Amy Hudson and Dr. James Fisher explore the rise of GLP-1 medications like Ozempic and Wegovy for weight loss. 

They discuss how these drugs work, why muscle mass, not just body weight, is the true marker of health, and why many people who lose weight too quickly end up weaker, not healthier. Tune in to hear the long-term risks of GLP-1 use and how strength training can help you maximize the benefits of GLP-1 medications.

• Dr. Fisher starts by explaining what GLP-1s are and how they work. Originally designed as a treatment for diabetes, GLP-1 medications help regulate blood sugar and insulin production. 
• He further adds that their ability to slow digestion and reduce appetite has made them a popular option for weight loss.
• Amy and Dr. Fisher cover why GLP-1s are effective for weight loss. 
• Unlike traditional diets that rely on willpower, GLP-1s make you feel full longer by delaying stomach emptying and reducing appetite, leading to natural calorie reduction.
• Dr. Fisher explains why drug companies have shifted their focus from diabetes treatment to weight loss. 
• With millions more people struggling with obesity than diabetes, the financial incentive to market GLP-1s as a weight-loss solution is undeniable.
• How many people are using GLP-1s? According to Dr. Fisher, around 7% of U.S. adults have taken or are currently taking GLP-1 medication specifically for weight loss. 
• Amy shares why people have always wanted a magic pill for weight loss. People have long searched for an easy way to shed pounds. GLP-1s might be the closest we’ve come, but the big question is, do they really work in the long run?
• If a drug could replicate the benefits of exercise—muscle retention, cardiovascular health, metabolic improvement—everyone would take it. But exercise does far more for the body than just burning calories, and no pill can truly replace it.
• The side effects of GLP-1s. GLP-1 drugs can help with weight loss, but they aren’t without risks. Dr. Fisher explains that users report nausea, vomiting, diarrhea, fatigue, and dizziness. 
• Dr. Fisher on the long-term effects of being on GLP-1s. While short-term studies show weight loss benefits, there are concerns about long-term muscle loss, metabolic slowdown, and potential dependency on the drugs.
• Why GLP-1s cause muscle loss along with fat loss. Rapid weight loss isn’t just about losing fat—it also leads to muscle loss. And without strength training, a significant portion of the weight you lose comes from muscle, which can be disastrous.
• The importance of strength training while losing weight – Dr. Fisher stresses that anyone using weight-loss medication must incorporate strength training. Otherwise, they risk losing lean muscle, which is essential for metabolism, strength, and long-term health. 
• Why weight loss alone isn’t a marker of health. Amy explains why weighing less doesn’t necessarily mean being healthier. Muscle mass, strength, and metabolic health are better indicators of overall well-being than just body weight alone.
• The “fat but fit” paradigm – research shows that being overweight but physically strong is healthier than being at a “normal” weight but weak. 
• Dr. Fisher goes over the dire consequences of muscle loss. Losing muscle accelerates aging, reduces mobility, and makes it harder to maintain a healthy weight as we grow older. 
• The problem with yo-yo dieting–what your personal trainer is not telling you about rapid weight loss. 
• Many people regain lost weight within a year, but the worst part is that they don’t regain the muscle they lost. This cycle leaves them with a higher body fat percentage and a lesser muscle mass than before.
• According to Dr. Fisher, if you lose weight but don’t maintain muscle, then regain the weight without rebuilding muscle, you’re in worse shape than before—both physically and metabolically.
• Amy and Dr. Fisher discuss the real metric for fitness success. Instead of focusing on the scale, look at muscle mass and strength as key indicators of progress.
• Dr. Fisher’s advice for anyone considering weight loss drugs: if you’re thinking about taking GLP-1s, make sure you have a plan to preserve muscle. Your personal trainer can guide you on how to use strength training to develop a stronger, fitter, and healthier body.

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We’ve kind of got things a bit backwards. We’re looking at our weight as being a marker of our health. And in fact, strength is a marker of health.

If you’re at a lower weight, but you have lower muscle mass, you’re actually at higher risk for all-cause mortality.

I used to joke that if exercise came in a pill, then everybody would take it.

Welcome to the Strength Changes Everything podcast, where we introduce you to the information, latest research, and tools that will enable you to live a strong, healthy life. On this podcast, we will also answer your questions about strength, health, and wellbeing.

