Angela Fitch’s household historical past of weight problems caught as much as her at age 40, when she was pregnant together with her first youngster.

As a doctor and weight problems medication specialist, Dr. Fitch knew the approach to life levers to tug—and he or she had the monetary means to yank them arduous.

After giving delivery, she lifted weights with a coach twice every week. She sweated by means of one Peloton exercise after one other and tracked her meals consumption on MyFitnessPal.

However, for the subsequent decade, Dr. Fitch misplaced (and regained) the identical 5 to 10 kilos. Her blood strain crept upward. Then got here a sleep apnea prognosis.

As her fiftieth birthday neared, Dr. Fitch determined to take the recommendation she gave her sufferers. She went on treatment. (And, she misplaced 30 kilos.)

Within the years since, Dr. Fitch has often stopped her meds. For just a few months, she maintains her outcomes.

Ultimately, nevertheless, the size climbs again. For now, she’s determined that she’ll be on treatment long-term.

In case you’re a coach, how does this story land with you?

Does it…

Make you’re feeling disenchanted? Does this look like a narrative of somebody “giving up” or “not attempting arduous sufficient”?

Encourage you with a way of awe? That trendy medication has found out learn how to deal with yet one more power illness?

Convey up questions? Like questioning concerning the results of being on treatment—doubtlessly long-term? (Or if weight reduction is even that related—as long as an individual is maintaining a healthy diet and exercising usually?)

Dr. Fitch is now president of the Weight problems Drugs Affiliation and chief medical officer of Recognized Properly, a main care and weight problems medication follow in Needham, Massachusetts. No matter how you’re feeling about her story, it illustrates what can initially look like an inconvenient fact for these of us within the well being teaching trade:

Habits change by itself isn’t at all times sufficient.

For many individuals with weight problems, semaglutide (Ozempic, Wegovy, Rebelsus), tirzepatide (Mounjaro, Zepbound), and different glucagon-like peptide-1 receptor agonists (GLP-1 RAs) function invaluable instruments that make important and lasting weight reduction potential.

However for well being coaches, these medication can look like an existential risk.

You may surprise:

‘Who wants a diet coach or a private coach when folks can get quicker, simpler, and extra dramatic outcomes with medication?’


Folks want well being coaches now greater than ever.

On this story, we’ll clarify why—and present you learn how to flip “the golden age of weight problems medication” into a large profession alternative.

With fats loss, there’s no such factor as an “straightforward method out.”

To handle diabetes or deal with most cancers, most individuals think about it regular and pure to mix way of life behaviors with prescription medication.

Nobody would inform somebody with most cancers, “You’re on chemo? Option to take the straightforward method out!”

Nonetheless, that’s what many individuals with weight problems hear after they point out treatment or surgical procedure.

For many years, a lot of society hasn’t seen weight problems because the illness that it’s.

As a substitute, folks have seen it as a willpower drawback.

The treatment: “Simply strive more durable.”

Nonetheless, quite than motivating folks to succeed, this “treatment” usually encourages them to surrender. (Extra importantly, the willpower idea isn’t based mostly on science.)

In actuality, folks with weight problems doubtless have as a lot willpower as anybody else.

Nonetheless, for them, fats loss is more durable—due to genetics and physiology, together with social, cultural, behavioral, and/or environmental components that work towards them.

Why is it so troublesome to lose fats?

Think about life 150 years in the past, earlier than the invention of the car. To get from level A to level B, you needed to stroll, pedal a bicycle, or trip a horse.

Meals was usually in brief provide, too. You needed to expend energy to get it, and meals would simply fulfill you (however not go away you feeling “full”).

At present, nevertheless…

“We stay in an obesogenic surroundings that’s full of low-cost, highly-palatable, energy-dense meals [that make overeating calories easy, often unconsciously], and numerous conveniences that cut back our bodily exercise,”
says Karl Nadolsky, MD, an endocrinologist and weight reduction specialist at Holland Hospital and co-host of the Docs Who Raise podcast.

