In the evolving landscape of weight management, the emergence of drugs such as Ozempic, Wegovy and Mounjaro marks a major shift. These drugs, and others like them, are classified as either GLP-1 analogs or GLP-1/GIP receptor agonists. For simplicity, in this blog they are collectively referred to as “GLP-1 drugs” or “GLP-1 Drugs.”
Although these drugs are intended for people with type 2 diabetes, they are increasingly being prescribed “off-label” for people with obesity (note that Wagovy is approved for weight loss, while the others are not). And while these drugs have been lauded for their effectiveness in appetite suppression and weight loss, they also bring new considerations for exercise professionals and health coaches. This blog aims to equip you with knowledge and practical strategies to effectively support your clients who, in collaboration with their doctors, choose these medications for their weight loss journey.
How do these drugs work?
GLP-1 drugs work by mimicking gut hormones, lowering blood sugar levels after eating and slowing stomach emptying. Their effectiveness in weight loss has garnered a lot of attention, but it is important to understand that weight loss alone does not include all of the health benefits.
Emerging research on the intersection of GLP-1 drugs and physical activity
In one of the first peer-reviewed articles of its kind, the researchers report how physical activity fits into the treatment of obesity when using GLP-1 drugs. This research highlights the need to refocus on lifestyle factors, including physical activity, for those using these drugs.
With these medications, the traditional goals of exceeding a minimum of 150 minutes of moderate-intensity physical activity per week and achieving 200 to –300+ minutes of exercise per week for significant weight loss and weight loss maintenance may be less relevant. That is, meeting the lower level public health recommendation of 150 minutes of moderate-intensity activity and two days of resistance training per week may be enough to support and maintain weight loss when a person takes a GLP-1 drug. This shift in focus recognizes the role of medication in weight loss, while also emphasizing the importance of physical activity for overall health. However, because research in this area is still emerging, there is no specific guidance in this area.
Key takeaways for exercise professionals and health coaches
Train to lose lean mass: A growing concern with GLP-1 drugs is the rate of loss of lean mass associated with rapid weight loss. Therefore, a comprehensive exercise program, with a strong focus on resistance training, is necessary to mitigate muscle loss and improve overall body composition.
Emphasize muscle quality over quantity: The research findings mentioned above highlight the importance of improving muscle function rather than simply increasing muscle mass. Resistance training, which is critical in this regard, enhances muscle strength and function without necessarily increasing muscle size, promoting better insulin and glucose control.
Promoting healthy eating habits: While GLP-1 drugs help suppress appetite, incorporating healthy eating habits is crucial. Encourage your clients to focus on nutrient-dense foods that support overall health and complement their weight loss goals. Balanced diets rich in fruits, vegetables, whole grains, lean proteins, and healthy fats can enhance drug effectiveness, improve energy levels for physical activity, and support metabolic health. As exercise professionals and health coaches, guide your clients to make informed food choices and develop sustainable eating habits that align with their health goals.
Explain possible side effects
As an exercise professional or health coach, it is important to be aware of the potential side effects caused by GLP-1 medications. While it is not within your scope of practice to determine if your client is experiencing a drug-related side effect, you may be the first person to recognize common symptoms with you or notice signs during your sessions. In this case, it would be wise to inform the client of the possible relationship between what they are experiencing and the medication they are taking and refer them to their prescribing physician. Here is a list of possible side effects to be aware of:
- Kidney, pancreas and stomach problems: Nausea, vomiting, diarrhoea, stomach/back pain, constipation, bloating, belching, gas, heartburn and dehydration
- Changes in vision
- Low blood sugar: Dizziness, lightheadedness, anxiety, slurred speech, sweating, irritability or mood changes, confusion, sleepiness, tremors, weakness, headache, feeling nervous, and fast heart rate
- Serious allergic reaction: Swelling of the face, lips, tongue or throat. severe rash or itching; and problems breathing or swallowing
- Depression or suicidal thoughts
- Runny nose or sore throat
- Stomach flu
- Decreased appetite
- Gallbladder problems: Fever, yellowing of the skin or eyes, and clay-colored stools
- Thyroid problems: Lump or swelling in the throat, hoarseness, difficulty swallowing and shortness of breath
Stay within the scope of practice: As exercise professionals and health coaches, it is vital to be active within your practice. This means:
- Providing evidence-based exercise and lifestyle recommendations
- Sharing evidence-based dietary guidelines and resources, such as those approved or developed by the federal government, especially the Dietary Guidelines for Americans and MyPlate recommendations
- Avoiding medical advice or adjustments to treatment regimens
- Partner with healthcare providers for a holistic approach to your client’s health
- Work with clients to identify and set non-weight loss goals
The future of exercise in the era of GLP-1 drugs
Research in this area is still emerging, and updated perspectives may evolve as new studies emerge. It’s important to keep up with the latest research and be flexible in adjusting your training and training strategies accordingly. Rest assured that these medications do not negate the need for lifestyle change or diminish the importance of the work you do with your clients. Your role in guiding clients on their weight loss journey, especially those using GLP-1 medications, is as invaluable as ever. And, remind clients that weight loss alone is no substitute for exercise and that there are countless reasons and benefits associated with physical activity and exercise beyond weight loss, including heart health, mobility, strength and emotional well-being.
conclusion
The ubiquity of GLP-1 drugs has reshaped the weight loss landscape, requiring a differentiated approach from exercise professionals and health coaches. By focusing on improving muscle quality, adjusting exercise recommendations, and understanding the effects of lean mass loss, you can play a critical role in the health and well-being of your clients. Stay informed, collaborate with healthcare professionals, and continue to inspire your customers to live healthier, more active lives.
For a deeper dive into the science behind weight loss, exercise, and these drugs, Watch this video by Dr. Steve Stites from the University of Kansas Health System.
And, be sure to stay tuned to ACE for more on this important topic.
