GLP-1’s and Weight Loss: 3 Surprising Facts
My Experience with Coaching GLP-1’s and Weight Loss
It may come as a surprise that – for all my years of coaching lifestyle change and sustainable fitness and nutrition – I have been an advocate of semaglutide (commonly called “GLP-1’s” or “weight loss medications) since it began to be prescribed for weight loss in 2021.
I don’t prescribe them, since I can’t, and I don’t do any kind of affiliate marketing, because I would have ethical issues with the conflict of interest. I also don’t use them personally, and I don’t think they’re appropriate for everyone. But for the last 5 years or so, I have supported some clients in enlarging their arsenal of lifestyles tools to include GLP-1’s, and I think they’re extremely effective and have remarkably few side effects in terms of what they can accomplish.
Currently, about 10% of my clients use a GLP-1 medication for weight loss. GLP-1’s are not antithetical to lifestyle change – they can be part of lifestyle change. I personally know many people who continue to think that GLP-1’s are a shortcut, and while I respect their viewpoints, I disagree.
The truth is that GLP-1’s do not replace a healthy lifestyle – instead, they often provide the “tipping point” that help people stick with sustainable healthy habits. GLP-1’s and weight loss can go hand-in-hand with improved lifestyle management.
But before we talk more about surprising facts about GLP-1’s and weight loss, let’s review how they actually work (and this section may hold some surprises, as well!).
GLP-1’s and Weight Loss: Why and How They Work
Improving insulin sensitivity
You may have noticed that there are many different types of weight loss medications. This is partly because most of the medications exist under one name to treat Type 2 Diabetes, and under another name to target weight loss. For example, Wegovy is the weight loss medication, and Ozempic is the Diabetes medication (same for Zepbound and Mounjaro, respectively).
This has to do with the history of GLP-1’s and weight loss – although now they are widely seen as “weight loss drugs,” they were initially recognized for their ability to increase insulin secretion and improve blood sugar control, which – obviously – leads to many other cardiovascular health benefits.
The pancreas naturally releases insulin when we eat, which helps cells to “open the door” to receive glucose (from a recent meal) out of your bloodstream and into energy production.
But if you have insulin resistance, your blood glucose stays too high because your cells are not responding to insulin’s messaging, and – basically – the door stays shut. The blood glucose has nowhere to go. Chronically elevated blood glucose is, long story short, what leads to Type 2 Diabetes.
Insulin resistance and its opposite, insulin sensitivity, have a bi-directional relationship with weight. If your body fat is high (particularly around your abdomen), this tends to decrease insulin sensitivity and encourage a hormonal state of insulin resistance.
Once you are struggling with insulin resistance, it can be very hard to turn things around and lose weight and thereby improve your insulin sensitivity. It becomes a vicious loop.
There are natural things you can do to improve insulin sensitivity, like exercise. There are also natural things you can to lower your blood glucose, like eating a lower carbohydrate diet.
But this is where a medication like a GLP-1 can be a game changer, because it provides a powerful intervention, hormonally changing how your body is producing and processing insulin. GLP-1’s and weight loss both dramatically improve insulin sensitivity.
When your insulin sensitivity is better, weight loss is easier. This is a huge reason why GLP-1’s are effective for both Type 2 Diabetes treatment and weight management.
Slowing gastric emptying
Another powerful aspect of GLP-1’s and weight loss is slower “gastric emptying” – essentially, your stomach digests food more gradually, which literally makes you feel fuller faster (and longer).
Since appetite control tends to be a major issue for people who struggle with weight loss, this feature helps to dramatically reduce food intake. If someone has been generally overeating, this can help to consolidate eating into appropriately-portioned meals with less hunger overall.
Anecdotally, my clients who are using GLP-1’s report that they still feel hungry before meals. It’s not that appetite entirely goes away. Instead, the slower digestion process helps users to fill up faster and stay fuller longer.
However, this benefit of semaglutide can also be a “bug” for some people. The slowed gastric emptying can be responsible for many of the side effects that people experience when they first start a GLP-1 – nausea, vomiting, bloating, heartburn, etc.
For people with pre-existing acid reflux, it’s possible that GLP-1’s are not a good fit. However, for many people, side effects are minimal and temporary, and can also be mitigated by lifestyle changes like reducing dietary fat intake and increasing fiber intake (along with water intake).
Changing the reward system in the brain
Our behaviors – including eating behaviors – are deeply connected to our brain’s memory, reward, and motivation system. Bad habits – and particularly addictions – can be thought of as this circuitry getting hijacked to the point that self-harming activities get scrambled with survival needs.
When it comes to food, most people know what to do to eat more healthfully, but many people have trouble putting these behaviors into action consistently. Some of these people are getting repeatedly tripped up by this reward system in the brain, beyond what is “average” for healthy lifestyle struggles.
