Weight Loss Drugs- how to improve the trade offs.
A Glasgow Personal Trainers Thoughts…
THE RISE OF WEIGHT LOSS DRUGS
It’s Glasow 2025 and almost everyone either knows someone who’s taking a weight loss injection or is hearing about a friend of a friend whose trying it. People are witnessing friends and colleagues lose life changing amounts of weight, and quite often it’s people who have struggled to lose just a few pounds in the past.
It’s not just Glasgow; it’s happening all over the world. The Financial times report that 1 in 8 Americans have tried the drugs and predict 1 in 5 by 2030, which will be 68.5 million people in the US alone. Weight loss injections have truly arrived and we’re already witnessing its effects on people’s health, behaviours, and the economy.
For me as a personal trainer it’s been an eye-opening phenomenon. I have so many questions. What will the long-term physiological effects of the drugs be on people? What will happen if they stop taking it? Who should take it? How I can help clients who decide to take it reduce potential side effects?
It’s still early days and already there’s a wealth of research coming out about the potential long-term effects, good and bad. I thought I’d write a quick blog to outline some of the evidence that the research is providing, identify potential issues people might run into, what strategies and tactics they can implement to mitigate some these downsides.
BRIEF EXPLANTION OF HOW WEIGHT LOSS DRUGS WORK
Most of these injections are GLP-1 receptor agonists. The GLP-1 (Glucagon-Like Peptide-1) is a hormone your body naturally produces in the gut after you eat.
Natural GLP-1 only lasts for a few minutes before its effects start to diminish. The medication is designed to be structurally similar but much hardier and can last up to a week. It tells your body you’ve just eaten a massive, satisfying meal—even if you haven't. I’ve heard of the most food obsessed people completely lose interest in food once they’ve started taking it.
The two main ways that the weight loss medications work are as follows.
1. Slowing Down Gastric Emptying
These drugs physically slow the rate at which food leaves your stomach and enters the small intestine. This process is called delayed gastric emptying. Food stays in your stomach longer, making you feel physically "full" for longer. I read an article of someone describe feeling “like they’ve sat at an all-day buffet after a couple of bites of a meal”.
2. Rewiring the Brain's "Reward Centre"
The medication also targets the reward centres in the brain like hypothalamus, which regulate appetite and cravings. People who have constantly craved food now experience reduced food noise, cravings and emotional eating. For people who have found it hard to reduce food noise this must be a truly liberating experience.
THE BENIFITS OF WEIGHTLOSS DRUGS
Some of the benefits of taking weight loss drugs are impressive. It is my belief that most of the benefits from the drugs come from the reduction in eating of unhealthy food and not the actual weight loss. There is no doubt that fat loss will improve many things, but fat gain is often a symptom of the underlying cause, and the underlying cause is too much ultra-processed food and not enough nutrient dense foods. Here are some of the health improvements that are being found.
Reduces type 2 diabetes
Reduces inflammation
Reduces cancer risk
Reduces CHD
Reduces dementia risk
These findings have been found in studies like the SELECT trial which followed 17,000 individuals taking the semaglutide weight loss drug and found: death rates reduced by 19%, cardiovascular death reduced by 15%, a 3.1 year reduction in biological age, brain markers improving by 5 years, type 2 diabetics reducing the likelihood of developing cardiovascular disease b 2.5 years.
THE DOWNSIDE WITH OZEMPIC
As outlined, there are lots of benefits for people who have a high risk of chronic diseases due to the eating habits that have led to them being overweight. But there are potential serious trade-offs and side effects of the medication that must be addressed. Let’s take a look.
Loss of muscle
The problem
Proteins are made up of amino acids, which are the building blocks of all cells that make up organs and tissues (including muscle), enzymes, hormones, and white blood cells. If a person doesn’t consume enough protein, they will pull amino acids from their muscle to use in other more essential organs like the brain, liver and heart. If this continues over a prolonged period, they will lose significant amounts of muscle.
Getting enough protein can be a challenge for a lot of people but even more so for someone who is eating very little food. Research indicates that people using weight loss drugs lose anywhere between 25-50% of their weight from lean tissue. As a personal trainer that’s a shocking number to me. Losing muscle will not only have a detrimental effect on strength and functional fitness, but will also mean a reduction of metabolism, which means it will be easier to regain weight back in the future. A loss of muscle is also associated with an increased risk of; type-2 diabetes risk, coronary heart disease risk, risk of osteoporosis, weakened immune system, and a loss of the structural integrity of cells. The evidence is clear for a healthy body you need healthy muscle.
The solution
Absolutely prioritise protein consumption in your diet.
Aim to consume 1.6- 2 grams per kilogram of ideal body weight of protein.
Much easier to meet our protein requirements if you consume animal protein.
For more information see our PROTEIN FACT SHEET.
You should also ideally aim to perform at least 2-3 progressive resistance training sessions a week to signal to the body that muscle is important.