You may surprise: Why do some folks acquire fats in an obesity-promoting surroundings whereas others don’t?

The reply comes right down to, largely, genetics and physiology.

(Weight problems is complicated and multifactorial. As we famous above, there are different influential components, however your genes and physiology are principally out of your management, and so treatment is likely to be one of the best instrument to change their impression.)

Genetically, some persons are extra predisposed to weight problems.

Some genes can result in extreme weight problems at a really early age. Nonetheless, these are fairly uncommon.

Rather more widespread is polygenic weight problems—when two or extra genes work collectively to predispose you to weight acquire, particularly if you’re uncovered to the obesogenic surroundings talked about earlier.

Individuals who inherit a number of of those so-called weight problems genes are inclined to have significantly persistent “I’m hungry” and “I’m not full but” alerts, says Dr. Nadolsky.

Weight problems genes additionally appear to trigger some folks to expertise what’s colloquially referred to as “meals noise.”

They really feel obsessive about meals, frequently pondering, “What am I going to eat subsequent? When is my subsequent meal? Can I eat now?

Physiologically, our bodies have a tendency to withstand fats loss.

In case you acquire loads of fats, the hormones in your intestine, fats cells, and mind can change the way you expertise starvation and fullness.

“It’s like a thermostat in a home, however now it’s damaged,” says Dr. Nadolsky. “So when folks lower energy and weight goes down, these physiologic components work towards them.”

After losing a few pounds, your intestine could frequently ship out the “I’m hungry” sign, even should you’ve not too long ago eaten, and even when you’ve got greater than sufficient physique fats to function a calorie reserve. It additionally may take extra meals so that you can really feel full than, say, another person who’s by no means been at a better weight.

Enter: GLP-1 medication

In 2017, semaglutide—an artificial analog of the metabolic hormone glucagon-like peptide 1—was authorised within the US as an antidiabetic and anti-obesity treatment.

With the emergence of this class of medicine, science provided folks with weight problems a comparatively protected and accessible technique to drop a few pounds long-term, as long as they continued the treatment.

How Ozempic and different weight problems medicines work

Present weight reduction drugs work primarily by mimicking the perform of glucagon-like peptide 1 (GLP-1), which is a hormone that performs a number of features:

  • Within the pancreas, it triggers insulin secretion, which helps regulate blood sugar.
  • Within the intestine, it slows gastric emptying, affecting your sensation of fullness.
  • Within the mind, it reduces cravings (the need for particular meals) and meals noise (intrusive ideas about meals).

In folks with weight problems, the physique shortly breaks down endogenous (pure) GLP-1, making it much less efficient. Consequently, it takes longer to really feel full, meals supply much less endurance, and meals noise turns into a near-constant companion, says Dr. Nadolsky.

Semaglutide (Ozempic, Wegovy, Rybelsus) and medicines prefer it flood the physique with synthetically made GLP-1 that lasts for much longer than the GLP-1 the physique produces. This long-lasting impact helps improve emotions of fullness, cut back between-meal starvation, and muffle cravings and meals noise.

Apparently, by calming down the mind’s reward heart, these medicines might also assist folks cut back addictive behaviors like drawback ingesting and compulsive playing, says Dr. Nadolsky.

The lesser-known historical past of weight reduction medication

To know the facility of semaglutide (Ozempic, Wegovy, Rybelsus) and different GLP-1 medicines, it’s useful to know a bit concerning the medication that predated it.

A long time earlier than the age of Ozempic, physicians realized that a number of medication initially developed to deal with different circumstances additionally appeared to assist folks drop a few pounds.

These included:

  • Qsymia, which pairs phentermine (an older weight reduction medication) with the epilepsy medication topiramate
  • Contrave, which mixes the antidepressant bupropion (Wellbutrin) with naltrexone, used to deal with addictions
  • Metformin, a diabetes medication

Nonetheless, weight reduction from these older medicines was modest, serving to folks to lose (and preserve off) round 5 to 10 % of their physique weight.1 2 3

Round 2010, liraglutide (Victoza, Saxenda) was authorised by the FDA to deal with diabetes. Like Ozempic and different newer weight reduction medicines, liraglutide mimics glucagon-like peptide-1 (GLP-1), however it’s much less efficient than the newer medicines.

