Think of your most recent family gathering. You may have a few uncles who have the same receding hairline, or some cousins who look similar in height, however, you will notice many differences among this group of people in their shapes, sizes, physical features, and mannerisms. Now let’s add in their daily habits such as occupation, sleep patterns, stress levels, taste in food, allergies, and physical activity. Everyone most likely has some sort of connection through relation or living in the same general geographical location, yet they are all different in their own way, inside and out. This is exactly why weight loss and body fat loss have no magic pill- we are all so different!
Through the years there have been many advances in medicine, technology, and research which has provided new techniques for weight and body fat loss. I am sure you know at least one person who has tried a strategy such as intermittent fasting, low carb/ketogenic diet, bariatric surgery, liposuction, or online intervention resources. You are going to hear many success or disaster stories among each of these methodologies, along with an array of pros and cons which can be confusing to understand underlying health risks. Even among most success stories, the most common concern is difficulty in maintaining long-term weight loss after intervention has been completed.
This brings us to GLP-1’s, the newest drug development that has a few FDA approvals to help individuals with weight loss. What are they? How do they work? Should I exercise while on them? Let’s dive in.
What are GLP-1’s?
To start, the name is an acronym for Glucagon-Like-Peptide-1 which is a naturally occurring hormone. It is involved in regulation of blood sugar which also can affect levels of appetite. The hormone is produced in your intestines as a response to food intake which will release insulin if blood glucose levels raise, decrease glucagon release from the liver, slow gastric emptying, and can reduce overall hunger cues. The initial development of GLP-1 medications derived from diabetes treatments in which they noticed weight loss benefits as well, which has led to their use for weight loss treatments.
Currently there are four drugs approved based on their effectiveness in promoting weight loss in addition to their use in managing type 2 diabetes. These drugs are:
- Liraglutide (Saxenda): Initially approved for the treatment of type 2 diabetes under the name Victoza, Liraglutide was later approved as Saxenda for weight management in adults with obesity or who are overweight with at least one weight-related condition such as hypertension, type 2 diabetes, or dyslipidemia.
- Semaglutide (Wegovy): Semaglutide is available under different brand names for different uses; for diabetes management as Ozempic, and for weight loss as Wegovy. Wegovy has been shown to produce significant weight loss in clinical trials, making it a popular choice for obesity treatment.
- Dulaglutide (Trulicity): While primarily used for the treatment of type 2 diabetes, Dulaglutide has also shown effectiveness in reducing body weight. However, as of my last update, it is not specifically approved for weight management.
- Exenatide (Bydureon, Byetta): Available in a twice-daily injection (Byetta) or a once-weekly injection (Bydureon), Exenatide was one of the first GLP-1 receptor agonists to be used in the treatment of type 2 diabetes. It also aids in weight loss, although to a lesser extent compared to some of the newer GLP-1 receptor agonists.
GLP-1’s are a breakthrough for weight management, however, any medication that affects hormone secretion and reception within your body can have significant side effects. As I spoke about previously, everyone is different and effects can vary per person. General known side effects of GLP-1’s include nausea, vomiting, diarrhea, constipation, and risk of pancreatitis and these symptoms can vary based on the medication you are utilizing. There are also other risks associated with pre-existing conditions, which is why you should always consult with a doctor about your personal situation. It is extremely important to work closely with a physician and take notes of your experiences along the way.
GLP-1’s and Exercise- What Does the Data Say?
Should you exercise while on GLP-1 medication? Will it affect your results? The short answer for both is yes. Studies completed in 2022 and 2023 show that the implementation of an exercise routine along with a GLP-1 medication can significantly improve results in weight loss, increase muscle mass, decrease abdominal obesity, reduce metabolic syndrome, and overall inflammation (compared to placebo and non-exercise groups). All of these benefits contribute to an overall reduction of health risks such as cardiovascular disease, type 2 diabetes, and obesity.
Just like any other study conducted, there can be limitations. In this case, both studies are small sample sizes (under 200 individuals total). This may have implications on how well the results can be generalized to the rest of the population. Additionally, these studies only utilize one GLP-1 (Liraglutide), which can mean the other medications could have different results.
It is important to view the methodologies of the studies to understand what type of exercises they utilized. Both of these studies examined general exercise, following 150 minutes per week of moderate exercise or 75 minutes per week of vigorous aerobic activity. They do not directly specify weight training; however, each study acknowledges weight training as productive to increase muscle mass and help control blood sugar. The relevance of increased muscle mass is important because higher amounts of muscle mass will help improve an individual’s resting metabolic rate, which means they will burn more calories in their day-to-day activities. Resistance training can also help with bone density, joint health, and stability.
Each study also discusses the need to further research with larger sample sizes or longer ranges of time. Most of this data is preliminary to get an idea of effectiveness, however, different methodologies and approaches can lead to more precise data about best practices. I hope to see more in-depth information about how to help individuals taper off the of the drugs effectively while still maintaining weight loss through exercise and how to optimize nutritional guidelines for these individuals.
