Newsflash: the GLP-1 weight loss medication train isn’t going anywhere. A hot topic of conversation amongst everyone in the health and wellness space, it remains both coveted and a little taboo, sought after but hard to access, impressive but not fully understood. In the past year, it has continued to pop up on our social feeds, in ads, on the red carpet, and during hangouts with friends or family.
At obé, our mission is to empower women to build body literacy and get excited about their fitness journey—whatever their goals may be. If weight loss is on the list, it’s crucial to have the best tools and the right information.
As far as the right tools go, our newest workout program, MuscleGuard, will be your best movement supplement. Designed to prevent muscle mass loss, build strength, protect bones, and improve body composition for those who are taking weight loss medication, this strength training plan checks all the boxes. The goal is to lower the risk of potential side effects related to muscle mass loss that come with weight loss, like chronic disease, slowed metabolism, reduced bone density, or sarcopenia. If that sounds a little intimidating, don’t stress—the program is super beginner-friendly.
But there’s more to it than just that—and understanding what’s happening to your body while you’re on a weight loss medication is the first step to a successful weight management journey. To answer all of your questions about weight loss medications, the importance of strength training during this time, and more, we turned to endocrinology expert, Dr. Rekha Kumar.
🎧 Prefer to listen? If you’re an obé member, check out the Mat Chat talk here.
Expert spotlight: Dr. Rekha Kumar is the Chief Medical Officer of Found*, one of the largest medically-assisted weight care programs in the US that helps people achieve lasting results by combining behavior change with biology. Formerly a practicing endocrinologist and obesity medicine specialist serving as the medical director of the American Board of Obesity Medicine, she recently co-authored a study examining medications that treat obesity and the attitudes towards them in the healthcare field.
Weight-loss drugs have become incredibly popular, seemingly overnight. What’s changed?
To give some context: I’m an endocrinologist by training, and examining endocrinology, diabetes, and metabolism. That’s what hormone doctors do. In the past 20 years, new information has come out indicating that hormones regulate body weight.
Years ago, we thought that fat tissue was just a depot for fat. What we’ve learned now is that fat cells are hormonally active, and they make many mediators or biomarkers that help regulate body weight. And because of all the hormonal regulation involved in body weight control, my field encompasses obesity medicine.
The reason that there’s so much hype about GLP-1 medications is because they’re very effective. When we’re hearing 20-25% total body weight loss, that’s almost as much as surgery.
How does this class of weight-loss medications work?
It’s both a physical thing and a brain thing. As a class of drugs, GLP-1s are glucagon-like peptide-1 receptor agonists that mimic a natural hormone we make called GLP-1. We make this hormone—which signals fullness to the brain, delays stomach emptying, and lowers blood sugar—in our intestines in response to a meal. The medications are an analog that lasts longer than your version of this hormone. So all of those effects are exaggerated on the medications, in addition to the hormone you make inside of you.
At Found, we address nutrition, sleep, stress, and exercise for each individual with a team of clinicians who can prescribe medication for weight loss when it’s appropriate. We don’t recommend GLP-1s for everybody, because our goal is to treat the root cause of each person’s weight gain. We call this personalized approach each member’s MetabolicPrint™.
MetabolicPrint helps uncover the root causes of weight gain and how to target them with treatment. There are four different MetabolicPrint profiles: Slow Metabolism, Brain-Gut Disconnect, Mood Responses, and Constant Cravings. Most people have a mix of two or more profiles in their MetabolicPrint and one is usually dominant. Everyone’s mix is unique.
A provider trained in obesity medicine can use MetabolicPrint to choose the most appropriate medication and lifestyle changes to help someone reach their weight loss goal. At Found, providers work with a portfolio of drugs that they can combine in more than 70 ways—and while not all of those may be right for any one person, most people usually have several options. And not all of the medicines are expensive injections—some are oral, non-GLP-1 medicines that are FDA-approved, affordable, and have a clinical track record of helping people lose weight and keep it off.
Can you tell us more about those other medications?
There are actually several non-GLP1 medications that come as pills and that have been used for years in academic obesity medicine practices. And they’re much more affordable—they’re just currently being overshadowed by GLP-1. But actually, the efficacy of oral non-GLP1 medicines can be nearly as effective as some GLP1s when paired with an appropriate program of lifestyle interventions.
What’s the relationship between weight loss and muscle loss?
Whenever we lose weight—whether that’s through diet, exercise, weight-loss surgery, or medicine—one-quarter to one-third of that weight is typically muscle. That’s just what happens when we lose weight.
What are the long-term effects of that muscle mass loss?
Metabolism slowing is the number one thing. We’d be concerned that somebody’s metabolism slows a lot when they lose lean muscle mass—and they’re a setup for rebound weight gain. Although people might desire a lot of weight loss quickly it’s important to remind them that the faster they lose upfront, the higher their chance of losing more muscle. That’s a set-up for rebound weight gain.
Going at a healthy pace by maintaining protein requirements and strength-based resistance training—is important. The goal isn’t just to weigh less, it’s to have a healthy body composition and improve metabolic health. And by the way, if you’re worried about ‘bulking up,’ it’s highly unlikely to impossible unless you’re taking muscle-growing steroids to bulk up.
