Navigating the path to weight loss can be a challenging endeavor for many clients. It often requires significant lifestyle changes, the formation of new habits, and sometimes medical intervention. Medical interventions can range from weight loss surgery to medications.
Recent advancements in weight loss medications, particularly the approval of glucagon-like peptide-1 (GLP-1) medications, have enhanced the effectiveness of these treatments and increased their popularity. Nearly one in eight adults (12%) reported using weight loss medication in the past year. This trend is expected to continue as these medications become more effective, affordable, and socially accepted.
As a fitness and wellness professional, you're on the front lines of health care, offering crucial support to clients on their weight loss journeys. This is especially true now, with the rising use of GLP-1s for weight loss.
It's absolutely essential you have the knowledge and skills to effectively guide and support clients who are using these medications. Your expertise can make a huge difference to their success.
Effects of Discontinuing GLP-1 Medications
Recent data indicates individuals often struggle to maintain the weight loss achieved with GLP-1 medications. For example, in the STEP-1 trial, participants lost approximately 37 pounds while on medication but regained about 27 pounds within a year of discontinuation.
Weight regains after treatment ends is not unique to GLP-1s—it’s also observed in weight loss surgery patients. Gaining weight lost is largely due to the lack of lifestyle changes, particularly in calorie intake and expenditure.
GLP-1s suppress appetite, reducing total calorie consumption. But once GLP-1s are discontinued, appetite returns to normal, and previous eating behaviors may resume.
UNDERSTANDING WEIGHT LOSS MEDICATIONS
Get the facts on how GLP-1s impact your clients' programming needs
Creating Sustainable Healthy Habits for Weight Management
Clients reaching their weight goals is fantastic, but the real win is helping them keep the weight off for good. That means guiding them to adopt new healthy habits they can actually stick with long-term.
Here's what you need to consider.
Develop a Maintenance Strategy
After discontinuing GLP-1s, clients should first understand their new total daily calorie needs. A person who lost a significant amount of weight will require fewer calories than they did at a higher weight.
Maintenance calorie intake must account for your client’s lower body weight. Estimate total calorie intake recommendations using equations like Harris-Benedict or Mifflin St-Jeor, or tools like the NASM Calorie Calculator.
Here’s an example.
A 45-year-old female client started at 200 pounds. She lost 40 pounds using GLP-1 medication—causing a shift in her calorie intake needs:
- Maintenance calories before GLP-1s at 200 pounds: 2,179 kcals
- Maintenance calories after GLP-1s at 160 pounds: 1,930 kcals
In most cases, clients will need to consume 200 to 400 fewer calories per day to maintain their lower body weight. Food behaviors, especially those before medication use, must be addressed for the calorie intake shift to be successful.
Transitioning food behaviors can be challenging, especially as appetite returns to normal levels shortly after stopping the medication.
Several dietary strategies help clients manage hunger, satiety, and appetite during this period:
- Energy density: Choose foods with low energy density and high volume.
- Protein: Aim for 0.7-1.0 grams per pound of body weight.
- Palatability: Choose foods that have low food-reward to increase satiety and reduce food noise.
Set Step Count Targets
In addition to managing calorie intake, daily physical activity is vital to a successful weight maintenance plan. Among individuals who lost about 25% of their body weight, physical activity was the main predictor of whether they regained half the weight lost.
Studies show that NEAT, which stands for Non-Exercise Activity Thermogenesis, plays a key role in increasing physical activity and weight management.
NEAT is simply all the calories you burn from movement that isn't formal exercise, sleeping, or eating. Think of it as the energy you use for everyday activities like:
- Doing household chores
- Fidgeting
- Performing yard work
- Standing instead of sitting
- Typing
- Walking to work
NEAT is a game-changer for fitness and wellness professionals because it helps clients understand that every bit of movement counts, not just their dedicated gym time.
- Combats sedentary living: A huge portion of the population has desk jobs or spends a lot of time sitting. NEAT is crucial for counteracting the negative health impacts of prolonged sitting, independent of formal exercise.
