The Good, the Bad, and the Ugly of GLP-1 Medications: What You Need to Know
Sep 29, 2026
If you've spent any time on social media lately, you've probably noticed two completely different conversations happening around GLP-1 medications.
On one side, they're being portrayed as miracle drugs. Take the injection, lose the weight, and all your problems are solved.
On the other side, you're hearing that they're dangerous, everyone is losing muscle, and people should just have more willpower and lose weight the old-fashioned way.
As usual, the reality is much more complicated.
I've worked with people taking GLP-1 medications for years, and I've seen how beneficial these medications can be. I've also seen what happens when someone receives a prescription without adequate guidance about nutrition, muscle preservation, side effects, or what to do when they eventually reach their goal weight.
There's a lot more to this conversation than whether these medications work.
So let's talk about the good, the bad, and the ugly of GLP-1 medications, including what the research tells us and what I believe deserves considerably more attention.
The Good: GLP-1 Medications Actually Work
We need to acknowledge this right away.
GLP-1 medications have produced substantial weight loss in clinical trials. For people who have struggled with obesity, persistent hunger, or difficulty maintaining weight loss, they can be valuable treatment options.
Let's look at some of the research.
In the landmark STEP 1 trial, published in the New England Journal of Medicine in 2021, researchers studied nearly 2,000 adults with overweight or obesity who did not have diabetes.
After 68 weeks, participants receiving semaglutide 2.4 mg lost approximately 15% of their starting body weight, compared with roughly 2.4% in the placebo group.
About half of those taking semaglutide lost at least 15% of their starting weight.
Then came tirzepatide.
In the SURMOUNT-1 trial, researchers studied more than 2,500 adults with obesity or overweight and a weight-related complication.
After 72 weeks, average weight loss was approximately:
- 15% with the 5 mg dose.
- 19.5% with the 10 mg dose.
- Nearly 21% with the 15 mg dose.
More than half of the participants receiving the highest dose lost at least 20% of their starting body weight.
Those are substantial results.
But here's where I think the conversation needs to go beyond weight loss.
The Benefits Can Extend Beyond the Scale
One of the most important studies involving semaglutide was the SELECT cardiovascular outcomes trial.
Researchers followed more than 17,000 adults who had overweight or obesity and established cardiovascular disease but did not have diabetes.
Semaglutide reduced the relative risk of a combined outcome of cardiovascular death, nonfatal heart attack, and nonfatal stroke by approximately 20% compared with placebo.
That's significant because we're no longer talking exclusively about fitting into smaller jeans.
We're talking about cardiovascular health.
Research involving tirzepatide has also demonstrated benefits in certain populations, including reduced progression from prediabetes to type 2 diabetes and improvements in obesity-related obstructive sleep apnea.
These findings are important, although the benefits demonstrated in specific study populations shouldn't automatically be assumed to apply to everyone taking these medications.
Obesity is a complex, chronic disease. Reducing its treatment to a conversation about willpower ignores the biological factors involved.
GLP-1 medications can be legitimate therapeutic tools.
That's the good.
Unfortunately, that isn't the entire story.
The Bad: Losing Your Appetite Doesn't Mean You're Well Nourished
One of the major benefits of GLP-1 medications is their ability to reduce appetite and what many people describe as food noise.
If you've spent years constantly thinking about food, battling cravings, or feeling hungry shortly after eating, having that noise quiet down can feel incredibly freeing.
I hear this regularly from my clients.
For some people, it's the first time in years that food isn't occupying so much of their mental energy.
But there's another side to that reduced appetite.
When you're no longer hungry, it's surprisingly easy to stop eating enough.
And eating less doesn't automatically mean you're eating better.
I've worked with people who were so focused on how little they could eat that they weren't getting adequate protein, fiber, vitamins, minerals, or even enough total food to support their health.
Some were relying almost entirely on protein shakes because they simply weren't hungry enough to prepare meals.
Others were experiencing constipation, dehydration, or digestive problems that made eating even more difficult.
This is where nutrition becomes incredibly important.
In 2025, several major professional organizations published a joint advisory addressing nutritional priorities during GLP-1 therapy.
The message was clear: medication alone isn't the entire treatment plan.
Nutrition, physical activity, resistance training, and monitoring nutritional status all deserve attention.
I've been incorporating these principles into my work with GLP-1 clients for years because I don't want someone to successfully lose weight while unintentionally compromising other aspects of their health.
What About the Side Effects?
We also need to talk about gastrointestinal side effects.
Nausea, vomiting, diarrhea, constipation, and abdominal discomfort are among the commonly reported side effects of GLP-1 medications.
These symptoms can be particularly troublesome when medication doses are increased.
And this brings me to something I frequently discuss with clients.
I don't love the mindset of trying to reach the highest possible dose as quickly as possible.
Sometimes someone is following a prescribed dose-escalation schedule, but they're experiencing significant digestive symptoms and struggling to eat adequately.
That deserves a conversation with their prescriber.
The goal should be an effective, medically appropriate treatment plan that someone can actually tolerate.
If you're so nauseated that you're barely eating, I don't consider that a nutritional victory simply because the number on the scale is dropping.
And please don't adjust your medication dose independently. Persistent or severe symptoms should be discussed with your prescribing clinician.
The Ugly: What Exactly Are You Losing?
This is probably one of my biggest concerns with weight loss in general, not just GLP-1 medications.
When someone tells me they've lost 30, 40, or 50 pounds, I want to know something else.
What exactly did you lose?
Your bathroom scale measures total body weight.
It doesn't tell you how much of that weight came from body fat, muscle, water, or other tissues.
And those distinctions matter.