The fact that you are tailoring an exercise program towards people who are on these is so important. I see people all the time who don’t have support through a tailored program like obé’s MuscleGuard, for example. I am concerned about their long-term trajectory. The last thing we want to see is people losing weight, spending a lot of money on these medicines, but not actually getting any healthier because they’re losing muscle and not improving their cardio-metabolic fitness.
For those feeling suppression in appetite, how do you make sure your body is nourished so you can maintain muscle?
Again, we want to lose as little muscle as we have control over, which means getting adequate protein and doing resistance training. If someone’s appetite is overly suppressed, they are turned away by food, or the thought of food grosses them out, we’ve probably overshot and I would want to cut back on the dose.
Sometimes people will say, “This is great, I’m not hungry at all.” I’m saying that’s not the point—the point is to have normal hunger cues so you can make good decisions. You need to prioritize protein and vegetables and keep complex carbs as a secondary. We don’t want to overshoot. The point isn’t to not eat, it’s to feel that you have more control over your choices.
There’s still a lot of stigma and judgment directed at those on weight-loss medications. As an expert in the field, what’s your perspective?
I think we have to reverse a decades-long narrative that was never rooted in science, partially because the science didn’t exist. There’s a tendency for people to want to judge people with obesity—‘they have that condition because they didn’t exercise, they ate too much, they’re lazy.’
In endocrinology, we’ve learned that’s clearly not the case. There’s this concept of set point weight—that your brain and your body try to always be at some set point. That set point tends to go up over time in people who have a genetic predisposition toward weight gain. Those who may have had certain illnesses, have gone through menopause, or are on certain medications can also experience it.
There are factors out of a person’s control that can’t be managed with nutrition and exercise alone that drive the body weight up. This has been shown in animal-model studies and human studies. A really interesting study examined what happened to “The Biggest Loser” cohort years after they completed the show. Even when they tried to stick to the right things, they tended to regain weight because their body was fighting against them. All the science shows us that this is not fully under our control or willpower.
When taking these types of weight-loss medications, are you resetting the brain? Or will you always need to be on them?
That’s probably the biggest question in this field right now: can you reset the set point? So far, the information we have is that while you’re on the medicine, your body will tolerate a lower set point. When you stop the medicine, your body will slowly regain up to that set point. But there may be other options besides being on the medicine and being off.
Maybe you de-escalate the dose, maybe you cycle on and off, maybe you take a break. I think we’re seeing this as very black and white right now: you’re either going to be on this medicine for life, or you’re going to come off for a bit and regain all the weight. There’s probably a whole slew of things we could do in between to manage weight over someone’s lifetime.
Can you tell us about the recent study by the American Heart Association on weight loss medication?
It was a cardiovascular outcomes trial in patients who have established cardiovascular disease and who took Wegovy, which is a GLP-1 that’s FDA-approved for weight loss. It looked at patients over five years, examining people who were at high risk for cardiovascular disease, comparing those who took Wegovy and those who didn’t.
People who took the medication had a 20% reduction in their risk of heart attack, stroke, and cardiovascular death. What’s particularly interesting is that the risk reduction started to be seen even before major weight loss. So there’s something about these medicines that was very protective.
I think this study was really important for the healthcare community because only 1% of doctors are trained in the science of obesity medicine. So there was even a lot of stigma within the medical community that these are vanity drugs, that they’re just for weight loss. But actually, they’re cardio-protective.
What does it mean to prescribe these types of drugs responsibly?
There’s medically-guided weight loss through a platform like Found—where someone is assessed for appropriateness and followed by a clinician and health coach. But in the world of medispas, there’s liberal dispensing of these medicines to whoever requests them.
The concern is the long-term trajectory. Are these people being followed for their health, blood sugar, cholesterol, and blood pressure? Do they have contraindications to the drug? Is that being assessed? There are reasons we don’t prescribe the drug to people who have a family history or personal history of medullary, thyroid cancer, pancreatitis, or prior allergy to another medicine in this class.
If you don’t have a sophisticated clinician who knows to ask those questions, someone might inappropriately be prescribed a medicine. We also need to make sure someone’s appropriate for it—whether they meet the criteria. That’s a body mass index of 30 or greater, or 27 or greater with a weight-related comorbidity. At Found, we’re pretty strict about that—we prescribe to people who meet the criteria and are appropriate for this class of meds. If they’re appropriate for medicine but something else is a better fit, that’s an option.
What else should our members know about weight loss medication?
I want to remind people that this is a long journey. It could be interrupted by other things. If you find something that works today, there could be changes in your treatment regimen along the way. Whether it’s interrupted by a financial reason, a pregnancy, or another medicine that makes you need to take a break, this is a very long road.
A weight journey is kind of forever for everybody. It gets harder and harder to maintain a healthy weight—for all of us. And we’re going to have to address it in some way. If we happen to be using medicine, it’s important to recognize that medicine might change over time or we may have to cycle on and cycle off for certain reasons. It’s important to continuously be under the care of somebody who knows the science of body weight.
*Found’s services and products are only available within the United States. This blog post is informational only and does not constitute medical advice. Talk to your healthcare provider about whether medication-assisted weight loss may be right for you and risk information.
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