GLP-1 Weight Loss: Are We Still Talking About Health?

I’ve been thinking a lot about GLP-1s lately.

You really can’t work in health and wellness right now without hearing about them. Semaglutide. Tirzepatide. Wegovy. Zepbound. Ozempic. Mounjaro.

They are everywhere.

At a studio where I taught, many of the members were using them. I hear about them from family members and coworkers. They’re in the headlines, television commercials, and all over our social media feeds. Sometimes it feels as though you can’t escape the suggestion that life will somehow be so much better with a GLP-1.

But this isn’t actually the first time I’ve heard about them.

For the last three or four years, nearly every fitness convention I’ve attended has included sessions about GLP-1s. The sessions were informative, but looking back, they also felt almost preparatory. As though the health and fitness industry knew we needed to understand what was coming. And now it’s here. It’s everywhere, and I figured I’d share what I’ve learned and what I’m experiencing coaching clients.

These medications are part of a larger class of what are called incretin-based medications. You may have also heard some of them discussed as “peptides.” And they are changing not only how we approach weight loss, but how we talk about appetite, obesity, movement, nutrition, and health itself. That’s the part I can’t stop thinking about. But my interest in this conversation has become a little more personal because I currently work with several clients who are taking a GLP-1 medication as part of their weight-loss journey.

I’m not their prescriber. Medication management is outside of my scope, and whether someone should begin, stop, or change a prescription belongs between that person and their medical provider. My role is different. I’m helping my clients care for their bodies while they are changing.

Over the last few years, I have worked with several clients who have used GLP-1–based medications as part of their weight-loss journey. Their experiences have not all been the same. I have supported clients while they were actively taking the medication, and I have also worked with a client who had stopped taking it and wanted to sustain her weight loss while gaining and maintaining muscle. Working with these women has caused me to think more deeply about what support looks like during and after weight loss with these medications. We talk a lot about how much weight someone can lose while taking a GLP-1, but I find myself thinking about what else is happening along the way. 

Are they maintaining muscle and strength? Are they adequately nourished when their appetite has changed? How is their energy? (This is a major obstacle) How is their body responding to exercise? And what happens when the medication is no longer part of the picture?

These are some of the questions that have made me want to look more closely at the research and have a larger conversation about what it means to support health while someone is using a GLP-1. We tend to focus on one question when someone is using a GLP-1: “How much weight did you lose?” But that is only one part of what is happening in their body, and it is not the only thing I am paying attention to with my clients.

I want to know what we are helping them maintain while their bodies are changing. Are they maintaining their strength and muscle? Are they eating enough to stay adequately nourished when their appetite has changed? Do they have the energy they need to move, exercise, and live their everyday lives? I’m also paying attention to things that are harder to measure, like how their relationship with food is changing and how they are learning to relate to a body that may be changing rather quickly.

Weight loss may be part of improving someone’s health, but weight loss by itself does not tell us the whole story of someone’s health. That is the conversation I think we need to be having alongside the excitement about how much weight someone can lose.

GLP-1 Weight Loss
Are We Still Talking About Health?

What Are GLP-1 Medications?

Before we go much further, let’s talk about what we’re actually talking about. GLP-1 stands for glucagon-like peptide-1, a naturally occurring hormone that is released in response to eating and plays a role in regulating blood sugar, appetite, and digestion.

Some medications, including semaglutide, work by mimicking the effects of GLP-1 in the body. Tirzepatide works a little differently because it acts on two hormone pathways: GLP-1 and GIP, or glucose-dependent insulinotropic polypeptide. GIP is another naturally occurring incretin hormone that helps the body respond to the food we eat, including helping regulate insulin secretion after a meal.

This is why you may hear medications like these described more broadly as incretin-based medications. They work with pathways that already exist in the body, although the medications are designed to produce longer-lasting effects than our naturally occurring incretin hormones.

These medications have changed the conversation around obesity treatment in a very real way, and researchers are beginning to explore whether their effects may have applications beyond diabetes and obesity. One area that recently caught my attention is lipedema, a chronic disorder of adipose tissue that primarily affects women. Early research is exploring whether GLP-1–based therapies could have a role in managing some aspects of lipedema, although the evidence is still very limited and these medications are not currently an established treatment for the condition.

What Do the Clinical Trials Show?

There is still a lot we don’t know. What we do know is that the weight-loss results reported in clinical trials of these medications have been significant.

