More ripple effects of GLP-1 medications: why lifestyle still matters

From a clinical perspective, there is a clear and appropriate place for GLP-1 medications. In some cases, particularly when obesity is severe or when other health conditions are present, GLP-1 therapies can be an effective intervention.

GLP-1 medications can support significant weight loss. As a result, many individuals experience improved metabolic health and blood sugar control as well as reduced cardiovascular risk. Psychologically, these medications can reduce “food noise,” improve appetite control and boost confidence and overall well-being.

Since the FDA approved Wegovy® in 2021, the prescribing of GLP-1 medications for weight loss has climbed quickly. The treatment is often described as “game-changing,” and for some individuals, it is. But the potential side effects of these medications, including gastrointestinal issues and rare complications such as risk to vision, are concerning.  

In some individuals, these effects can be severe enough to require dose adjustments or discontinuation. There are also emerging concerns about the impact on muscle mass, bone density and overall nutritional status — particularly when weight loss occurs rapidly without appropriate dietary support. Losing weight is not solely about reducing fat; preserving lean muscle is important for long-term health, mobility, and metabolic function. 

Unfortunately, many individuals who have taken GLP-1 medications for weight loss regain weight after stopping their course of treatment. In a STEP 1 clinical trial of semaglutide, the results showed that on average, individuals gained back two-thirds of the weight they had lost within one year after stopping treatment. 

The initial benefits seen during GLP-1 treatment, such as improvements in cardiometabolic risk factors (for example, lower blood pressure and cholesterol), largely diminished and moved back toward baseline after stopping therapy.*

This raises both clinical and economic concerns. If the weight loss achieved during GLP-1 treatment is not sustained, the long-term value of the intervention becomes limited. From a healthcare system perspective, it also prompts questions about cost effectiveness when medications are used in isolation without supportive programs.

The use of GLP-1 medications for weight loss raises an important question: Are we treating the root cause of an individual’s health challenges, or primarily managing the symptoms? 

While GLP-1 medications can play a valuable role in helping individuals reset or regain control, they shouldn’t serve as a substitute for long-term behavioral and lifestyle changes. They are most effective when combined with a comprehensive approach that includes healthy nutrition, physical activity, adequate sleep and behavioral support.

Improving nutrition

In today’s world, highly engineered, ultra-processed foods are widely available and can stimulate appetite and increase consumption. These foods can disrupt natural satiety signals, making it easier to overeat and gain weight. In many ways, GLP-1 medications counteract this cycle by helping individuals feel full sooner and reducing the desire for these foods.

Tron Emptage, Chief Clinical Officer for Optum Workers’ Comp and Auto No-Fault, is a pharmacist by trade, but also a long-distance runner and an advocate for a whole-food, plant-based diet. 

As he points out, “Many ultra-processed foods include chemicals, modified food substances and flavorings that enhance palatability, potentially encouraging excess consumption. One of the effects of GLP-1 medications is the lessening of food cravings, which can lead to a decrease in food consumption. So what if an individual could work on avoiding the ultra-processed foods to begin with?”

A long-term, holistic approach to overall health should emphasize whole, minimally processed foods, including fruits, vegetables, lean proteins, healthy fats and whole grains. These foods naturally support satiety and metabolic health.

Increasing physical activity

Lifestyle changes should also incorporate both aerobic exercise and strength training. Resistance or weight-bearing exercise is especially important to preserve muscle mass during weight loss. 

Dr. Robert Hall, Medical Director for Optum Workers’ Comp and Auto No-Fault, underscores the importance of increased physical activity and exercise as core contributors to successful and long-lasting weight loss. “Just like other complex chronic diseases, such as high blood pressure and heart disease, medications alone can only get us so far. There needs to be a fundamental shift in lifestyle habits, and a multifactorial approach has consistently been found to be the most effective treatment for chronic health conditions.” 

Prioritizing sleep and recovery

Poor sleep can disrupt hormones that regulate hunger and satiety, making weight management more difficult. Lifestyle changes, such as changes to bedtime routines and the sleep environment, can help individuals get more consistent, high-quality sleep.

Supporting mental and behavioral health

Emotions, stress, and habits all influence long-term weight management outcomes. Behavioral counseling or coaching can help individuals manage their eating habits and build sustainable routines.

Providing education

Access to credible, evidence-based resources helps individuals make informed decisions and avoid misinformation.

For decades, the clinical team at Optum Workers’ Comp and Auto No-Fault has educated injured workers and payers on the importance of behavioral and lifestyle modifications that promote overall health and better long-term outcomes.

For individuals using or considering GLP-1 medications, a few key principles can help guide decision-making:

• Recognize the role: Acknowledge that while GLP-1 medications can be effective tools, they’re not a cure-all.
• Understand the risks: Learn about the potential side effects and long-term complications.
• Plan for sustainability: Think beyond short-term weight loss and focus on long-term health.
• Prioritize muscle preservation: Incorporate strength training and adequate protein intake during and after treatment.
• Build healthy habits: Prioritize proper nutrition, adequate sleep and physical activity.
• Seek support if needed: Engage with a behavioral health coach or enroll in a structured program to overcome psychological hurdles.
• Focus on overall health: Remember that weight is only one measure; energy, mood, metabolic health and quality of life also matter.

GLP-1 medications are an exciting step forward in treating obesity and metabolic conditions. They can offer real benefits for many people and, when used appropriately, can be an important part of care.

At the same time, they’re not a substitute for lifestyle changes. Lasting health and sustainable weight loss rely on things like daily habits, environment and the choices we make around food, movement and overall wellbeing.

In the end, the most effective approach isn’t medication alone but medication paired with a commitment to healthier living. By aligning clinical tools with behavioral change, individuals and healthcare systems alike can achieve more durable, meaningful outcomes.