A prescription can help you lose weight. It cannot do a single repetition for you.
That is where I want to start the GLP-1 conversation. Not with a celebrity photograph. Not with the promise of dropping a clothing size before your next vacation. With a question that the weight-loss business too often treats as optional: what are you building while you are getting smaller?
Here is my position. GLP-1 medicines can be valuable medical tools. But the version of the story that sells weight loss as a substitute for strength training, adequate nutrition, and a workable daily routine is an incomplete transformation.
I am not impressed by a smaller number in isolation. I want to know whether you are stronger, whether you can eat in a way that supports your life, and whether your progress has a plan behind it. If you are a man running a company, raising a family, and trying to remain physically capable for the next twenty years, those questions matter more than a dramatic caption.
The controversial part should not be that a coach expects more than weight loss. The controversial part is how comfortable we have become celebrating weight loss without asking what came with it.
Before the weight-loss boom, there was diabetes research
GLP-1 stands for glucagon-like peptide-1. It is a hormone your body produces. Medicines in this category act on the GLP-1 receptor, influencing processes involved in blood-glucose regulation and appetite. Their scientific history began long before the current conversation about looking leaner.
One remarkable chapter involves the Gila monster. VA researcher John Eng identified exendin-4, a peptide in its venom with GLP-1-like activity that lasted longer than the natural human hormone. A synthetic version, exenatide, became Byetta, approved for type 2 diabetes in 2005. By October 2026, that first U.S. approval is more than twenty years old. Modern semaglutide is not extracted from lizards; the animal story explains an important early medicine, not how every medicine in the category is made. Source: U.S. Department of Veterans Affairs.
The move into obesity treatment also did not happen overnight. Liraglutide received U.S. approval for weight management as Saxenda in 2014. Semaglutide was approved for diabetes as Ozempic in 2017 and for weight management as Wegovy in 2021. Tirzepatide followed as Mounjaro for diabetes in 2022 and Zepbound for weight management in 2023. Tirzepatide activates both GIP and GLP-1 receptors; it is related to, but different from, a GLP-1-only medicine. These are selected historical milestones, not an exhaustive list of current products or indications. Source: FDA approval-history table.
That history matters because two lazy arguments dominate this subject. One treats these medicines as a fashionable invention with no scientific foundation. The other treats their medical legitimacy as proof that every weight-loss sales pitch built around them deserves your trust. Neither argument is good enough.
The shortcut being sold is bigger than the medicine
For someone living with obesity, reducing appetite can be a meaningful medical advantage. Calling that person lazy does nothing to improve their care. Obesity is not a character assessment, and struggling to manage body weight does not mean someone lacks ambition.
My objection is to the fantasy that one intervention can take responsibility for everything else.
You take the medication. You eat less. The number falls. People congratulate you. Nobody asks whether you have a training plan, whether you are meeting your nutritional needs, or what happens if your treatment changes.
That is where a useful tool becomes an excuse for an inadequate process.
I understand why the promise appeals to executives. You delegate. You buy expertise. You use technology to remove friction. There is nothing wrong with making a difficult task easier. But your body still needs the experiences that produce the capabilities you want. No prescription can create the practice of lifting well, make tomorrow's lunch available, or reserve time on your calendar.
Call the medicine a cheat code if you want. The dangerous cheat is lowering the definition of success until the scale is the only thing that has to improve.
Weight loss is not automatically fat loss
The muscle concern deserves a serious discussion. It also deserves better evidence than the exaggerated statistics circulating online.
In the exploratory STEP 1 DXA substudy, 140 participants were assessed; 76% were women. The semaglutide group lost 15% of body weight over 68 weeks. Total fat mass fell 19.3%, and total lean body mass fell 9.7%. The proportion of body weight represented by lean mass increased. Those percentages refer to different starting compartments. They do not mean that 9.7% of the weight lost was muscle. Source: STEP 1 body-composition analysis.