Why does Ozempic get all of the credit score?

Ozempic has turn out to be the Kleenex of weight reduction medicines—a reputation model folks toss round as if it’s generic.

This fame is a minimum of partly earned: Dr. Fitch says that semaglutide (Ozempic, Rybelsus, Wegovy) additionally works extra successfully than liraglutide, its GLP-1 predecessor.

“Semaglutide is 94 % just like our personal GLP-1,” she says, “They’ve been capable of make it nearer and nearer to the GLP-1 our our bodies make.”

It additionally lasts longer than liraglutide, and extra of it reaches the mind.

Nonetheless, newer meds outperform Ozempic. (See the desk within the part under.)

And there are different medicines—accessible orally quite than by way of injection—coming. These drugs might be simpler to mass produce, which can drive down prices and make GLP-1 medicines much more accessible to extra folks.

So, though Ozempic is the present reigning model of the load loss drug world, it could be ousted in time.

The rising effectiveness of weight reduction medication (particularly together with way of life modifications)

Researchers measure a weight-loss medication’s success based mostly on the share of people that attain key weight reduction milestones.

For instance, most individuals begin to see well being advantages after shedding 5 % of their weight—and remission from illness after shedding round 20 %.

Because the chart under reveals, weight reduction medicines have turn out to be more and more efficient at serving to folks to achieve each milestones.

Drugs % of people that lose 5% of their weight % of people that lose >20% of their weight
First-generation weight reduction medicines (Qsymia, Contrave, Metformin) 4 5 6 53-80% 10-20%
Semaglutide (Ozempic, Rybelsus, Wegovy) 7 8 86% 32%
Tirzepatide (Mounjaro, Zepbound) 9 10 85-91% 50-57%
Retatrutide (not but FDA authorised) 11 12 92-100% 80-83%

How do weight reduction drugs evaluate to conventional interventions?

Up to now, weight reduction interventions have centered on way of life modifications like calorie or macronutrient manipulation, train, and typically counseling.

Relatively than pitting way of life modifications towards weight reduction medicines or surgical procedure, it’s extra useful to think about all of them as instruments.

Because the graph under reveals, the extra weight reduction instruments somebody makes use of—together with teaching—the extra important the outcomes.13 14 15 16

Fats loss usually comes with highly effective well being advantages

For years, the medical neighborhood has advised of us that shedding 5 to 10 % of their physique weight was adequate.

Partly, this message was designed to right-set folks’s expectations, as few lose rather more than that (and preserve it off) with way of life modifications alone.

As well as, this modest weight reduction additionally results in measurable well being enhancements. Lose 5 to 10 % of your complete weight, and also you’ll begin to see blood sugar, ldl cholesterol, and strain drop.17

Nonetheless, shedding 15 to twenty % of your weight, as folks are inclined to do after they mix way of life modifications with second-generation GLP-1s, and also you do rather more than enhance your well being. You may go into remission for a number of well being issues, together with:

  • Hypertension
  • Diabetes
  • Fatty liver illness
  • Sleep apnea

Which means, by taking a GLP-1 medication, you may give you the option finally to cease taking a number of different medication, says Dr. Nadolsky.

Specialists suspect GLP-1s could enhance well being even when no weight reduction happens.

“The medicines appear to supply additive advantages past simply weight discount,” says Dr. Nadolsky.

Analysis signifies that GLP-1s could cut back the chance of main cardiovascular occasions (coronary heart assaults and strokes) in folks with diabetes or coronary heart illness.18 19 20 In folks with diabetes, they appear to enhance kidney perform, too.21

The speculation is that organs all through the physique have GLP-1 receptors on their cells. When the GLP-1s connect to those receptors within the kidneys and coronary heart, they appear to guard these organs from harm.