In the STEP 1 clinical trial, adults with overweight or obesity who received semaglutide 2.4 mg alongside lifestyle intervention lost an average of 14.9% of their starting body weight over 68 weeks, compared with 2.4% among participants receiving placebo (Wilding et al., 2021).

In the SURMOUNT-1 trial, participants receiving tirzepatide experienced average weight reductions ranging from 15.0% to 20.9% over 72 weeks, depending on the dose, compared with 3.1% with placebo (Jastreboff et al., 2022).

Those numbers matter, and I don’t think we need to minimize them in order to have an honest conversation about what health looks like while someone is losing that weight.

Maybe It Was Never Just About Willpower

For a long time, people living in larger bodies have been handed some version of the same message: eat less, move more, and try harder. As someone who has experienced significant weight loss myself, this part of the conversation matters to me because I know what it is like to believe that changing your body will somehow change everything else.

I also know what it is like for food, exercise, weight, discipline, and even worth to become tangled together. What I understand differently now is that human physiology is far more complicated than the idea that someone’s body size simply reflects how disciplined they are.

That doesn’t mean our choices don’t matter, because they do. What we eat, how we move, how we sleep, and many of the choices we make can influence our health. But appetite regulation, metabolism, and obesity cannot be adequately explained by willpower alone. Appetite itself is influenced by complex physiological processes, including hormonal signals between the digestive system and the brain. This is part of what I think the rise of incretin-based medications has made harder to ignore.

Tirzepatide acts on both GIP and GLP-1 receptors and can decrease calorie intake by affecting appetite. Semaglutide acts on GLP-1 receptors and similarly affects appetite and calorie intake (U.S. Food and Drug Administration [FDA], 2025, 2026). Perhaps one of the unexpected things to come from this shift is an opportunity to have a different conversation about our bodies. Instead of assuming that someone’s weight tells us how disciplined they are, maybe we can become more curious about the many things that influence health and what it actually looks like to care for the whole person.

GLP-1 Weight Loss Doesn’t Tell Us What Was Lost

This is where I want us to slow the conversation down a little.

When someone says, “I lost 20 pounds!”

What we know is that their total body weight went down by 20 pounds. The scale cannot tell us what those 20 pounds were made of. Some of that weight may have come from body fat. Others may have come from lean tissue. It may reflect changes in body water. And that distinction matters when we start talking about GLP-1 medications and muscle loss. I’ve shared in the past that body weight and body composition are two different things.

Weight Loss and Body Composition Are Not the Same Thing

In a body-composition analysis from the STEP 1 trial, participants taking semaglutide experienced a substantial reduction in body fat. Total fat mass decreased by about 19.3%. Lean body mass also decreased by approximately 9.7%. But here is where the nuance matters. Even though the absolute amount of lean mass decreased, lean mass actually made up a greater percentage of total body weight after weight loss because fat mass decreased even more.

Lean Body Mass Is Not the Same as Muscle

And I want to be careful with the language we use here, because lean body mass and skeletal muscle are not the same thing. Lean body mass includes more than muscle.

So I don’t think it is scientifically responsible to take this finding and simply say: “GLP-1s make you lose muscle.” That turns a complicated finding into a simple headline.

What the Research Actually Tells Us

Here’s what the research actually tells us:

When we lose a significant amount of weight, we don’t lose only body fat. Some lean body mass may be lost too. That can also happen during weight loss with GLP-1 medications. But lean body mass is not the same thing as muscle, so we need to be careful about saying that all lean mass lost is muscle. What this research does highlight is the importance of paying attention to body composition, which is not just the number on the scale. During significant weight loss, preserving lean tissue, maintaining physical function, and supporting adequate nutrition matter too (Wilding et al., 2021).

WEIGHT LOSS ≠ FAT LOSS

The scale tells you how much you weigh. It doesn’t tell you exactly what changed.

Why I Care About Strength and Muscle During GLP-1 Weight Loss

I care about muscle for reasons that have very little to do with whether someone looks “toned.”

• Muscle helps us live.
• It helps us get out of a chair.
• Carry groceries.
• Climb stairs.
• Pick things up.
• Play with our children and grandchildren.
• Remain physically capable as we age.

And muscle is metabolically active tissue with important roles in glucose metabolism and physical function. Meaning, Muscle is active tissue that helps your body manage blood sugar and supports strength, movement, and everyday function. This is one reason resistance training has become such an important part of how I think about health, particularly as women move through midlife and beyond. So when my client tells me the scale moved, yes, I acknowledge that. But there are other questions I am asking too.

