Weight-Loss Drugs and Exercise

The obesity management drugs we have been discussing include Ozempic, Wegovy, Mounjaro, and others based on molecules that imitate GLP-1 (glucagon-like peptide-1).

People who want pharmaceuticals may be disappointed to learn that all these meds are intended to be used along with deliberate diet modification and perpetual exercise. The prescribers are presumably aware of that — it’s their job to know such an elementary fact. Maybe they just don’t do well at conveying the message to patients. Or maybe it’s just that people have a way of ignoring unpleasant truths they don’t want to hear.

According to research published in Diabetes Care, persons who used Ozempic in conjunction with exercise lost considerably more weight than those who used Ozempic alone. Furthermore, individuals who took Ozempic with exercise improved their blood sugar management and cardiovascular risk factors…

To lose overall weight should not be the goal. The idea is to lose fat. Quoted in this piece is Dr. Rob Newton, professor of exercise medicine, at Australia’s Edith Cowan University:

There’s little understanding that a healthy balance of muscle and fat is key to fending off chronic disease and frailty over the long haul. Most chronic disease isn’t driven by fat mass but low levels of muscle mass and inactivity… Muscle loss caused by repeated dieting without exercise is one reason why it can be hard to maintain long-term weight loss.

One writer makes the point:

The aim when losing weight should be to change your body composition — the ratio of fat to muscle — not just become a smaller “skinny fat” version of yourself.

According to endocrinologist Dr. Robert Kushner, “If you lose weight, you never just lose fat… and it’s very hard to gain back muscle mass once you’ve lost it, particularly as you age.” Basically, anyone who undertakes to shed a large amount of weight should engage in “a robust physically active program with both aerobic and resistance training.”

Dr. Nancie Manning says:

Aim for at least 150 minutes of moderate-intensity exercise per week, such as brisk walking or cycling. Strength training is also important for building muscle and improving metabolism.

Longevity expert Dr. Peter Attia has said that “almost every patient we put on [semaglutide] has lost muscle mass at a rate that alarms me.” Body composition is the important thing, but the FDA wants the drug’s results to be measured only in weight loss.

Dr. Attia does have a point. The average human head weighs 11 pounds, but we don’t chop it off just to get a lower number on the scale.

Your responses and feedback are welcome!

Source: “The Benefits Of Combining Ozempic With Exercise For Weight Loss,” PharmacyPlanet.com, 04/29/23
Source: “People who take semaglutide but don’t resistance train,” Insider.com, 02/01/23
Source: “Is Mounjaro the weight-loss drug we’ve been waiting for?,” NationalGeographic.com, 05/02/23
Source: “Ozempic And Exercise The Perfect Weight Loss Combo,” WellnessCenterOfLakewoodRanch.com, current
Source: “Peter Attia Says Ozempic Could Make You ‘Fatter’,” HoneHealth.com, 05/02/23
Image by Daniel R. Blume/CC BY-SA 2.0

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OVERWEIGHT: What Kids Say explores the obesity problem from the often-overlooked perspective of children struggling with being overweight.

About Dr. Robert A. Pretlow

Dr. Robert A. Pretlow is a pediatrician and childhood obesity specialist. He has been researching and spreading awareness on the childhood obesity epidemic in the US for more than a decade.
You can contact Dr. Pretlow at:


Dr. Pretlow’s invited presentation at the American Society of Animal Science 2020 Conference
What’s Causing Obesity in Companion Animals and What Can We Do About It

Dr. Pretlow’s invited presentation at the World Obesity Federation 2019 Conference:
Food/Eating Addiction and the Displacement Mechanism

Dr. Pretlow’s Multi-Center Clinical Trial Kick-off Speech 2018:
Obesity: Tackling the Root Cause

Dr. Pretlow’s 2017 Workshop on
Treatment of Obesity Using the Addiction Model

Dr. Pretlow’s invited presentation for
TEC and UNC 2016

Dr. Pretlow’s invited presentation at the 2015 Obesity Summit in London, UK.

Dr. Pretlow’s invited keynote at the 2014 European Childhood Obesity Group Congress in Salzburg, Austria.

Dr. Pretlow’s presentation at the 2013 European Congress on Obesity in Liverpool, UK.

Dr. Pretlow’s presentation at the 2011 International Conference on Childhood Obesity in Lisbon, Portugal.

Dr. Pretlow’s presentation at the 2010 Uniting Against Childhood Obesity Conference in Houston, TX.

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