For that reason, in 2023, the American Coronary heart Affiliation listed GLP-1 receptor agonists as one of many yr’s prime advances in heart problems.

Ozempic unintended effects

You’ve doubtless heard that slowed gastric emptying from GLP-1s can result in nausea, constipation, and different GI woes.

That’s all true.

Nonetheless, for many, these unintended effects are manageable, particularly with the assistance of some key methods (which we’ll cowl later).

For now, nevertheless, we’d wish to hash out a specific draw back you’ve doubtless heard about from the media—as a result of it presents an enormous alternative for well being coaches.

When folks take GLP-1 weight reduction medicines, about 30 to 40 % of the load they lose can come from lean mass.22 23 24

Put one other method: For each 10 kilos somebody loses, about six to seven come from fats and three to 4 from muscle, bone, and different non-fat tissues.

This statistic has been broadcast amongst many media shops in latest weeks as a dire warning towards taking Ozempic, Wegovy, or Zepbound.

Such tales usually fail to say two necessary caveats:

Caveat #1: Folks with extreme weight problems typically have extra muscle and bone mass than others.

To know why, think about you had been compelled to put on a 100- or 200-pound physique swimsuit on daily basis for a yr. On a regular basis actions—getting out and in of chairs, strolling to and from the mailbox, climbing steps right into a constructing—would really feel like a resistance exercise.

That’s doubtless partly why bariatric surgical procedure sufferers expertise a nine-year extension on their life expectancy, regardless of 30 % of their weight reduction coming from lean mass. They’ve extra muscle than common to start with, and subsequently can safely lose some.25 26

For folks with extreme weight problems, the well being increase from physique fats loss offsets the well being threat of muscle and bone loss, says Dr. Fitch.

That stated, there’s a caveat to the caveat: People who find themselves solely 30 kilos or so obese could not be beginning out with muscle and bone mass to spare. Particularly in the event that they’re older, they might start their weight reduction journey already under-muscled, with comparatively low bone density. In these folks, one other drop in lean mass and bone density can add as much as massive well being issues.


Caveat #2: Muscle and bone loss aren’t inevitable.

As Dr. Nadolsky places it, “Muscle loss isn’t a cause to keep away from treating weight problems [with medication]. It’s a cause to do extra train.”

That is the place coaches can shine.

By displaying purchasers learn how to undertake muscle-building behaviors like energy coaching, mixed with sufficient protein consumption, you’ll be able to assist folks offset the worst of the unintended effects when taking these medicines.

The yo-yo drawback

GLP-1s are costly, costing roughly $1000 USD a month. Consequently, many insurers both refuse to cowl them or restrict their protection to a yr or two.

As soon as the cash runs out, folks are inclined to go off the meds—and the starvation and cravings return.

In the event that they’ve accomplished little to alter their foundational consuming habits, this places them at a big drawback. In the event that they’re not consuming slowly and mindfully and enhancing satiety with veggies and lean protein, the return of starvation and meals noise could be overpowering.

That’s doubtless why, in a single examine, individuals who stopped taking semaglutide regained, on common, two-thirds of the load they’d misplaced.27

Line graph shows that people who take semaglutide will regain, on average, about two-thirds of the weight they lose within a year of discontinuing medication.

Once more, right here’s one other alternative for coaches…

Use weight reduction medication as a key that unlocks way of life modifications.

Weight reduction medicines don’t render behavior-based methods out of date; they make them extra essential.

When GLP-1 medicines muffle meals noise and starvation, your consumer will discover it simpler to prioritize protein, fruits and veggies, legumes, and different minimally processed entire meals. Equally, as the size goes down, purchasers really feel higher, in order that they’re extra prone to embrace weight lifting and do different types of train.

In accordance with a 2024 shopper traits survey, 41 % of GLP-1 medication customers reported that their train frequency elevated since happening the treatment. The vast majority of them additionally reported an enchancment in weight loss program high quality, selecting to eat extra protein, in addition to vegetables and fruit.28

That is nice information, as a result of, as talked about above, way of life modifications are essential to preserving lean mass and stopping regain, ought to purchasers select to discontinue treatment.