Loss of bone
The problem
People who take weight loss drugs are also at a higher risk of losing bone density as bone health is very heavily correlated with muscle. When we stress muscle we stimulate the growth of bone, and conversely when we cease to supply the building blocks and appropriate stress to bones, they will start to degrade. If a person loses a significant amount of bone density, they put themselves at a higher risk of fractures from falls and osteoporosis in later life, which can have a catastrophic effect on mortality rates. Females should be especially mindful of this as the menopause can accelerate bone loss faster than in men due to the loss of oestrogen.
The Solution
The same approach is needed as with muscle.
Stress muscle through resistance training so your body knows to prioritise maintaining them.
Bones are 50% protein, make sure you consume enough protein.
Additionally make sure your eating foods rich in calcium and vitamin D are essential for bone health and repair.
You can get Vitamin D and calcium from; sardines, salmon, dairy and egg yolks.
The best source of Vitamin D is sun on the skin, so get your daily dose outside.
Loss of nutrients
The Problem
A big challenge for someone eating significantly less food is: can they get enough nutrients from the little food they are eating? Generalisation alert, but people who take weight loss drugs may be at a higher risk of eating ultra processed foods that contain little or no nutrients. If an individual has become overweight due to eating ultra processed foods and continues to eat the same ultra-process foods, but just in smaller quantities, they are likely to become malnourished due to low levels of vitamins, minerals, and macro-nutrients in their diet.
The body is constantly prioritising how to use the nutrients you are giving it, like keeping the heart beating and the brain functioning. Over time non-essential systems like hair, bone density, and skin start to suffer if insufficient nutrients are consumed in the diet. Signs of a prolonged diet low in nutrients are cognitive decline, poor mood, fatigue, poorly functioning immune system, and physical structural decay to tissues like muscle. If you are experiencing a general lack of well-being make sure your deficient in micronutrients contained in vitamins and minerals.
The Solution
Avoid ultra processed food that has very little nutrient density.
Maximise the nutritional value of each meal.
Start with protein.
Plenty of plants.
Unprocessed carbs like potatoes and rice.
Minimally processed fats like olive oil, nuts, seeds, and oily fish.
Increase in food noise after ceasing the drug
The Problem
By “food noise” we mean persistent, intrusive thoughts about eating food. There have been lots of reports of users of weight loss drugs experiencing increased food noise after they cease using the drug. Rather than there being one cause for this its most likely to be a myriad of reasons. From hormones like leptin dropping due to weight loss, to the loss of the effects of the drug silencing effect, and the loss of muscle. Whatever the reason it’s a real problem. But there are solutions to reduce it.
The Solution
Mimic the satiating feeling the GLP-1 drug provide by eating food that slows digestion like protein, plenty of plants that contain fibre.
Keep hydrated with water and electrolytes as dehydration can stimulate hunger.
Minimise sugars and refined carbs in diet to improve blood sugar levels, as stable blood sugar levels will make it easier to control food cravings.
Maintain muscle during the weight loss to maintain metabolism and mitochondrial health.
Significant increase in weight regains after ceasing taking drug.
The problem
One of the biggest issues with the weight loss drugs is that it seems a significant amount of people regain all the weight they lose after about 1-1.5 years. This ma lead to people having to take the drug for the rest of their lives, which could be a massive financial burden to them.
The Solution
But it doesn’t have to be this way. If you follow the strategies outlined in this blog you could significantly reduce the chances of weight regain once you stop taking the drug. When you start taking the drug start working on the long-term changes you need to put in place for long term success. Treat the drug as a tool that can help you start implementing positive changes not the complete solution. Look after your muscle and eat a nutrient dense diet.
CONCLUSION
Should You Take Weight Loss Drugs?
Taking weight loss drugs is a personal choice and it’s not my place to say if someone should take them or not. I can understand why people would want to take them. As a personal trainer, I’ve witnessed the struggles some people have saying no to unhealthy food, and the overwhelming feeling when trying to develop the momentum of the first few steps towards a healthier life. The significant health benefits we outlined when a person ceases to overeat unhealthy foods, there is a case to be made that some people will benefit from taking the drug. But there are trade offs that people should not ignore.
The Trade offs of Weight Loss Drugs
I once read the following quote: “there’s two types of medication, one with side effects, and ones that don’t work”. We are learning as more people take the drugs that there are trade-offs. The biggest being a loss of muscle and bone, which is particularly of concern for people after middle age. We know what you losing muscle after middle-age is very hard to gain back, and low bone and muscle health is one of the biggest predictors of healthy ageing and mortality risk. The other risk is having to potentially take the drug for the rest of your life due to the majority of people regaining all their weight when they cease to take the drug.
I do believe however it may be possible to limit muscle loss and weight regain if you follow some of the advice laid out in this article.
Recap- how to reduce pitfalls and potential side effects of weight loss drugs.
Progressive resistance training 2-3 times a week minimum.
Target a minimum protein intake of 1.6 grams per KG of ideal bod weight a day, but going up to 2.2grams is great.
Maximise nutrient intake in each meal.
Consistently build the habits and approach to be able to come off weight loss drugs and not regain weight.