I’m Amy Hudson. I own and operate three exercise coach studios. My co-hosts are Brian Saigon, co-founder and CEO of The Exercise Coach, and Dr. James Fisher, leading researcher in evidence-based strength training.

And now for today’s episode. Hey everyone, it’s Amy and Dr. Fisher with you today. We are answering a question that has come in that’s a very common one on the topic of GLP-1s. You may have heard of this and you may have know people that are taking GLP-1s. You may have heard of this and you may have know people that are taking GLP-1s. So today in this episode we’re going to go through what these are, you know, how they work, the prevalence of the use, and some factors to consider when, you know, thinking about this as a means to weight loss. Hey Dr. Fisher, how are you doing? I’m doing great Amy, thank you. How are you? I’m doing great. So GLP-1, this is a hot-button issue and we are gonna dive right in. So first of all, can you tell us a little bit about GLP-1s? I mean what are they and and how do they work?

Yeah, absolutely. So this is a hugely contemporary topic in both the US and the UK as far as a weight loss drug. But it’s worth kind of taking a step back, both for perspective and back in time. So GLP-1 is glucagon-like peptide 1 and that’s a naturally occurring hormone that helps control blood sugar levels.

And it was originally developed, the GLP-1 receptor agonist, so the medication itself was originally developed for diabetics to help the body produce more insulin, reduce the amount of sugar, of blood sugar, I should say, which can be really bad for diabetics. So it can cause organ damage and peripheral neuropathy, diabetic retinopathy.

So diabetes can cause a lot of problems. So it’s a really important type of medication that is of course FDA approved and is a genuine pharmaceutical product.

So they originally developed then to, for as a drug for diabetes.

Yeah, absolutely.

Yeah.

Okay.

So then talk us through how did they get into more of the mainstream? I mean people are taking these now that are not diabetics. So walk us through how this drug has evolved.

Yeah. So as with most with well with many pharmaceuticals certainly, there is a secondary effect of certain types of medication and in this case there was identified, you know, considerable weight loss in diabetics using GLP-1 receptor agonists. So it’s become, and it’s been used for about 20 years in the pharmaceutical industry for diabetics, and then more recently has been recognized and prescribed for, specifically for weight loss. Now whether it should or shouldn’t be prescribed for weight loss is debatable, but it certainly is being prescribed and it certainly seems efficacious for weight loss. But we’ll talk a bit about some of the potential implications of that.

Right. I mean, I think from the beginning of time, people have wanted some kind of pill or magic potion for weight loss, right? So if something comes out that suggests that it might be that solution, it’s going to gain in popularity, right?

Yeah, absolutely. The reality is the pharmaceutical industry is a business. As much as we might like to think that it’s purely virtuous and it’s there purely for our own health and well-being, it’s a money-making business. And of course they’ve realized that there’s a lot more money to be made in helping people to lose weight than there is purely in helping diabetics. There’s a lot more people trying to lose weight than there are diabetics, uh, to take it. So, uh, so it, if there’s a pill for it, then, uh, then people, people will take it if, if it’s, uh, if it’s an easier option. Um, I used to joke that, you know, if exercise came in a pill, then everybody would take it. So, uh, it’s a, it’s a tricky one.

Yes. Do you have any facts or figures about how, how common this is or how many people are using it currently? Yeah, so if we go back over time over the last decade it’s gone from around 30,000 to just shy of a million people in the US and that equates to somewhere around 7% of adults currently taking or having claimed to have taken GLP-1 medication specifically for weight loss. So it’s got a reasonably high prevalence. Now of course it does list in the packaging, it should list, the side effects and from the people that I’ve spoken to who have taken GLP-1 medication, there are gastrointestinal side effects as well as headaches, dizziness, fatigue, and so forth. A few other side effects as well. Now it’s worth clarifying a lot of medication has a side effect, so this is not for us to be berating GLP-1 use. Of course, if it’s used for a genuine reason, I think that it’s, this is more of an education for people.

Mm-hmm.

So just to clarify, so how it works is that it, it helps to regulate insulin levels in the body, right? Does it decrease appetite?