My Experience
I have worked with at least a dozen clients who are taking some form of a GLP-1 medication. Some individuals do have side effects in which we have consulted with their physician. However, the clients who do not have side effects conduct workout routines as normal. A limitation to consider is that the client has a suppressed appetite, and you need to ensure they are hitting appropriate macronutrients to recover from the workout and have energy for the day. Individual plans can vary per person but typically consist of at least 1-2 full body compound exercises performed for 4-6 sets of 4-6 repetitions. These movements include squats, deadlifts, rows, and presses to help bone density and overall strength. From there I will add in accessory movements for purposes of muscle hypertrophy, muscular endurance, or cardiovascular fitness based on their goals and capabilities. Through this anecdotal experience, I have had multiple clients successfully lose 50+ pounds over the course of a year and have maintained habits taught during our training sessions to keep the weight off.
If you are a personal trainer or someone taking GLP-1’s in addition to exercise, my main take aways are these:
- Consult with a doctor about new signs or symptoms to pay attention to when starting a workout routine. The medications are relatively new, so more research will continue to come out about best practices.
- Ensure you are still eating enough food to make certain you are not at too much of a caloric deficit in addition to exercise. Burning a lot of calories while simultaneously being deficient on calories consumed could lead to unhealthy weight loss and many other metabolic problems down the road. In general, controlled, slow, and steady practices will lead to success and keep the weight off long term. Consult with a dietician for nutritional guidance.
- Strength train at least 2-3 days per week, working in some compound movements and accessory movements based on the client’s skill levels. Adding muscle mass should be a goal.
- Listen to your body. I tell everyone this, regardless of medication. Your body will keep score, and let you know if you are doing too much or too little. Identifiers could be your sleep quality, stress levels, workout recovery, and energy levels during the day. Wearable tools such as Whoop or Oura are great to see day-to-day biometrics of how your body is functioning and recovery scores.
To conclude, nothing is magic, especially weight loss. It is crucial to check in on data from studies and connect with qualified professionals such as your doctor, a dietician, and a personal trainer to ensure quality results. GLP-1 medication can be a helpful tool to add in for weight management, however, information is starting to come to light about how important it is to focus on other areas such as cardio, nutrition, and strength to see the most efficient results. Please see the references I gathered below for up-to-date information and studies that have been conducted. Feel free to comment or send me a personal message with any questions or comments regarding your health and fitness journey!
-Nick Fey
(Disclaimer: I am not a medical professional, please refer to your doctor for questions about if GLP-1’s or other weight loss interventions are appropriate for you. All references are cited below)
References:
Akerstrom T, Stolpe MN, Widmer R, et al. “Endurance Training Improves GLP-1 Sensitivity and Glucose Tolerance in Overweight Women.” Journal of the Endocrine Society. September 2022.
American Diabetes Association. (2023). “9. Pharmacologic Approaches to Glycemic Treatment: Standards of Medical Care in Diabetes—2023”. Diabetes Care, 46(Supplement 1), S140-S157.
Davies, M., D’Alessio, D. A., Fradkin, J., Kernan, W. N., Mathieu, C., Mingrone, G., Rossing, P., Tsapas, A., Wexler, D. J., & Buse, J. B. (2018). “Management of Hyperglycemia in Type 2 Diabetes, 2018. A Consensus Report by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD)”. Diabetologia, 61(12), 2461-2498.
Khera, R., Murad, M. H., Chandar, A. K., Dulai, P. S., Wang, Z., Prokop, L. J., Loomba, R., Camilleri, M., & Singh, S. (2016). “Association of Pharmacological Treatments for Obesity With Weight Loss and Adverse Events: A Systematic Review and Meta-analysis”. JAMA, 315(22), 2424-2434.
Pi-Sunyer, X., Astrup, A., Fujioka, K., Greenway, F., Halpern, A., Krempf, M., Lau, D. C. W., le Roux, C. W., Violante Ortiz, R., Jensen, C. B., & Wilding, J. P. H. (2015). “A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management”. The New England Journal of Medicine, 373, 11-22.
Sandsdal RM, Juhl CR, Jensen SBK, et al. “Combination of Exercise and GLP-1 Receptor Agonist Treatment Reduces Severity of Metabolic Syndrome, Abdominal Obesity and Inflammation: A Randomized Controlled Trial.” Cardiovascular Diabetology. February 25, 2023.
Wilding, J. P. H., Batterham, R. L., Calanna, S., Davies, M., Van Gaal, L. F., Lingvay, I., McGowan, B. M., Rosenstock, J., Tran, M. T. V., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., Kushner, R. F. (2021). “Once-Weekly Semaglutide in Adults with Overweight or Obesity”. The New England Journal of Medicine, 384, 989-1002.
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