- Enhances weight management: For clients aiming for weight loss, increasing NEAT significantly contributes to creating a calorie deficit without necessarily requiring more intense or longer exercise sessions. This can be more sustainable and less daunting for many.
- Expands their activity mindset: Many clients think "exercise" only happens during their scheduled workouts. NEAT helps them realize that activities like walking, doing chores, standing, and even fidgeting contribute significantly to their daily calorie burn and overall health.
- Practical strategies for long-term adherence: NEAT promotes continuous movement, rather than just isolated exercise bouts. This makes it easier for clients to maintain an active lifestyle long-term.
Tracking overall step count is a fantastic way to measure daily physical activity, and it perfectly captures NEAT.
Research suggests aiming for 8,000 to 12,000 steps per day to reduce the risk of obesity and weight regain. While the exact number may vary for each person, this range provides a target for most individuals.
The Role of Fitness Professionals in Medical Weight Loss
As a fitness and wellness professional, you're essential for the success of medical weight loss programs that help people lose a significant amount of weight—think 10% or more of their body weight—and keep it off for good.
Even with powerful new medications like GLP-1s, just taking a pill isn't always enough for the best results.
When people lose weight, especially quickly, they can sometimes lose muscle and even bone density. This can really impact their quality of life as they age.
Through well-planned exercise and nutrition, you can support your clients and preserve their valuable muscle and bones. Specifically, resistance training calorie deficit modeling are key to maintaining both lean mass and bone density.
While studies are still fine-tuning the exact exercise and diet advice for GLP-1 users, you can confidently apply what you already know from other successful weight loss strategies.
Find a summary of these evidence-based recommendations in Table 1.
Table1. Exercise and Nutrition Recommendations for Individuals Using GLP-1 Medications
<li> <p>Row 1</p>
<ul>
<li>GOAL</li>
<li>RECOMMENDATION</li>
<li>RATIONALE</li>
</ul>
</li>
<li> <p>Row 2</p>
<ul>
<li>Training Frequency</li>
<li>3–4 sessions per week</li>
<li>Provides adequate stimulus for muscle preservation and bone loading while allowing recovery.</li>
</ul>
</li>
<li> <p>Row 3</p>
<ul>
<li>Training Type</li>
<li>Full-body resistance training</li>
<li>Targets all major muscle groups; improves total lean mass retention and whole-body strength.</li>
</ul>
</li>
<li> <p>Row 4</p>
<ul>
<li>Exercise Selection</li>
<li>Emphasize compound lifts (e.g., squats, deadlifts, presses, rows) + accessory isolation work</li>
<li>Compound lifts preserve more lean mass and stimulate osteogenic loading for bone density.</li>
</ul>
</li>
<li> <p>Row 5</p>
<ul>
<li>Volume</li>
<li>2–4 sets per exercise, 8–12 reps</li>
<li>Moderate volume with hypertrophy-range reps best supports muscle maintenance during hypocaloric states.</li>
</ul>
</li>
<li> <p>Row 6</p>
<ul>
<li>Load/Intensity</li>
<li>70–85% of 1RM</li>
<li>Sufficient to promote strength and hypertrophy, even in energy deficit conditions.</li>
</ul>
</li>
<li> <p>Row 7</p>
<ul>
<li>Progressive Overload</li>
<li>Gradually increase weight or reps weekly</li>
<li>Necessary to maintain stimulus as the body adapts and weight is lost.</li>
</ul>
</li>
<li> <p>Row 8</p>
<ul>
<li>Rest Periods</li>
<li>1–2 minutes for hypertrophy, 2–3 minutes for strength</li>
<li>Supports performance while minimizing fatigue and preserving training quality.</li>
</ul>
</li>
<li> <p>Row 9</p>
<ul>
<li>Bone-Specific Loading</li>
<li>Include weight-bearing and axial-loading exercises (e.g., loaded carries, step-ups, lunges)</li>
<li>These enhance bone mineral density, particularly important in older adults or postmenopausal women.</li>
</ul>
</li>
<li> <p>Row 10</p>
<ul>
<li>Protein Intake</li>
<li>1.6–2.2 g/kg body weight per day</li>
<li>Maximizes muscle protein synthesis and helps mitigate lean mass loss.</li>
</ul>
</li>
<li> <p>Row 11</p>
<ul>
<li>Consistency</li>
<li>Minimum 12 weeks of uninterrupted training</li>
<li>Long enough to offset lean mass losses associated with rapid fat loss.</li>
</ul>
</li>
</ul>
Strategies for Integrating Medical Weight Loss into Fitness Programs
As more of your clients turn to medical weight loss options, like GLP-1 medications, it's crucial for you as a fitness and wellness professional to know how to effectively weave these into their fitness plans.