You’re right, it does. So it slows digestion down and it reduces appetite. Of course, the slowing of digestion is what might cause gastrointestinal issues. And in fact, people who are physically fit and healthy and specifically engage in strength training actually increase their gastrointestinal transit time and that can serve to reduce certain types of cancer, sort of gastrointestinal cancer.

So I don’t know that we necessarily want to slow our digestion, but in this case it does slow our digestion and it reduces appetite. And that of course is why people feel full for longer and therefore they don’t feel the same appetite to eat and hence they end up losing weight.

So what are potential long-term or do we know any long-term potential effects of being on this drug for a while? Yeah, so I had a bit of a search around for this and there’s not this really not much detailed about what the long-term effects of the use of GLP-1 receptor agonists is for the lay population or even for diabetics. So I presume there are trials that have been done, but certainly they’re not that easy to uncover at this stage. So now there are long-term side effects of a lot of medications, so it would be remiss of us to think that there are no long-term effects, but how severe they are, we simply can’t talk about yet. Okay, so what would be, you know, so this is a good foundation for what these drugs are, how they work, you know, how they may help somebody short-term lose weight, but you know, what would be some factors to consider if somebody wanted to lose weight and was looking at this as an option?

Yeah, so this is the big question and this is the point of real concern from my perspective. And that is that rapid weight loss, especially without exercise, causes a weight loss where about around 50% of that weight loss is muscle mass and around 50% of it is of course, fat mass. Now the fat mass is the intent. That’s what people are trying to lose. But, uh, but of course, when we talk about weight, people aren’t necessarily dissociated between muscle mass and fat mass. They’re simply looking at the scales and saying, Hey, I lost 10 pounds. They’re not thinking about the disastrous implications of I lost five pounds of muscle. So as soon as somebody is thinking about a weight loss program and especially is considering the use of any weight loss medication, especially including and especially GLP-1 receptor agonists, for me I think the key thing is to get strength training ticked off, make sure that’s a regular occurrence in that person’s lifestyle so that they’re either building or retaining as much muscle as they can. And then from there, and of course, that will lead to some fat loss as well. And from there, to then consider any kind of weight loss medication as well. By doing so, they can hold on to as much muscle as they can and retain the muscle that they’ve already got and hopefully the weight that they lose as a product of taking that kind of medication will be predominantly fat. So that’s the priority from my perspective. Yes, and we’ve talked about this a lot of, uh, a lot on this podcast and on other episodes, but if this is somebody’s first episode that they’re listening to us on the Strength Changes Everything podcast, can you just remind us, I mean, what are the negative consequences of somebody going and losing weight and losing muscle mass? So picture somebody a year from today having lost, like you just said, 50% muscle mass on some kind of a diet. What is the negative outcome that they might not realize could happen? Absolutely. So the key thing is that muscular strength and muscle mass are clear predictors of quality of life as we age, and also reduction in all-cause mortality. We’ve talked about on a previous episode, I think it was the episode where we talked about no non-responders to resistance type exercise. And there’s something called a fat but fit paradigm. And basically that paradigm says that, and the reason it’s called a paradigm is because it’s counterintuitive.

But what that kind of profile says is that it’s better to be overweight and strong than it is to be normal weight and weak or unfit. And that’s a really important message. And to me, that’s exactly what lends itself to this this concept of taking kind of weight loss medication before engaging in strength training is we’ve kind of got things a bit backwards.

We’re looking at our weight as being a marker of our health and in fact weight is not a marker of our health. Strength is a marker of health. Muscle mass is a marker of health. Theycle mass is a marker of health. They’re the clear two indicators for quality of life and all cause mortality. And in fact, there was a study a few years back that looked at muscle mass index and body mass index. And it even showed that the people with the lower body mass index, which is what most people would think about as being a marker of health, the people with the lower body mass index, which is what most people would think about as being a marker of health. The people with the lowest body mass index actually had the highest mortality rate because they also had the lowest muscle mass index, whereas people with the highest body mass index had the highest muscle mass index and therefore had the lowest mortality rate. I know that you’re about to explain what body mass index is, Amy, because I didn’t do that.

So I’ll leave that to you.

