It feels like everyone is either on a GLP-1 right now or thinking about it. And that's not just a feeling. About 11% of U.S. adults are currently taking one for weight loss, nearly four times as many as in 2024.
So let me start with what I'm not saying. I'm not anti-GLP-1. The results people are seeing are real, and there is legitimate research behind these medications. Now that our physician has joined the Nuvitru team, GLP-1s are one of the tools we can offer when they're truly the right fit.
But I'm hesitant. After 11 years in women's health, I've learned to slow down whenever something gets sold as the answer for everyone. And I'd rather be honest with you about why than tell you what's popular.
Why I'm Hesitant About GLP-1s for Weight Loss
They don't answer the question of why
GLP-1 stands for glucagon-like peptide-1. It's a hormone your gut already makes after you eat. It tells your brain you're full, slows down how fast your stomach empties, and helps your body release insulin. The medications mimic that signal, but stronger and longer lasting. That's why appetite drops so dramatically.
What the medication doesn't do is tell you what caused your metabolism to slow down to begin with. When someone comes to me struggling with their weight, I want to know what's going on underneath. In my experience, most people haven't actually looked at the foundational pieces yet:
- Blood sugar and insulin resistance, which most people have never been tested for
- Thyroid function, beyond a single TSH number
- Cortisol and your stress response, which can push fat storage toward your belly
- Gut health, which affects inflammation, nutrient absorption, and hormone balance
- Micronutrients like magnesium, B vitamins, zinc, and iron, which your thyroid and blood sugar regulation depend on
If one of these is driving your weight gain, a GLP-1 can quiet the symptom while the cause keeps going. I dig into each of these in Why Can't I Lose Weight? 7 Hidden Reasons.
The weight usually comes back when you stop
This is the part that doesn't make it into the before-and-after photos.
To me, that tells us the medication was doing the heavy lifting, and whatever was driving the weight gain was still there. That's fine if the plan is to stay on it long-term and that's a decision you've made with your provider. But a lot of people start a GLP-1 assuming it's a temporary fix, and that's not how it usually plays out.
You can lose muscle along with fat
When your appetite is turned way down, it's easy to eat far less than your body needs, especially protein. When the deficit is that big, your body pulls from muscle, not just fat. Studies vary, but lean mass often makes up around a quarter of the weight lost on these medications, and sometimes more.
Muscle is your metabolic engine. It burns energy at rest and helps you clear sugar from your blood. Losing it can leave you with a slower metabolism, which makes regaining weight after you stop even more likely. This is one of the biggest things I watch for.
Eating very little makes nutrient gaps more likely
If you're only eating a few bites at a meal, every bite has to count. I regularly see people on GLP-1s who are low on protein and running short on key vitamins and minerals simply because they aren't eating enough food. That can show up as fatigue, hair thinning, constipation, and feeling weak, which often gets blamed on the medication alone.
Adoption is moving faster than long-term evidence and oversight
I want to be fair here. These drugs aren't brand new. GLP-1 medications have been used for type 2 diabetes for nearly two decades. What is new is millions of people without diabetes taking them for weight loss, often for years, and many getting them online with very little support.
One recent study found most GLP-1 users got their medication through online pharmacies, and many turned to social media instead of a healthcare provider for advice on side effects. Some participants raised concerns about how thorough the screening was before they got a prescription. That worries me. A medication this powerful deserves real oversight, not a quick online form.
I've also watched this pattern play out before in health: something with a strong mechanism and fast results gets adopted by everyone, and we only learn the long-term story later. I'm not saying that's what will happen here. I'm saying I'd rather move thoughtfully than follow the crowd.
Side effects are real
Nausea, constipation, diarrhea, and reflux are common, especially when the dose goes up. Less often, these medications are linked to gallbladder problems and pancreatitis. For many people the side effects are manageable, but they're one of the most common reasons people stop, and they're worth talking through before you start.
When a GLP-1 Can Make Sense
Hesitant doesn't mean never. There are people for whom a GLP-1 can be a genuinely helpful tool, like someone carrying significant weight that's putting their health at risk, or someone with insulin resistance that isn't responding even after the foundational work is in place.
If a GLP-1 is part of your plan, these are my non-negotiables:
Labs first
Know your starting point for blood sugar, insulin, thyroid, hormones, and nutrients, so you know what you're actually treating.
Protein at every meal
Even when you aren't hungry. This is how you protect your muscle.
Strength training two to three times a week
Muscle is use it or lose it, especially in a calorie deficit.
Track body composition, not just weight
At Nuvitru, we use InBody scans so we can see whether you're losing fat or muscle before it becomes a problem.
The lowest dose that works
More appetite suppression isn't always better if it means you stop eating enough.
A plan for what happens next
Before you start, talk about whether this is long-term or whether there's a step-down plan, and what needs to be in place for you to keep your results.
What I Recommend Before You Start
Before we rush to a solution, let's understand the problem. For most of my patients, that means comprehensive labs, a real look at blood sugar, thyroid, cortisol, gut health, and nutrient status, and building the foundation: enough protein, strength training, better sleep, and steadier blood sugar.
Sometimes that work is enough on its own. Sometimes it isn't, and a GLP-1 becomes a reasonable next step. Either way, you'll be making that decision with real information about your body, and you'll have a foundation that helps you keep your results instead of losing them the moment you stop.
Frequently Asked Questions
Are GLP-1s safe for weight loss?
GLP-1 medications are FDA-approved for weight management in certain people and have been used for type 2 diabetes for years. Common side effects include nausea, constipation, and reflux, and less common risks include gallbladder problems and pancreatitis. They're safest when prescribed after a full evaluation and monitored by a provider who tracks your labs, nutrition, and body composition.
What happens when you stop taking a GLP-1?
Most people regain a large share of the weight. In the STEP 1 trial extension, people regained about two-thirds of the weight they had lost within a year of stopping semaglutide, and many of their metabolic improvements faded too. Having a plan for nutrition, strength training, and the underlying causes of weight gain before you stop makes a big difference.
Do GLP-1s cause muscle loss?
They can. The medication doesn't break down muscle directly, but eating very little, especially too little protein, creates a deficit large enough that your body pulls from muscle. Eating enough protein and strength training two to three times a week are the best ways to protect it.
Can I lose weight without a GLP-1?
Yes. Many people struggling with weight have never been tested for insulin resistance, thyroid issues, cortisol imbalance, gut problems, or nutrient deficiencies. Addressing those root causes, along with protein, strength training, and sleep, can help your body respond again.
Does Nuvitru offer GLP-1s?
Yes, through our physician, when they're appropriate for you. We start with comprehensive labs and foundational work first, and if a GLP-1 makes sense, we pair it with nutrition support, strength guidance, and body composition tracking.
Not Sure Where to Start?
If you've been wondering whether a GLP-1 is your only option, you aren't alone. It almost never is the only option, and it's rarely the first one I'd reach for. My team and I will look at what's actually going on in your body and help you decide what makes sense, with or without medication. We see patients in our Austin clinic in Lakeway and virtually across the country.
Want to talk it through? Book a free consult and we'll walk through your history, your goals, and whether our Weight Loss Program is the right next step.
This article is for educational purposes and is not a substitute for individualized medical advice. Never start, stop, or change a medication without talking to your prescribing provider.
Sources
- STEP 1 trial extension — Diabetes, Obesity and Metabolism (2022)
- In U.S., GLP-1 Usage Reaches New High — Gallup (2026)
- Weight-loss drug users turn to social media over doctors for advice — University of Leicester (2026); survey of UK users