In an exploratory body-composition analysis from the STEP 1 trial, researchers used DXA scans to examine changes in body composition among a subgroup of participants taking semaglutide.
Fat mass decreased substantially, and visceral fat also declined.
However, total lean body mass decreased by approximately 10%.
There's an important distinction here.
Lean body mass isn't identical to skeletal muscle, and losing some lean mass is common during substantial weight loss, regardless of whether someone uses medication.
These results don't establish that semaglutide uniquely damages muscle.
But they do highlight something we need to pay attention to.
Losing weight and improving body composition aren't necessarily the same thing.
I wish body-composition assessments were more routinely incorporated into weight-management care rather than focusing almost exclusively on total weight.
Particularly for women in their 40s, 50s, and beyond, preserving skeletal muscle becomes increasingly important.
I don't want someone to lose 50 pounds only to discover that they're substantially weaker and have lost valuable muscle along the way.
Protein Alone Won't Protect Your Muscle
This connects directly to my previous article about the protein paradox.
We've become obsessed with protein, particularly in conversations about GLP-1 medications.
And while adequate protein is essential, there's something people keep overlooking.
You have to use your muscles.
Protein provides the raw materials for muscle maintenance and growth.
Resistance training provides the stimulus.
You need both.
If you're taking a GLP-1, I want you thinking about more than your daily protein target.
Are you lifting weights?
Are you progressively challenging your muscles?
Are you maintaining your strength?
Are you eating enough high-quality protein from nutrient-dense foods?
Are you paying attention to changes in body composition rather than obsessing exclusively over the scale?
These are the conversations I want more people having.
You can read more about protein quality and why simply eating more protein isn't always the answer in my article, The Protein Paradox: Why More Protein Isn't Always Better.
The Other Ugly: What Happens When You Stop Taking a GLP-1?
Here's another conversation that needs to happen before someone starts these medications.
What's your long-term plan?
Think about every diet you've ever tried.
What happened when you stopped following it?
Did you have a realistic maintenance strategy, or did you gradually return to your previous habits?
With GLP-1 medications, there's an additional biological component.
When treatment is discontinued, appetite and hunger can return, and weight regain is common.
An extension of the STEP 1 trial followed participants after semaglutide treatment ended.
One year after stopping treatment, participants had regained approximately two-thirds of the weight they had previously lost.
Many of their cardiometabolic improvements also moved back toward their original levels.
Similar concerns emerged in the SURMOUNT-4 trial involving tirzepatide.
Participants who continued taking the medication maintained or continued their weight loss, while those switched to placebo experienced substantial weight regain.
Now, I want to be clear about something.
These findings don't mean the medications don't work.
They demonstrate that the biological effects of treatment can play an important role in maintaining weight reduction.
Obesity is a chronic disease, and some people may benefit from continuing medication long term.
But whether you plan to remain on medication or eventually discontinue it, you need to understand what maintaining your results may involve.
And that conversation should happen before you've lost 50 pounds.
Don't Waste the Opportunity These Medications Give You
This is the part I really want you to think about.
Imagine that, for the first time in years, you're no longer constantly hungry.
You're not thinking about your next meal all day.
Your cravings have decreased, and you're finally able to manage your portions without feeling like you're fighting your body every step of the way.
What are you doing with that opportunity?
Are you simply eating as little as possible and watching the scale?
Or are you using this time to establish habits that can support your health for years to come?
This is exactly why I created my GLP-1 Fat Loss Success Blueprint.
I want people to understand how to use these medications as part of a comprehensive approach to fat loss rather than relying exclusively on appetite suppression.
Learn how to build balanced meals around nutrient-dense foods.
Understand what appropriate portions look like for your needs.
Prioritize quality protein without forgetting your vegetables, fruit, fiber, and essential fats.
Hydrate.
Lift weights.
Walk regularly.
Get adequate sleep.
Pay attention to your digestion.
And start thinking about maintenance before you reach your goal weight.
None of these habits guarantees that you'll maintain every pound you've lost if you discontinue medication. However, they support your overall health, physical function, and ability to manage your weight over time.
A medication can reduce your appetite.
It can't lift the weights for you.
It can't choose nutrient-dense foods for you.
And it can't automatically create the behaviors that support long-term health.
Those are things you have to work on while the medication is helping you.
So, Are GLP-1 Medications Good or Bad?
I think we're asking the wrong question.
These medications have demonstrated substantial weight-loss benefits and meaningful health improvements in specific populations.
They also have side effects, nutritional considerations, and long-term treatment implications that deserve attention.
And it's entirely possible to lose a tremendous amount of weight without adequately supporting your nutrition, strength, or long-term maintenance.
That's why I want people to have a much more complete understanding of what they're getting into.
If you're considering a GLP-1, talk with your healthcare provider about whether it's appropriate for you, what benefits and risks apply to your medical history, and what your long-term treatment plan might look like.
If you're already taking one, start thinking about what you're doing alongside the medication.
Because ultimately, the goal shouldn't simply be to become the lightest version of yourself.
I want you to become healthier, stronger, and better equipped to maintain your results.
And that requires more than a prescription.
Your GLP-1 Prescription Is Only One Piece of the Puzzle
I've worked with enough GLP-1 clients to know that the medication is only part of the process.
That's why my GLP-1 Fat Loss Success Blueprint is designed to guide you through the nutritional and lifestyle considerations that matter before, during, and after GLP-1 treatment.
It's a comprehensive 90-day program covering nutrition, protein, muscle preservation, hydration, digestive health, and long-term maintenance.
You can choose the self-guided option or explore additional individualized support.
If you're ready to approach GLP-1 weight loss with a more comprehensive strategy, I'd love to help.
