Months After Coaching Clients on GLP-1s: The Conversations That Surprised Me
When I answered Jeff: “I think these medications are going to save thousands of lives, and that obesity should be treated as a chronic illness. If we support taking blood pressure medications and insulin indefinitely, why demonize taking a medication that could do away with the others and improve quality of life?“ Relief flooded Jeff’s face, and the tears that welled up in his eyes made my own throat catch. “Thank you,” he said.
I can recount a dozen other interactions like the one I experienced with Jeff. After speaking with dozens of people over the past few weeks who are using GLP-1 medications, three themes kept appearing again and again. And each one revealed something important about how we still misunderstand weight, health, and metabolism. The conversations I have still surprise me, but the science validates them. We have work to do.
GENETICS
Genetics play a major role in body weight regulation. In fact, research estimates 40–70% of obesity risk is heritable.
This means that weight is impacted by biological systems including:
- appetite regulation
- energy expenditure
- fat storage
- hunger hormones
Twin and family studies repeatedly show that genetics have a strong influence on not only body weight alone but on the actual places throughout the body in which fat is stored and distributed.
EPIGENETICS
Perhaps what has been most interesting is the emerging research that suggests environmental conditions experienced by previous generations, such as famine,can alter gene expression in descendants.
Takeaway 2: The Side Effects Narrative Is Often Very Different From Reality
We often hear dramatic stories about side effects from GLP-1 medications. Yet when speaking with clients:
Most reported minimal or manageable side effects.
he most common patterns I heard were:
- mild constipation
- reduced appetite
- hair shedding during rapid weight loss
An important note to make about hair loss is that hair shedding is actually common during rapid weight loss, not unique to GLP-1 medications.
This condition is called telogen effluvium, where hair temporarily sheds after a metabolic stress event like rapid weight loss.
This is also why people may be mistaken for being sick, and, most importantly, why slow, steady weight loss under the supervision of a professional is essential.
Documented Benefits
After meeting with clients, there is no doubt that the benefits of these medications largely outweigh the negatives. GLP-1 medications have demonstrated benefits including:
- improved blood sugar control
- reduced cardiovascular risk
- reduced blood pressure
- improvement or remission of type 2 diabetes
GLP-1 drugs have also been shown to reduce major cardiovascular events in high-risk patients. Many of my clients have been able to discontinue medications for, hypertension, insulin resistance, and diabetes.
Takeaway 3: Almost No One Was Told About Body Composition
This was the most surprising pattern: nearly every client had a goal weight, but almost none had been told about:
• body fat percentage
• lean muscle mass
• metabolic rate
• recomposition
Why Muscle Matters During Weight Loss
Muscle mass plays a crucial role in metabolic health. Skeletal muscle is one of the body’s primary sites of glucose disposal, meaning it directly affects insulin sensitivity.
Muscle supports:
• metabolic rate
• blood sugar regulation
• energy levels
• bone health
Losing muscle during weight loss can lower metabolic rate and contribute to fatigue.
Actionable Takeaways
1: Reframe the Conversation Around Weight
Steps:
- Stop viewing obesity as a willpower issue.
- Understand the biological drivers of weight.
- Focus on sustainable metabolic health rather than punishments or restrictions
High Body Fat Percentages and Health
xcess body fat is associated with increased inflammation and metabolic dysfunction.
Adipose tissue, otherwise known as extra fatty tissue, releases inflammatory cytokines that contribute to:
- insulin resistance
- cardiovascular disease
- chronic inflammation
This explains why someone may lose weight but still feel:
- fatigued
- metabolically sluggish
- low energy
Body composition matters more than the scale alone.
2. Prioritize Muscle While Losing Weight
Preserving muscle helps maintain metabolic rate.
Steps:
- Aim for adequate protein intake: 100 grams minimum a day to preserve muscle and more to gain.
- Include resistance training 2–3 times per week
- Track body composition, not just weight
