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APRIL 2026 TABLEHOPPING

GLP1’S

Everyone and their brother has heard about or is taking a GLP1 drug to lose weight. We are talking about Wygovy, Bydureon, Ozempic, Zepbound and Mounjaro to name the most popular drugs. GLP stands for Glucagon-Like Peptide-1, a natural gut hormone that regulates blood sugar, appetite, and digestion. These drugs have become widely popular because they can help patients lose weight. With this weight loss comes less diabetic complications, less arthritic issues, and hopefully less cardiovascular disease. Nothing we have ever used before has given us the weight loss results seen with these drugs.

These drugs are pretty cheap to manufacture and the drug companies are making fortunes and the insurance companies are facing huge costs. Soon there will be oral versions of these injected drugs and their popularity and costs can only continue to increase. These drugs can produce tremendous weight loss for some people and modest weight loss for many others. The advertised risks of thyroid cancer and pancreatic issues seem to be minimal in the short term and the side effects of nausea and constipation are easily treated. We really have no idea about long term risks but there are, of course, concerns. Here’s an interesting article in Diabetes Care entitled “Do GLP-1 based therapy increase cancer risk.” PMID: 23882053. Another in Gastroenterology entitled “Pancreatitis, pancreatic, and thyroid cancer with glucagon-like peptide-1-based therapies” PMID: 21334333 that suggests also that pancreatic cancer may be increased.

What I worry about and what I see all the time in my patients on these drugs is both the muscle loss AND the bone loss. Unless you are careful up to half the weight you lose can be muscle and the protein loss also involves the bones which have a protein matrix. Say you lose 30 pounds of weight on one of these drugs…Half is protein and half is fat. Now at some point you stop the drug and the weight returns. Now however when you put the 30 pounds back on it’s all fat so you are at the same original weight but now you are fatter than before and have weaker bones. Putting on muscle mass and bone mass is not at all easy.

Here’s what I tell my patients…If you have to take one of these drugs to lose weight so be it but do it right. First, you must have more protein in your diet. Second, you must exercise to keep the muscle mass intact. Third, and most important, you must have a low carb diet or you will not have the best results and sustainable results. My good friend Steve took the shots but made no effort whatsoever to change his diet. He didn’t lose a pound. Just eating less will not work in the long run. You need to cut the carbs.

My next suggestion is to measure your body composition. See for yourself what percentage of your weight loss is muscle, bone and fat. The gold standard is something called a Dexa scan which is not easy to get done locally but there are other devices including the INBODY scan which several local gyms have and amazon sells a device for less than 100 dollars that is pretty accurate. I measure the weight and how much bone , muscle and fat yearly on all my patients. If you are on a GLP1 agent I would check your composition quarterly. It’s the only way to know what’s really going on. You can weigh the same amount year after year all the while losing muscle and gaining fat. Unless you measure you can’t possibly know. Your doctor won’t do this because it’s not covered by insurance and the doctor can’t make any money from it. That seems to be how things work now in my profession. Luckily , as I said you can get a pretty accurate set of numbers from a scale available at Amazon. Here’s just one listing as an example. FITINDEX Smart Scale with BMI, Body Fat, Muscle Mass, Scale for Body Weight and Fat Percentage, High Accurate Bluetooth Scale with Large Display, 13 Body Composition Analyzer Sync APP, 500lbs, 11.8”

 
Ideally, if you are on a GLP1 drug I would recommend seeing your provider monthly to keep on track. You don’t have to check the body composition monthly but I find success often relies in part with accountability and seeing our provider more often is one way of holding yourself accountable. These visits are very often covered by your insurance company. The visits should include your weight trends, any side effects, what dietary changes have been made etc. The shot alone works. The shot with supervision works better. Try it both ways and see for yourself.

Now we come to the biggest issue yet. What to do chronically. Will people have to stay on these meds forever? How do you wean off? What about micro-dosing? Well, the drug companies don’t want to hear about micro dosing because they will have mico-profits. We just don’t know the best course of action yet. The oral agents are coming and that will make it easier for chronic use. Please remember these drugs give you sustained benefits for your health only if you modify your lifestyle and change your underlying diet and get more exercise. I know, if you change your diet and exercise you can achieve weight loss without these meds but many people just can’t get off the mark without help. That’s how I see these meds…use them to get you going on the weight loss journey then continue to modify the diet and exercise so eventually you can maintain and improve on your own. You can be sure big pharma is working on newer versions of these drugs that are muscle and bone sparing etc but I am putting my faith into changing your habits not so much changing your meds. I am looking forward to seeing how this all plays out. Until next month…Get well and stay well.

JT Barry, MD