GLP-1 drugs like Mounjaro (tirzepatide) mimic natural hormones to regulate blood sugar and reduce hunger, helping with diabetes management and often resulting in significant weight loss. After speaking with a client recently who has friends already using, and considering using, Mounjaro I thought I would do some research to try and better understand the drugs before giving any advice. I was aware of the risks and rewards of these drugs but as they gain notoriety, are the people using them in the know? GLP-1's promise a low effort solution to obesity, a serious problem in today's society, and I can see why there would be a caution to the wind approach. But what could this mean to our long term health and how can we utilise them safely and effectively?
My initial reaction
When I first became aware of GLP-1's like Mounjaro and Ozempic as a PT, I hated it. It filled me with anxiety and I thought, "well that's my career over with, people won't come to a PT to help them lose weight now because the magic pill finally exists". It also left a sour taste because the results wouldn't have been 'earned', almost a superiority complex about how hard I'd worked for my health and physique and that other people shouldn't have such easy access to it. That is awful I know, but this was my chimp brain talking.
Personally I have trained consistently and put in a lot of work from the age of 15, and I've always done it 'the hard way'. I wouldn't dream of using performance enhancing drugs, unlike a scary amount of people in the industry nowadays. No shade on those who do use them, it's just not me.
Rather than seeking synthetic help to improve my physique, I actually made it harder than it needed to be. Overtraining most of my life, predominantly due to the fact that I loved training (what a wanker, I know) but also because like many people I fell into thinking more work = more results. It doesn't by the way. Knowing what I know now, if I'd done a lot less high intensity training and placed more emphasis on recovery in my teens and twenties, I'd probably be in even better shape than I am now and my sports performance would undoubtedly have been much higher!
So there I am on my high horse thinking these drugs are a bad thing because it's going to give people health who haven't worked for it and also make my life as a PT much harder, not to mention the damage these drugs have the potential to cause. Thankfully, it wasn't long before I gained some perspective and came to my senses.
A shift in perspective
I still do believe that these drugs are fundamentally unhealthy and do have side effects that have the potential to be catastrophic. But in the case of someone carrying 100lbs of excess bodyfat, the 'unhealthy' that these drugs cause, is much 'healthier' than the stress of all that extra weight on the body. Not only that, but one of the biggest barriers to entry for exercise, especially in a gym environment, is a sense of shame or embarrassment about being overweight. If you ask me it is just straight up sad that the person who needs exercise the most, is too ashamed, or self conscious to actually do it because of the very problem that it would help fix! There are a lot of people who convince themselves that they'll start working out when they've lost a bit of weight, because then they would feel comfortable and confident enough to step foot in a gym. Obviously it is infinitely better for people to start exercising in the first instance, before or at the latest when they start taking these drugs. But if it takes the initial weight loss from Mounjaro or Ozempic etc for them to be able to start, surely that is better than someone remaining fat and sedentary and continuing down that path!
What the science says
So what is so "potentially catastrophic" about GLP-1's? There are people out there saying that these drugs cause muscle and bone loss. They don't. Muscle and bone loss is a really serious problem, especially for women, but GLP-1's do not cause these organs to atrophy. What GLP-1's do is disrupt signals between your brain and digestive system, causing you to stop eating. It is the resulting reduction in calories that causes the 'intended' weight loss for the patient. Unfortunately though it is not just body fat we lose when we're in a calorie deficit as dramatic as what we get with these drugs. We lose 'weight', which is a combination of body fat, muscle and bone and it's losing the latter two that really does cause health problems.
The problems caused by losing muscle and bone are profound and need to be seriously considered by anyone using a GLP-1. Muscle and bone are so vital for many things, the factor I'll focus on mainly is metabolic health, since that is the 'natural' driver of body mass that we're 'affecting' with the GLP-1's.
In very simple terms a dramatic shortage of calories (which is what GLP-1's create) causes a loss of muscle mass and bone density. This means, among other things, your body won't burn as many calories throughout any given day, week, month. With a diminishing caloric burn, unless you keep gradually reducing the amount you eat, you'll likely put body fat back on rapidly as soon as the amount of calories in is a higher number than the calories you burn. And if you do keep reducing caloric intake, continual undernourishment will lead to systems and processes of the body simply not working. As well as even more loss and degradation of muscle and bone tissue, the downward spiral will continue.
Muscle and bone do a huge amount to protect us from illness, injury and disease. We need as much lean muscle as possible, and our bones to be nice and strong. To put it bluntly, the less muscle and bone density you have, the earlier and more likely you are to need full time care in order to survive.
What you should do if you're taking GLP-1s
So what's the answer? Stay fat, or suffer the almost equal health issues that come along with taking the GLP-1? Happily you can, to some degree, mitigate the ill-effects of such a pronounced reduction in food intake while using these drugs. Two things are very important when taking Mounjaro, Wegovy or Ozempic. You must prioritise protein in your diet and you must strength train. Implementing these two factors together whilst losing a large amount of weight will limit the amount of muscle you lose and therefore the level of metabolic damage and bone frailty you'll cause. This will make your quality of life better. It'll help prevent diseases like Osteoporosis and Alzheimer's. It'll also give you a much better chance of actually coming off the drugs once you achieve a more manageable weight, for a few reasons:
- Your metabolic rate will still be at a level where your body can burn enough calories to maintain your weight without gaining fat if you start eating a more 'normal' diet.
- You will have learned the skill of exercise and gained the confidence to carry on. This will have profound effects on the quality of the rest of your life.
- Because you have held onto some of your muscle, it makes every day tasks as well as exercising much more manageable and enjoyable. It's all well and good losing a load of weight, but if that weight was your muscle, using and enjoying your now 'slimmer' body will be more difficult.
- It will support and enhance the effects the drug has, rather than simply shedding body tissue and looking smaller, frail and haggard, hence the term 'Ozempic face', you'll have maintained some semblance of health giving you a platform to build from.
If you're on a GLP-1, eat a high protein diet and lift heavy things. That's really, really important.
Why coaching still matters
So when I first became aware of GLP-1's I was worried they would make my profession obsolete. In actual fact I think they make my profession even more vital than it was before. By most forecasts, there are going to be a lot of people taking GLP-1's in the coming years and decades. Obviously I would prefer it if people just used diet and exercise to achieve the weight loss, but is that realistic?
If patients on these drugs want to not be completely fucked, sorry but it's true, they'd better start implementing the practices that will protect them from frailty. These drugs essentially speed up the ageing process and strength training is the only thing we can do to slow it down. Strength training in mid life is proven to make old-age less frail and more independent. GLP-1's have the very real potential to bring the frailty associated with people in their 70's & 80's much earlier in life.
If you are a candidate for GLP-1's you're quite likely to have many barriers to strength training and a healthy diet; low self esteem, poor nutritional awareness and low physical skills, and that is understandable in today's society. These things are dramatically improved by practicing strength training but a lack of them to begin with can make it difficult to get started.
This is where hiring a good coach or PT comes in. I pride myself on coaching people to better health and physiques not only by creating an effective program and instructing the techniques, but also building my clients up mentally and emotionally, helping them to develop all the skills necessary to live a healthy and full life. Through empathy, gentle coaching, support and encouragement. Any coach can prescribe a program. Find one who understands and will give you the full package, not just reps and sets.