Amy Quinton Yes, but that is a huge, important, eye-opening truth. If you haven’t heard that before, it’s that it’s very easy to take weight as an indication of how healthy I am. But what Dr. Fisher just said is that if you’re at a lower weight but you have lower muscle mass or not enough muscle mass, you’re actually at higher risk for all-cause mortality. So it’s not the first metric to look

1. The metric of success really is our muscle mass, which isn’t what the scale will tell us, a regular scale, right? So that’s why it’s important to know what our muscle mass which isn’t what the scale will tell us a regular scale right so that’s why it’s important to know what our muscle mass is we have bioimpedance devices and we’ve talked about that on a smart scales podcast in the past to get to know what that is or at exercise coach studios we offer body composition readings but yeah BMI is a standard metric of you know you um, you know, you’ll, you can pull up on Google charts and you can see normal weight, healthy weight, and then another range is overweight and then another range is obese. Right. And, um, it’s, uh, BMI is just a straight up marker of, uh, height and weight, but that doesn’t tell the whole story. Right. height and weight, but that doesn’t tell the whole story, right? So what Dr.

Fisher is saying is somebody might be at a higher weight because they have more muscle mass and truly metabolically they’re way healthier than somebody who might be 5 or 10 pounds lighter in the normal weight category, right? Or in another category on this BMI chart, but really more muscle mass is every single day of the week more advantageous.

Exactly, exactly, really well put. But I would even go a step further than that and say even people that think of themselves as being overweight or obese and might physically be obese have more, potentially have more muscle mass because of carrying around that additional weight. So if they go on a weight loss strategy to try to lose some of that body fat, then that’s fine.

You know, fat loss is okay. I’m not for a second saying that people shouldn’t try to lose body fat if they are carrying an excess. But muscle loss is absolutely disastrous and that’s the key thing in all of this. We need to hang on to and build as much muscle as we can because that’s the biggest marker for quality of life as we age.

And you’ve said in other podcasts, Dr. Fisher, some statistics about when people yo-yo diet within a year of losing weight, where 50% of that is muscle mass and 50% of that is body fat, a certain percentage of people regain all the weight. What was that stat? Yeah, so I don’t remember the exact statistic, but most people will regain all of the weight that they lost, but half of it, half of the way they lost was muscle, but they won’t regain the muscle that they lost. So we know that most people lose, uh, you know, uh, a reasonably high percentage of one to 5% every decade of life of muscle mass. Um, and if we, if we’re just giving it away because we’re going on a drastic weight loss diet, that’s, you know, we’re, we’re quite literally aging our body 10 years.

If I lose, you know, five or 10 pounds of muscle, I’m effectively aging my body. Um, you know, unnecessarily, you know, with the intention that I’m trying to do myself some good. And this is the point of this, this is educational, right? We’re not trying to tell people not to lose weight and not to take certain medication, but we are trying to help people to make a more educated decision.

Absolutely. Yeah. So the point being is that we have to care for our muscle mass. This has to be a part of the conversation related to weight loss, is preserving muscle mass so that metabolically we are healthier for the long term. We want to keep the long-term perspective in mind and how healthy will I be in one year or five years, not just in six months.

And muscle mass is the key piece to consider when it comes to this. Yeah, I was just going to add that we’ve talked about the benefits of strength training in other ways as well, but we’ve also talked about the approach to strength training as being, you know, can be relatively uncomplicated, can be brief, can be infrequent, you know, exactly as the exercise coach prescribed. So it doesn’t have to be that, oh, I want to take this medication to lose weight and I haven’t got the time to go to the gym five or six days a week. That’s not what’s being advocated at all. You know, getting strength training as part of a weekly routine, as part of a lifestyle habit is relatively palatable. You know, so maybe people need to go back and listen through some other podcasts. Absolutely.

No, this was a, this was a very important thing to, um, to touch on. And I’m so glad we did. Um, do you have any other thoughts on this that we didn’t get to in this episode?

No, I think we hit everything there. I mean, thank you.

Well, thank you for teaching us on this. This is an evolving topic as always, so I’m sure it’ll be one we’ll revisit again on the podcast. You know that our position on strength is that it is the number one thing that we want to focus on for our overall health and well-being, and so we hope that that is something that you take away from this episode today. We will see you next time on the podcast.

Hope you remember, strength changes everything. Thanks for listening. If you enjoyed today’s episode, please share it with a friend. You can submit a question or connect with the show at strengthchangeseverything.com.

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