- Build strong, open relationships. Start by promoting genuine, empathetic conversations with your clients. Talk openly and honestly about their use of medications like GLP-1s as a tool in their weight loss journey.
- Collaborate with their health care provider. You are a key player on your client's healthcare team. It's important to collaborate with their physician to make sure your dietary advice and exercise programs are perfectly suited for them.
- Continue learning about weight loss medications. Stay on top of the latest information regarding weight loss medications. Pursuing continuing education confirms you have the most current knowledge and the right tools to support your clients through their unique journey.
Become the go-to expert for clients using GLP-1 medications, guiding them safely and effectively toward their best health outcomes. NASM’s Understanding Weight Loss Medications increases your confidence in supporting clients through the complexities of medical weight loss through targeted strategies for exercise, nutrition, and behavioral coaching.
Rachel: A GLP-1 Case Study
The concepts discussed in this article are illustrated through a case study of a client named Rachel.
Rachel, a 46-year-old marketing executive, struggled with her weight since her 20s. After reaching a BMI (body mass index) of 32 and a weight of 205 pounds, she consulted her physician about using GLP-1s for weight loss. Her doctor prescribed the medication and suggested she work with a fitness and wellness professional to exercise and improve her eating habits.
Rachel contacted an NASM-Certified Personal Trainer and Nutrition Coach based on a friend's recommendation. During the initial consultation, the NASM certified coach had an in-depth and empathetic conversation that normalized her challenges. Together, they aligned values and goals, initiated a behavior-based nutrition plan, and outlined a structured exercise regimen.
With Rachel's consent, her fitness and wellness professional communicated with her physician to confirm goals, discuss lab markers, and evaluate contraindications for high-intensity training. This team-based approach ensured Rachel's dietary adjustments and resistance training protocols were safe and complementary to her overall health care plan.
Working together, Rachel, her trainer, and her doctor created a holistic health plan.
- Coaching. Weekly check-ins for accountability, behavior support, and mindset reinforcement.
- Exercise. Full-body resistance training 3x per week, emphasizing progressive overload with compound movements (squats, rows, and presses).
- High-satiety nutrition. Protein intake of 120 to 140 grams per day, high-fiber vegetables, and low-palatability meals to reduce cravings.
- Non-exercise activity thermogenesis. A daily step goal of 10,000 to support energy expenditure and habit continuity.
This collaborative process, well-designed intervention, and weekly accountability led Rachel to lose 63 pounds over a year and keep her weight loss within a 2 to 3 pounds range for at least another year. Additionally, Rachel maintained her bone density and experienced minimal lean body mass loss.
Future Trends in Weight Loss Medications
The development and commercialization of GLP-1 medications have increased their usage sixfold in the past decade. This trend is likely to continue as these medications evolve, become more affordable, and receive Food and Drug Administration approval for more indications.
Approximately 40 medications within the GLP-1 family are currently in research and development by top pharmaceutical companies, targeting weight loss and other chronic disease outcomes.
This significant investment in new GLP-1 medications implies they will remain a major part of the weight loss and management in the coming decades, with their use expected to evolve.
Understanding GLP-1s for weight loss requires digging into scientific research, knowing practical applications, and reviewing insights from industry experts—maximizing the benefits of GLP1-s and effectively supporting clients in their weight loss journey.
References
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