When I am onboarding clients who are reporting long-term, profound battles with weight, this is where I might pose the question: “Is there a reason you haven’t considered a GLP-1?” Sometimes, something is happening in the brain that is not being helped by repeated “traditional” attempts at weight loss.
GLP-1’s and weight loss affect more than just insulin – medications like Wegovy and Zepbound also directly affects the “reward system” in the brain.
Taking a GLP-1 can make hyperpalatable foods seem a little less compelling – this is what has been described as the reduction of “food noise.” Essentially, GLP-1’s turn down the volume on your brain’s cravings and attention to food. This is why GLP-1’s and weight loss are so connected, despite their initial focus on Type 2 Diabetes.
I have found this to be incredibly helpful for clients who have struggled for decades with their weight – instead of having to rigidly control their life to manage their cravings, they have massive amounts of mental and emotional energy liberated to focus on other things (like work, relationships, self-development, etc.).
Requiring long-term use
Finally, an important aspect of GLP-1’s and weight loss is that it is likely long-term (at some dose) for most people who use them therapeutically. It’s not as though you take a GLP-1 to get to your goal weight and then – problem solved – you stop taking them and everything’s fine.
It’s been shown that cessation of GLP-1 usage typically results in returns to baseline – i.e., weight regain. They don’t “fix” you – they provide benefits while you’re taking them.
This is largely why I don’t see GLP-1’s as a replacement for a healthy lifestyle. For many people, GLP-1’s are costly and not covered by insurance. To have some kind of “exit plan” (even if it’s a lower maintenance dose that is more affordable), exercise is crucial for weight loss maintenance.
For my clients who are currently using GLP-1’s for weight loss, I coach them to see weight loss medications as part of their “portfolio” in their health – it shouldn’t be 100% of their investment. Instead, I encourage them to diversify their efforts between a reasonable GLP-1 dosage, consistent exercise (with enough intensity), and an overall dietary pattern that emphasizes blood sugar control. The GLP-1 is not the panacea – it’s simply what makes it all “click.”
GLP-1’s and Weight Loss: 3 Surprising Facts
Up to speed on how GLP-1’s and weight loss? Now, let’s dive in to three facts about GLP-1’s that I think lead to the most misunderstandings/myths.
GLP-1 weight loss is regular weight loss
I don’t know how else to say this – GLP-1’s do not cause a magical vortex of weight loss. Yes, they improve insulin sensitivity. Yes, they slow gastric emptying. Yes, they reduce the attractiveness of high-calorie foods to the brain. But the actual weight loss that they cause is no different than the weight loss that results from a restricted-calorie diet.
In other words, you would experience the exact same weight loss if you could – hypothetically – restrict yourself to an 800-1400 calorie diet for more than a year. Most people who take Ozempic or Wegovy or Zepbound don’t lose more than 20% of their bodyweight. That means that if you weigh 200 pounds, you’re likely to lose 40 pounds – not 80 or 100.
GLP-1’s and weight loss are not a magical journey – the medications produce the same gradual weight loss that dieting does.
As part of this discussion, I want to put to bed the many related myths that have sprung up around weight loss medications, such as the persistent message that GLP-1’s cause muscle loss. It’s not the weight loss medication – it’s the weight loss!
If you could manage to eat a low-calorie diet consistently for a year and lose 20% of your bodyweight, you would lose muscle mass along with fat. This is a natural part of weight loss… unless you intervene.
The intervention for this is regular, challenging strength training. When people lose weight (whether with a GLP-1 or without it), strength training helps to prevent lean mass loss, along with eating a high-protein diet. The “stress” of strength training sends key messages to the metabolism and brain, signaling for more muscle remodeling and maintenance.
This is key for GLP-1’s and weight loss – you have to jump in front of the potential losses in muscle and bone by giving your body the challenge of hard workouts.
The weight loss trajectory of one of my clients using a GLP-1… she had already lost about 20 pounds by the time we started working together, and the strength training has helped significantly with her body composition.
GLP-1’s and weight loss are not doing something specifically unique to the tissues of the body, whether we’re talking about muscle or the face. Instead, what is novel is that people are successfully losing large amounts of weight, which we’re not used to seeing in a mainstream way.
Strength training, eating a higher-protein diet, and being on a reasonable dose of a GLP-1 (instead of a “crash diet” dose) can help tremendously in mitigating these kinds of body changes as part of weight loss.
This is a side note, but I have also seen and heard so many people – including people I know personally – remark on “Ozempic face” or something similar. I hate to say it, but much of what is seen as changes in appearance is simply fat loss, which doesn’t always look good on the face. Or, at the very least, it can be surprising.
This is particularly true if someone is older – with less fat and collagen in their facial tissue, their appearance can change dramatically when they lose weight.
GLP-1’s can help with addictions
I touched on this a bit earlier, but one of the unexpected horizons of GLP-1 research is how they affect the reward center of the brain, and what this means for other addictions beyond binge eating (like alcohol, smoking, or other substances of abuse).
