lead to certain side effects, with gastrointestinal issues being the most commonly reported adverse events. These side effects are generally temporary, mild to moderate in severity, and tend to improve over time. The most frequently reported side effects associated with semaglutide include nausea, diarrhea, vomiting, and decreased appetite. Additionally, some participants may experience hypoglycemia, which was reported in a small percentage of patients at different dosage levels.

Long-term use of GLP-1 agonists like semaglutide may pose certain risks and considerations. While these medications have shown significant benefits in weight loss and glycemic control, there are potential risks associated with their prolonged use. Some of the risks and considerations include:

Pancreatitis: There have been concerns about the association between GLP-1 agonists and pancreatitis. However, recent meta-analyses have not shown a substantial increase in the risk of pancreatitis with GLP-1 agonist use.

Cardiovascular outcomes: GLP-1 agonists have been linked to cardiovascular benefits in some studies, but long-term effects on cardiovascular health require further investigation. There is one study where heart muscle was shown to shrink in both mice and human cells but, it’s important to note that that was in cells, not in actual human or mice subjects.

Cholelithiasis: GLP-1 agonists may have a slight increase in the risk of cholelithiasis, which is the formation of gallstones. However, the risk is not significantly elevated based on available data.

Renal safety: Long-term effects on renal function and safety with prolonged use of GLP-1 agonists need to be monitored and studied further.

Weight loss sustainability: While GLP-1 agonists can lead to significant weight loss, the sustainability of this weight loss over the long term and its impact on overall health need to be evaluated.

Immunogenicity: There may be concerns about the potential immunogenicity of GLP-1 agonists with extended use, which could impact their efficacy and safety. Basically if they trigger an immune response or not.

Muscle Loss and A GLP-1:

There are varying reported effects of GLP-1-based therapies on lean mass changes in clinical trials: in some studies, reductions in lean mass range between 40% and 60% as a proportion of total weight lost, while other studies show lean mass reductions of approximately 15% or less of total weight lost.

It’s also important to note in some of the research mentioned, changes in lean mass may not always reflect changes in muscle mass as the first measure includes not only muscle but also organs, bone, fluids, and water in fat tissue.

It seems that the muscle loss that comes along with the GLP-1 is generally with what is expected given ageing, disease status, and weight loss achieved. This can be stopped, slowed, and you can even gain muscle while on a GLP-1 if your nutrition is in check and your are performing regular strength training.

Stopping GLP-1 Drugs: What Happens Next

When non-diabetic individuals stop taking GLP-1 drugs like semaglutide, a few things can happen. First, there’s the possibility of gaining back some or all of the weight they lost while on the medication. GLP-1 drugs work by reducing hunger and helping you feel full, so without them, it’s easy to return to old eating habits.

These medications also help regulate things like blood sugar levels and insulin sensitivity. When you stop taking them, your body might take some time to adjust, and you might notice changes in your energy or metabolism.

Some people also notice their appetite changes after stopping GLP-1 drugs. The medication influences signals in the brain that control hunger, so those signals might feel different without it. On the upside, any gastrointestinal side effects you experienced while on the medication, like nausea or diarrhea, are likely to go away once you stop.

So, What To Do About GLP-1s If You Are On One?

Start strength training now. This is important for everyone, all the time. Not just folks taking a GLP-1. Aim for 2-3 full body sessions per week. More can be better if you go after it the right way but, you don’t have to.

You are losing weight, improving insulin sensitivity, and you have more energy. This is great! But, having more energy and not strength training is like being a hyper dog in a cage. You’ll have all this energy but you won’t be able to do anything with it. Maybe not right away, but as you age, you’ll notice things change. As they do with folks not on a GLP-1 who do not strength train as well. The difference with someone on a GLP-1 and someone who is not is that folks on the GLP-1 lose weight pretty rapidly. Someone who loses weight slowly may be able to slow the rate of muscle loss as they will generally be bringing in more food. Losing weight rapidly tends to lead to more lean mass and muscle loss.

At BFP, we can help with this. We have several clients who strength train with us while using a GLP-1. We can say definitively that the folks we work with on a GLP-1 who strength train with us not only stop losing muscle, but many actually gain muscle. How do we know? We have a highly accurate machine called the Inbody 380. It tells us exactly how many pounds of muscle mass and pounds of fat mass an individual has. We make sure to have them hop once a month.

What About Nutrition?

This is probably the most important part while taking a GLP-1. Not just the amount of food as most don’t eat much when taking a GLP-1. More importantly, your habits, thoughts, and views surrounding food while on a GLP-1.

The most common thing I’ve seen with folks who stop taking GLP-1s is that they state they are “hungry all the time” and they have a sort of fear of eating. They are scared to gain the weight back. They have lost weight, but their relationship with food hasn’t improved. Many of them still see food as something that impedes or gets in the way of their goals. Rightfully so since this person may have spent the last several months not eating more than a few snacks a day because the medication keeps them from feeling hungry.

To help with this, you need the guidance of an educated Nutrition Coach who can help you while you are on the GLP-1 so that when you come off of it, you are less likely to have that fear, you are prepared for the “hungry all the time” feeling, and you have someone there to support you through it all.

A nutrition coach can also help hold you accountable to eating well while on a GLP-1. Not just “eat your veggies and protein” but also making sure your eating is a habit so that you can maintain that habit over time. A coach can work with you utilizing a holistic approach. Focusing on things like stress, sleep, water and others. We do this because each one affects appetite and your relationship with food. We want you to have a healthy relationship with food forever. Not just avoid it while on the medication so that you can gain all the weight back after you stop taking it. Again, so when you stop taking the GLP-1, you’ll have a regular habit of eating at specific times and you’ll continue to do so as you work to get your hunger hormones back on track.

Quick Tip: If you are on a GLP-1 and not sure how to eat when you aren’t hungry, try to eat as you would off the medication. Not necessarily the same amount but, try to eat 2 to 3 times per day or more depending on your schedule.

At the bare minimum, have a snack at what are your normal meal times. If you can eat a meal, do it in balance.

Have half the plate with veggies, ¼ protein and ¼ non-starchy carbs. Make sure you get some fats as well whether through salad dressing, the protein, or potentially a small amount of avocado or nuts. This is known as “The Plate Method” and it’s worked for 100s of our clients.

Not only will it help you have a healthy relationship with food but it also teaches you how to balance your nutrients. When we take this balanced approach, we don't miss anything. This means things in our body are more likely to work the way they are supposed to work.

Use the same method for snacks.

As with all medical advice, please discuss with your doctor. If you plan to take a GLP-1, seek out a doctor that can point you in the right direction of a habit program with accountability (some have them in house while others partner with us). As far as living your healthiest life possible whether on a GLP-1 or not, give BFP a shot. Schedule your No Sweat Intro by filling out the contact form on the website. We will reach out to get you scheduled asap.

References:

Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. Jensen, Simon Birk Kjær et al. eClinicalMedicine, Volume 69, 102475

Neeland IJ, Linge J, Birkenfeld AL. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obes Metab. 2024 Sep;26 Suppl 4:16-27. doi: 10.1111/dom.15728. Epub 2024 Jun 27. PMID: 38937282.

Abdullah Bin Ahmed I. A Comprehensive Review on Weight Gain following Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists for Obesity. J Obes. 2024 May 10;2024:8056440. doi: 10.1155/2024/8056440. PMID: 38765635; PMCID: PMC11101251.