In my 32-year career as a health fitness professional, I’ve never seen anything change the world like GLP-1 receptor agonists have.

Semaglutide (Ozempic) and tirzeptide (Mounjarno) were originally approved by the FDA to treat type 2 diabetes. These drugs mimic natural hormones to increase insulin secretion, decrease glucagon release, and slow gastric emptying.

Metformin is the go-to drug for most folks with type 2 diabetes. Patients with kidney or liver disease can’t tolerate metformin. Also, metformin doesn’t always control blood sugar well enough, so the GLP-1 drugs are often added as a secondary drug to work in tandem with metformin. These new drugs have been lifesaving for people who need them to help control type 2 diabetes.

As doctors began to treat patients with these drugs, they noticed weight loss was an unexpected side effect. That’s because GLP-1’s slow down digestion by keeping food in the gut longer, which ultimately reduces appetite.

The drug companies quickly pushed the FDA to approve higher doses of these drugs as a treatment for obesity. It only makes sense that if a normal dose helps with some weight loss, a higher dose should help with more weight loss. In June 2021, the FDA approved Wegovy, the trade name for a higher dose of Ozempic, as treatment for obesity, marking the first time since 2014 the federal health authorities had given the green light to a new weight loss drug. In November 2023, Eli Lilly received FDA approval for tirzeptide as a treatment for obesity under the brand name Zepbound.

An overwhelming amount of people are now taking these drugs to help them lose weight. About one in eight adults (12%) say they have taken a GLP-1 drug at some point, while 6% are currently using them. People take these drugs because they work. In clinical trials, Zepbound achieved an average weight loss of 48 pounds with the highest dose. Wegovy achieved an average weight loss of 15% (about 35 pounds) over the course of a year.

What’s the Problem?

From my perspective, there’s a major problem with these drugs that no one seems to be talking about. It’s the excessive amount of muscle people are losing. I first noticed this about two years ago in the phone calls we were getting. Lots of people were calling saying “I’ve been on weight loss drugs, I’ve lost a lot of strength, and I need to do something to get it back.”

Most of the people I talk to are not as concerned about the muscle they’ve lost, but they are concerned about the decline in their ability to move and their lack of energy. In the past six months, the phone calls have been more concerning. I’ve spoken to two different people recently who lost so much strength from weight loss drugs that they could hardly get up out of a chair. I wish I was making this up—I’m not.

Muscle Loss/Weight Loss

Any time you lose weight, you don’t just lose fat. A good deal of the weight you lose is lean tissue, which includes muscle, bone, and organ tissue. The faster you lose weight, the higher the percentage of lean tissue you lose. If you want to lose more fat, you need to lose weight slowly. Anyone who’s ever had to lose weight for an athletic competition knows this. When you look at the numbers, losing 36 to 48 pounds over the course of a year is a relatively slow rate of weight loss. So, what’s going on?

A study published last fall confirmed what I’ve suspected all along. Lean tissue loss with GLP-1 drugs ranges from 25% to 39% of the total weight lost over 36-72 weeks. By comparison, weight loss from diet and exercise usually results in lean tissue loss of 10% to 30%. That’s a significant difference. If you’re taking GLP-1 receptor agonists to lose weight, you need to know that you’re going to lose a lot of muscle.

Muscle affects every aspect of your health in more ways than most of us really understand. Losing too much muscle will compromise your ability to walk, run, move, and lift heavy objects. The health of your immune system is ultimately determined by how much muscle you have. And nothing—no supplement, energy drink, or drug—will affect your energy levels the way muscle will.

If you don’t believe me or the study I just cited, just look around. People who lose weight on GLP-1 drugs look different than people who lose weight through good nutrition and exercise. The difference is in the amount of muscle they lose.

What Happens When You Stop Taking the Drugs?

Over a third of new GLP-1 users stop taking their medication within one year. And at this point, half the people who have taken GLP-1s no longer take them. Most people quit because of the side effects. GLP-1s slow gastric emptying, which means food stays in the gut a lot longer than it should. Instead of getting digested, food starts rotting in your gut. That’s why so many people experience nausea, vomiting, and diarrhea.

In the clinical trials for semaglutide, participants regained their weight when they stopped taking the drugs. If you decide to take these drugs, you will have to take them for the rest of your life if you want to maintain your weight loss.

Remember, GLP-1s control your hunger by making you feel full all the time. I’ve had clients tell me they couldn’t force themselves to eat much food because they weren’t hungry or they always felt full. As soon as you stop taking these drugs, the feeling of fullness goes away. Your body will start demanding you to eat, and you won’t be able to control it.

So far, there is no indication that weight loss can be maintained once someone stops taking these drugs or even goes on a lower dose.

What Happens When You Regain Lost Weight?

When you regain lost weight, you don’t gain back what you lost. You gain back more fat and less muscle, bone, and organ tissue. This creates a more concerning health issue.

We all lose fat-free mass as we age. Losing it by losing weight and gaining back more fat simply accelerates the aging process. The result for most people who go on and off weight loss drugs is a fatter and less muscular physique with weaker organs.

You also must keep in mind that the amount of muscle you have is what ultimately determines your metabolism. So, if you lose weight then regain it, you will have a lower metabolism and probably end up weighing more than you did before you lost the weight.

Strength Training is a Must

If you’re currently taking a GLP-1, hopefully you’re strength training to preserve muscle mass and stay strong. A hard 20-minute workout once a week can make it happen. We have quite a few clients who are taking GLP-1s and training with us to stay strong.

There Are Other Options

We’ve been helping our clients lose weight and keep it off long-term through our Simple 9^©  nutritional program for years. In fact, we’ve helped our clients lose over 40,000 pounds since 2013. If you haven’t tried our Simple 9^© program yet, please do. It’s about making healthy choices you can live with for the rest of your life. If you want to start this program, just ask your coach.

And if you’re taking GLP-1s or recently quit, and you realize you’ve lost a lot of strength, please contact us. We’d love the opportunity to help you improve your life so you can do the things you once did but aren’t strong enough to do anymore.

Stay Strong,

Bo Railey