In the SURMOUNT-1 tirzepatide DXA substudy, approximately three quarters of the weight reduction was fat mass and one quarter was lean mass. The proportions were similar to placebo despite substantially greater total weight reduction with tirzepatide. That does not support the blanket claim that most weight lost is muscle, or that these medicines uniquely cause a disproportionate loss of lean tissue. Source: SURMOUNT-1 body-composition study.
Lean mass is not a synonym for skeletal muscle. DXA estimates a broader tissue compartment, including water and other non-fat soft tissue. A change in that measurement is not a direct measurement of muscle fibers disappearing. A scan also does not tell the entire story about strength, muscle quality, or everyday function.
Those distinctions should make the conversation more useful, not make us dismiss the issue. Losing lean tissue can still matter, especially when someone begins with limited strength or difficulty meeting nutritional needs. The question is what the individual is losing, how well they function, and what support they need.
I want to see a training record alongside a progress photograph. Are your exercises becoming more controlled? Can you complete useful work? Are your normal working weights holding up? Can you carry your suitcase and get up from the floor comfortably? If those answers are getting worse, I want to investigate rather than applaud a lower weigh-in.
Smaller does not always mean less capable, either
It would be convenient for an anti-medication argument if every reduction in lean tissue meant poorer function. The research does not allow that simple conclusion.
A 2026 secondary analysis of STEP UP examined body composition and function with semaglutide. In its MRI subset, estimated reductions in thigh muscle volume were not statistically significant versus placebo, while muscle fat infiltration improved. It is a different study, with different measures, from the earlier DXA analysis. It does not eliminate individual concerns or guarantee preserved muscle, but it reinforces why kilograms of lean tissue alone cannot settle the whole question. Source: STEP UP secondary analysis.
If my argument needs distorted science to sound forceful, it is not a strong argument. I would rather make the harder, more defensible point: an effective medical treatment still deserves a complete plan around it.
Less appetite is not a nutrition education
Imagine an executive whose breakfast is coffee, whose lunch depends on the meeting schedule, and whose dinner arrives through an app. Reducing his appetite may reduce how much he eats. It does not automatically teach him how to structure the day.
He still needs a dependable breakfast if that helps him meet his needs. He still needs a lunch option near the office. He still needs a plan for the airport, the client dinner, and the evening when he gets home late.
These are examples of planning gaps, not a description of everyone taking medication. Many people make substantial changes while using GLP-1 therapy, and their work deserves credit.
But a smaller portion of an inadequate routine is still an inadequate routine. If someone has limited appetite, the food they can comfortably eat needs thought. Protein, fiber, micronutrients, fluids, and adequate energy cannot be replaced by satisfaction that the day contained very little food.
My coaching question is simple: what are you going to eat tomorrow, and how will it get in front of you?
If the answer is a shrug, there is work to do. If symptoms make eating or drinking persistently difficult, that is a conversation for the prescribing team. A person should not have to choose between tolerating treatment and meeting basic nutritional needs without help.
What the regain research actually tells us
The STEP 1 extension followed a subset after semaglutide and the trial's structured lifestyle intervention ended. One year later, participants previously receiving semaglutide had regained about two thirds of their prior weight loss on average. Their net weight remained 5.6% below baseline, and many cardiometabolic improvements moved back toward baseline. These are group averages from follow-up, not a prediction for every individual. The study also did not isolate stopping medication from ending structured lifestyle support. Source: STEP 1 trial extension.
That finding should change the sales conversation. If a program talks endlessly about how quickly you can lose weight and barely mentions how treatment and maintenance will work over time, ask better questions.
The finding does not prove that participants lacked discipline. It does not establish that everyone who strength trains will maintain weight loss after stopping medication. Hunger and weight regulation are not problems that a motivational speech can reliably solve.
Continuing medication can be appropriate long-term care. Stopping is not a graduation ceremony everyone should aim for. The decision belongs with the prescribing clinician and the patient, considering benefits, side effects, preferences, access, and medical circumstances.
What I want is preparation. What if coverage changes? What if symptoms interfere with eating? What if your work schedule shifts? If appetite returns, who helps you respond? Those questions belong near the beginning, when you have time to build support.