When working with purchasers on GLP-1s, preserve the next challenges in thoughts.

Teaching technique #1: Discover methods to eat nutritiously regardless of unintended effects.

The slowed abdomen emptying brought on by GLP-1 medication can set off nausea and constipation.

Thankfully, for most individuals, these GI woes are inclined to resolve inside a number of weeks.

Nonetheless, should you’re working with a consumer who’s experiencing loads of nausea, they gained’t doubtless welcome salads into their lives with open arms. (Consider how you’re feeling when you might have the abdomen flu. A bowl of roughage doesn’t look like it’ll “go down straightforward.”)

As a substitute, assist purchasers discover extra palatable methods to eat nutritious meals. (For instance, vegetables and fruit within the type of a smoothie or pureed soup is likely to be simpler.)

Dr. Nadolsky additionally suggests folks keep away from the next widespread offenders:

  • Large parts of any variety
  • Greasy, fatty meals
  • Extremely processed meals
  • Any sturdy meals smells that set off a consumer’s gag reflex
  • Sugar alcohols (like xylitol, erythritol, maltitol, and sorbitol, usually present in weight loss program sodas, chewing gum, and low-sugar protein bars), which might set off diarrhea in some

Teaching technique #2: Prioritize energy coaching.

To protect muscle mass, purpose for a minimum of two full-body resistance coaching periods every week.

As well as, transfer round as a lot as you’ll be able to. Strolling and different types of bodily exercise are important for protecting the load off—and can assist to maneuver meals by means of the intestine to ease digestion.29 30

(Want inspiration for energy coaching? Try our free train video library.)

Teaching technique #3: Lean into lean protein.

Along with energy coaching, protein is important for serving to to guard muscle mass.

You need to use our free macros calculator to find out the correct quantity of protein for you or your consumer. (Spoiler: Most individuals will want 1 to 2 palm-sized protein parts per meal, or about 0.5 to 1 gram of protein per pound of body weight per day.)

Teaching technique #4: Fill your plate with fruit and veggies.

Moreover being good in your general well being, entire, recent, and frozen produce fuels you with essential vitamins that may assist drive down ranges of irritation.

Along with elevating your threat for illness, power irritation can block protein synthesis, making it more durable to keep up muscle mass.

(Didn’t know managing irritation issues with regards to preserving muscle? Discover out extra muscle-supporting methods right here: The best way to construct muscle energy, dimension, and energy)

Teaching technique #5: Select high-fiber carbs over low-fiber carbs.

Beans, lentils, entire grains, and starchy tubers like potatoes and candy potatoes usually tend to assist purchasers really feel full and handle blood sugar than lower-fiber, extra extremely processed choices.

(Learn extra concerning the drawbacks—and occasional advantages—of processed meals right here: Minimally processed vs. extremely processed meals.)

Teaching technique #6: Select wholesome fat.

Wholesome fat can assist you’re feeling full between meals and shield your general well being. Gravitate towards fat from entire meals like avocado, fatty fish (which can be a protein!), seeds, nuts, and olive oil—utilizing them to exchange much less wholesome fat from extremely processed meals.

(Undecided which fat are wholesome? Use our 3-step information for selecting one of the best meals in your physique.)

Teaching technique #7: Construct resilient habits.

It could go with out saying, however the above recommendations are simply the beginning.

(There’s additionally: high quality sleep, social help, stress administration, and extra.)

Most significantly, purchasers want your assist to make all the above simpler and extra computerized.

And that’s the true reward of teaching: You’re not merely serving to purchasers determine what to eat and learn how to transfer; You’re displaying them learn how to take away limitations and create methods and routines so their highway to well being is a bit smoother.

That method, in the event that they do must cease taking treatment, their ingrained way of life habits (that the medication made simpler for them to undertake) will make it extra doubtless that they preserve their outcomes.

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