Obviously, this is an exciting and very new field of research – and one that is not in my scope of practice! But an important part of the research to consider is that a GLP-1 may quiet the addictive impulse, but it doesn’t treat the underlying emotional / psychological state that was using a self-soothing strategy to cope.
In other words, if you start a GLP-1 and you’re not already connected to a mental health professional, it might be worth adding someone to your team as part of the process of embarking on a GLP-1’s and weight loss journey.
The research is mixed on whether GLP-1’s and weight loss improve anxiety/depression or worsen it, but it’s important to know that there might be psychological repercussions to decreasing the use of a coping mechanism.
A weight loss medication is not a panacea, and reducing the motivation for hedonic eating may reveal other things that were getting covered up by a preoccupation with food and weight.
Yes, you can lose weight too fast with a GLP-1
For me, this comes under the category of sustainability, as well as personalization.
Remember, GLP-1 weight loss is just like regular weight loss.
If your diet is too low in calories for you for a prolonged period of time, you may get “good results” (especially initially), but you might struggle more with negative side effects like muscle loss, “low energy availability” (i.e., literally not having enough fuel in your body for both exercise and normal function), hair loss, bone density issues, menstrual disruptions, etc.
Often, this comes down to dosing. I encourage all of my clients to work with their own personal physician as part of their GLP-1 journey, so that health can be more closely monitored and dosing can be adjusted based on results.
It’s also helpful to consider working with a dietitian to establish proper meal and calorie goals. This is something I do with my clients for GLP-1’s and weight loss – we pay attention to meal size and macro distribution to make sure that they’re not undereating as part of their exercise plan.
This can be incredibly counterintuitive after years of unsuccessful dieting, but it’s important to remember that weight loss medications are powerful prescription drugs. They have a profound effect on appetite, insulin, and the reward centers in the brain, and this can dramatically change how you eat – and it is possible to not eat enough and to have negative consequences over time.
Another one of my clients, exhibiting healthy, gradual weight loss with a GLP-1 and intentional meal planning to maximize protein and fiber
So… Do I Recommend Them?
I don’t technically recommend them because I am not a physician! But I support my clients who use them. And, as I said before, with a few of my clients, I have actually asked, “Is there a reason you’re not considering a GLP-1?”
I think they add something important to the conversation of weight loss.
Something that I particularly like about them is that they often separate exercise from weight loss. Some of my clients who are using GLP-1’s now have a better relationship not only with food, but with exercise as well, because they’re not in a love-hate relationship with exercise as a moderator of weight. Instead, they see exercise as something they do to be strong, healthy, and self-caring. GLP-1’s and weight loss can be an incredibly positive conversation – not a “giving up.”
Some people are rigidly anti-weight loss medications, and there is a narrative about “natural” being better. In fact, for pretty much every one of my clients who now uses a GLP-1, it took years to overcome that internal voice – the one that told them they were “cheating” if they used a weight loss medication. There continues to be a persistent cultural narrative that f you can’t do it “naturally” with diet, exercise, and willpower, that you are taking some kind of unhealthy shortcut.
While the long-term nature of GLP-1’s and weight loss is something to be considered (in terms of cost, dosage, management, etc.), there’s no doubt that its availability is a huge asset for anyone who has struggled with their weight for decades. I am serious about public health, and 2025 was the first year that obesity rates actually decreased instead of increased in the United States. For any health professional, I think that’s something worth paying attention to.
So I keep GLP-1’s and weight loss in the conversation, because they’re important. And if I don’t talk about them with clients, they’ll go elsewhere for the information. That being said, I focus on where GLP-1’s and weight loss overlap with fitness, nutrition, and long-term habit management – I’m not a physician, and in fact I recommend that clients do not get GLP-1’s without their GP.
If you’re considering a weight loss medication – or you’re taking one and want to build muscle, avoid bone loss, and create an ideal diet – reach out to set up a 30-minute consultation. It’s free, it’s easy, and I would love to chat!
References for GLP-1’s and Weight Loss
Your Brain on GLP-1’s: What We’re Learning About the Mental Side
Psychiatric effects of GLP‐1 receptor agonists: A systematic review of emerging evidence
A new era of weight loss: Mental health effects of GLP-1 drugs
A brain reward circuit inhibited by next-generation weight-loss drugs in mice
Do GLP-1 Receptor Agonists Alter Brain Responses to Reward-Related Cues? A Systematic Review
Ozempic may have revealed the brain’s hidden “craving center”
The GLP-1 journey: from discovery science to therapeutic impact
Insulin Resistance and Weight Management
Study shows liraglutide results in increased insulin sensitivity independent of weight loss
How does Ozempic work? Understanding GLP-1s for diabetes, weight loss, and beyond
Weight drugs are bringing down down the country’s obesity rate, a survey shows