• Are you getting stronger?
• How are your workouts feeling?
• How is your recovery?
• Are we progressing your training appropriately?
• How is your energy?
• Are you adequately nourished?
• What is happening beyond the number on the scale?

As my daughter says, “You ask a lot of questions,” and I do. Because I don’t want someone to arrive at a smaller body only to discover that they have also become less capable in it. They don’t have the energy to move the way they want to move. They’ve lost strength. Their mobility has changed. Their body may be smaller, but is it functioning better?

Because then I have to ask: what was the point? If health was the goal, I think we have to care about more than whether the number on the scale went down. We also have to care about what your body can still do when you get there.

Nutrition Still Matters When You Take a GLP-1

This is another piece of the conversation that matters. GLP-1-based medications can significantly reduce appetite.

For someone who has spent years feeling consumed by hunger, food thoughts, or constantly trying to restrict food, that change can feel significant.

But a reduced desire to eat does not mean the body has stopped requiring nourishment.

• Protein still matters.
• Carbohydrates still serve a purpose.
• Dietary fat still serves a purpose.
• Vitamins and minerals still matter.
• Fiber matters.
• Hydration matters.

Food is not simply something we need to consume less of in order to occupy a smaller body. Food nourishes a living body. And this isn’t something holistic practitioners made up because we don’t like medication. A 2025 joint advisory from the American College of Lifestyle Medicine, American Society for Nutrition, Obesity Medicine Association and The Obesity Society specifically addressed nutritional priorities for people receiving GLP-1 therapy. Among the concerns the advisory identifies are inadequate nutrient intake and changes in muscle and bone that can accompany substantial weight loss. It emphasizes appropriate nutrition and lifestyle support as part of GLP-1 treatment. That is an important part of this conversation (Mozaffarian et al., 2025).

Exercise Didn’t Suddenly Become Irrelevant

Something else caught my attention while doing the research for this post. The current FDA-approved prescribing information for both Wegovy and Zepbound still describes these medications as being used in combination with a reduced-calorie diet and increased physical activity (Novo Nordisk Inc., 2026; Eli Lilly and Company, 2026).

Think about that for a moment. Even the medical treatment itself isn’t positioned as:

Take this medication, and everything else no longer matters.

Movement still matters.
Nourishment STILL matters.
Lifestyle STILL MATTERS.
(Sorry for raising my voice.)

The medication can be a tool within someone’s care without becoming the entirety of their health. These medications are not cheat codes. They are an additional tool that, for some of my clients, can be used alongside movement, nourishment, and other aspects of their care.

How I’m Supporting My Client Who Takes a GLP-1

So, what am I actually doing differently with my client?

In some ways, nothing. I’m still doing what I believe good health and fitness support should do. The scale is only one part of what we’re watching week after week. Strength training is part of the plan because I want her to maintain strength and muscle. Walking helps us build cardiovascular fitness and support her overall capacity. We’re also paying attention to whether she’s actually nourishing her body enough to support everything we’re asking it to do. I ask my clients to check in with themselves to become aware of what their body needs physically, emotionally, and mentally. What are they carrying?

We’re also paying attention to recovery, energy, strength, and how she’s moving. And throughout all of it, we’re watching how her body responds because that matters too. And when something belongs within the scope of her medical provider, that’s where it belongs. The medication isn’t the center of our work together.

She is. That distinction is important to me.

I Don’t Want Us to Make the Same Mistake Twice

For years, wellness culture told people: If you can’t lose weight, you aren’t trying hard enough.

I don’t want us to replace that incomplete message with another one:

Just take the medication. Neither one sees the whole person. And maybe that is the part of this conversation I care about most. Because I’ve spent years learning that health cannot simply be about controlling a body. My own journey started with wanting to become smaller. But God has done so much more in me than change the size of my body. I’ve had to examine how I relate to food. I’ve had to rethink what movement looks like for me and learn that it’s okay for that to look different on different days. And rest? I’m still working on that one. But I’ve come to believe rest is just as much a part of wellness as movement and nourishment. I don’t subscribe to the 80/20 rule anymore.

For me, it’s more like 33/33/34: 33% movement, 33% rest, and 34% nutrition.

I’ve also learned that my thoughts and emotions are important messengers. They need to be noticed, inventoried, and processed. They are not ignored because they don’t fit neatly into a meal plan or workout program.

My expectations matter too. So does the way I relate to the body God has given me. Somewhere along the way, health became less about fighting my body and more about learning how to live faithfully within it. And that changes the questions I ask now.