Yes, these medicines can improve health
An honest critique has to acknowledge meaningful benefits.
In 2024, the FDA approved Wegovy to reduce cardiovascular death, heart attack, and stroke risk in adults with established cardiovascular disease and overweight or obesity. In the supporting trial, major cardiovascular events occurred in 6.5% of participants receiving Wegovy and 8.0% receiving placebo: an absolute difference of 1.5 percentage points, often described as a 20% relative reduction. That result applies to the studied population, not automatically to every person seeking weight loss. Source: FDA.
So I will not tell you that someone cannot become healthier unless every habit changes first. That would be false. Medical outcomes, fitness, eating skills, and body composition overlap, but they are different things.
My standard is that we should care about all of them. The existence of a medical benefit is a reason to take the rest of the plan seriously. It is not permission to ignore it.
What I want included in a serious plan
Start with resistance training that fits the person. Choose appropriate movements, manageable starting loads, and a schedule that can survive the workweek. Record what you do. Progress when performance supports it. Make the appointments real before another week disappears into meetings.
Plan nutrition around what you can consistently obtain and tolerate. Discuss appropriate intake with qualified professionals, particularly if medical conditions or treatment symptoms complicate the picture. A registered dietitian can help turn a vague instruction to eat better into a useful plan.
Track multiple dimensions. A waist measurement, body-weight trend, training log, daily function, and clinician-selected health markers answer different questions. Use body-composition testing when it will influence a decision, and interpret small changes cautiously.
Include aerobic activity and ordinary movement. A good plan should support walking through an airport, taking the stairs, and enjoying a weekend with your family. Fitness has a life outside the mirror.
Coordinate care. Your prescriber manages medication and medical risk. A dietitian can address nutritional adequacy and eating difficulties. A coach helps you practice appropriate training and repeatable routines. Each professional should stay within their role and communicate when that helps you.
A 2025 joint advisory from four professional organizations emphasized nutrition, resistance training, assessment of strength and function, and wider lifestyle support alongside GLP-1 therapy. Those are reasonable care priorities, not a reason to blame people whose treatment is difficult. Source: joint clinical advisory.
Questions worth asking before another progress photo
What exactly are we trying to improve beyond body weight? What is my resistance-training plan? Who is checking whether I am eating adequately? How will we respond if my performance is declining? What does long-term treatment look like? What is the plan if access changes?
If nobody can answer, the plan needs more substance.
And if you are already using a GLP-1 without that support, you have not missed your opportunity. Start with the next useful action. Put a training appointment on the calendar. Bring food-intake concerns to your care team. Establish a few consistent measurements. Pick a dependable meal you can repeat.
You do not need to earn the right to receive medical treatment by proving perfect habits first. You do deserve a treatment process that takes your whole life seriously.
My position: demand more from the transformation
I support tools that help people improve their health. I challenge the idea that getting lighter completes the job.
If you lead a company, you already understand that one improving number cannot tell you whether the whole operation is healthy. Bring that judgment to your body. Ask what is improving, what needs protecting, and what you are building for the years ahead.
I want a man who feels capable in his life. Who has a plan for a difficult week. Who can eat without making every decision from scratch. Who trains because strength matters to him, rather than because he is trying to punish himself for dinner.
The medication can be part of that story. It should never be the only standard by which the story is judged.
If weight loss is part of your goal, make strength part of the conversation. Apply for private coaching with Body By Akram to build training and practical routines around your schedule. Medication decisions remain with your prescribing clinician.
Akram Hameed is the founder of Body By Akram and an executive fitness coach in Scottsdale, Arizona. This article presents a coaching perspective and research context, not individualized medical advice. Do not change a prescribed medicine based on a blog article.
Feature photograph: HualinXMN, Wikimedia Commons, CC BY-SA 4.0. Original photograph, unchanged. Product pictured was sold in mainland China; devices vary by market. Editorial illustration, not dosing guidance.