What Does Stewardship Look Like When Medication Is Part of the Story?

Romans 12:1 has shaped the way I understand the body for years:

“Present your bodies as a living sacrifice, holy and acceptable to God, which is your spiritual worship.”

It’s what started this blog, my business, and this mission nine years ago.

I didn’t read that verse as an instruction to produce a certain kind of body or to make my body look a particular way. I read it as an invitation to offer God the body I have and to care for it as part of my worship. That includes nourishing it, moving it, paying attention to what it is communicating, resting when rest is needed, and receiving appropriate care when care is needed.

For me, that has also meant learning to stop treating my body like something I have to conquer before I can finally be at peace with it. I spent enough years believing that a smaller body, a stronger body, or a more disciplined body would somehow make me healthier or more acceptable. Romans 12:1 keeps bringing me back to something different. My body is not something separate from my spiritual life. It is part of the life I am offering to God.

That is why I don’t believe taking medication automatically represents failure, and I don’t believe losing weight automatically represents health. Medication may be an appropriate part of someone’s care, and weight loss may be beneficial in some circumstances, but neither one tells us the whole story of a person’s health.

Human beings are more complex than that. Our conversations about health should be too.

The question isn’t only:
How much weight did I lose?

What am I preserving?
What am I strengthening?
How am I caring for what God entrusted to me?

GLP-1s May Be Changing Weight Loss. I Want to Keep Talking About Health.

I think we are going to be talking about these medications for a long time, and I want to make room for a conversation that can hold some complexity. This isn’t an area where I’m interested in reducing the conversation to whether GLP-1s are good or bad. There are better questions for us to ask.

• What happens to muscle during significant weight loss?
• How do we adequately nourish someone whose appetite has changed dramatically?
• What role does strength training play?
• What should we be paying attention to besides the number on the scale?
• What happens when someone reaches their goal weight, and what does long-term care look like after that?

I am also interested in something that is harder to measure. How do we help people remain connected to their bodies while their bodies are changing? And what does whole-person health look like when medication becomes part of someone’s story?

Those are some of the questions I want to explore throughout this series. Not because I think there is one simple answer, but because I think the conversation about health deserves more than one. Whether weight loss happens through medication, nutrition changes, surgery, movement, or some combination of them, I keep coming back to the same thing: a changing number on the scale cannot tell us everything we need to know about a person’s health.

You are more than that number. And caring for your body was always meant to be about more than making it smaller.

References & Further Reading

Wilding JPH, Batterham RL, Calanna S, et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” New England Journal of Medicine. 2021;384:989–1002.
https://www.nejm.org/doi/full/10.1056/NEJMoa2032183

Jastreboff AM, Aronne LJ, Ahmad NN, et al. “Tirzepatide Once Weekly for the Treatment of Obesity.” New England Journal of Medicine. 2022;387:205–216.
https://www.nejm.org/doi/full/10.1056/NEJMoa2206038

Jastreboff, A. M., Aronne, L. J., Ahmad, N. N., Wharton, S., Connery, L., Alves, B., Kiyosue, A., Zhang, S., Liu, B., Bunck, M. C., & Stefanski, A. (2022). Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine, 387(3), 205–216. https://www.nejm.org/doi/10.1056/NEJMoa2206038

Wilding JPH, et al. “Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study.”
https://pmc.ncbi.nlm.nih.gov/articles/PMC8089287/

Mozaffarian D, et al. “Nutritional Priorities to Support GLP-1 Therapy for Obesity: A Joint Advisory.” 2025.
https://pubmed.ncbi.nlm.nih.gov/40445127/

U.S. Food and Drug Administration. Wegovy (semaglutide), Current Prescribing Information, 2026.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/215256s033lbl.pdf

U.S. Food and Drug Administration. Zepbound (tirzepatide), Current Prescribing Information, 2026.
https://www.accessdata.fda.gov/drugsatfda_docs/label/2026/217806s042lbl.pdf

Medical disclaimer: This article is provided for educational purposes and does not constitute medical advice. Prescription medications should be initiated, adjusted or discontinued only under the guidance of an appropriately licensed healthcare professional.

About the Author
De Bolton, B.S. in Fitness and Exercise Science
De is a holistic health practitioner and fitness professional whose work focuses on movement, nutrition, strength, and whole-person health.

Credentials: NASM Certified Personal Trainer • NASM Corrective Exercise Specialist • NASM Weight Loss Specialist • NASM Fitness Nutrition Specialist • Certified LiveWell Health Coach