GLP-1s, Strength Training, and Building Better Health

GLP-1 medications are changing the way we approach weight loss, and I think that's a good thing.

For decades, people struggling with their weight have heard some version of the same advice: eat less, move more, and be consistent.

It's not necessarily bad advice. Nutrition and exercise remain important parts of health. But for many people, those recommendations haven't been enough to produce meaningful, sustainable changes in body weight.

Medications like semaglutide (Wegovy, Ozempic) and tirzepatide (Zepbound, Mounjaro) have introduced another option. For appropriately selected patients, these medications can produce substantial weight loss and improve important health outcomes.

I see that as progress.

But I also see an opportunity.

What if we treated weight loss as the beginning of a broader improvement in health, rather than the final destination?

That's where strength training, nutrition, and sustainable lifestyle changes enter the conversation.

GLP-1 Medications Are a Valuable Medical Advancement

Obesity is a complex, chronic condition influenced by genetics, physiology, environment, behavior, and numerous other factors.

Reducing it to a matter of willpower has never adequately explained why weight management can be so difficult.

GLP-1-based medications help regulate appetite and food intake through biological pathways involved in hunger, satiety, and metabolic regulation.

And their effectiveness extends beyond changing the number on a scale.

Research has demonstrated improvements in several cardiometabolic risk factors. Some medications have also demonstrated reductions in major clinical outcomes for specific patient populations.

For example, the SELECT trial found that semaglutide reduced the relative risk of major adverse cardiovascular events by approximately 20% in adults with established cardiovascular disease and overweight or obesity who did not have diabetes.

That's meaningful.

We're talking about reducing the risk of heart attacks, strokes, and cardiovascular death in a population already at elevated risk.

Not simply fitting into smaller clothing.

Of course, these medications aren't appropriate for everyone, and their benefits, contraindications, side effects, and long-term use should be discussed with a qualified prescribing clinician.

But the larger point remains:

If modern medicine can help someone meaningfully improve their health, especially after years of unsuccessful attempts through traditional approaches, that's something worth supporting.

It doesn't mean they've taken the easy way out.

It means they have another effective tool available.

Weight Loss Is Valuable. Physical Capacity Matters Too.

Here's where I think we can expand the conversation.

Imagine two people who each lose 40 pounds.

Both have improved their body weight, and depending on their starting health, both may experience important medical benefits.

But one person has also developed a consistent strength-training routine.

They're stronger than when they started. Their balance and movement confidence have improved. They can lift heavier objects, tolerate longer hikes, and participate in activities they previously found intimidating.

The other person hasn't made those changes.

Both may have benefited from losing weight, but they haven't necessarily developed the same physical capabilities.

That's not a criticism of either person.

It's a reminder that body weight represents only one dimension of health.

The scale tells you how much weight you've lost. It doesn't tell you what you've kept—or what you've gained along the way.

At Ascent, we spend a lot of time thinking about strength, movement, and physical capacity because those qualities influence what people can actually do with their bodies.

And they're qualities we can train.

Why Strength Training Is Especially Valuable During Weight Loss

When someone loses a substantial amount of weight, the reduction generally includes both fat mass and lean body mass.

Lean body mass includes skeletal muscle, but also water, organs, and other nonfat tissues. It isn't a direct measurement of muscle alone.

This isn't a problem unique to GLP-1 medications. It's something that happens with significant weight loss through many different approaches.

A 2025 body-composition analysis from the SURMOUNT-1 trial found that approximately 75% of weight lost with tirzepatide was fat mass and 25% was lean mass.

A 2026 systematic review and meta-analysis involving 20 randomized controlled trials found that the proportion of lean mass lost during treatment with incretin-based medications was broadly comparable to weight loss through lifestyle interventions.

But there was an important finding.

Lifestyle programs incorporating resistance training showed a more favorable pattern of lean-mass preservation.

These findings don't tell us exactly how much muscle an individual taking a GLP-1 will preserve by lifting weights, but they reinforce a well-established principle.

Strength training provides a stimulus that helps the body maintain muscle and strength during periods of weight loss.

And maintaining muscle has implications well beyond appearance.

Muscle Supports More Than Metabolism

Skeletal muscle plays an important role in glucose regulation, movement, and physical function.

Strength also influences our ability to manage the physical demands of everyday life.

For someone living in Alaska, that might mean hiking, skiing, snowboarding, fishing, carrying equipment, or navigating uneven terrain.

For someone else, it might mean comfortably climbing stairs, getting off the floor, carrying groceries, or keeping up with their grandchildren.

You don't have to be an athlete to benefit from being stronger.

And you certainly don't have to become a competitive weightlifter.

You just need an appropriately challenging training program and the consistency to keep showing up.

Medication and Exercise Aren't Competing Strategies

One of the most encouraging developments in this conversation is that major medical and nutrition organizations are increasingly discussing lifestyle support alongside GLP-1 treatment.

A 2025 joint scientific advisory from the American College of Lifestyle Medicine, American Society for Nutrition, Obesity Medicine Association, and The Obesity Society emphasized several priorities for patients using GLP-1 medications:

• Appropriate nutritional intake, including sufficient protein
• Regular resistance training to support lean mass and strength
• Aerobic activity for cardiovascular health
• Monitoring and management of medication-related side effects
• Long-term behavioral and lifestyle support

The goal isn't to make medication dependent on someone's ability to maintain a perfect exercise routine.

It's to recognize that medications, nutrition, and exercise address different aspects of health.

A GLP-1 medication can help regulate appetite and facilitate weight loss.

Resistance training can improve muscular strength and support lean tissue.

Cardiovascular exercise can improve endurance and cardiorespiratory fitness.

Appropriate nutrition supports recovery and helps meet the body's needs while food intake changes.

And consistent routines make those behaviors more practical to maintain.

These approaches work alongside one another. We don't have to choose between them.

You Don't Need an Extreme Workout Program

I think this is an important part of the conversation, especially for people who haven't exercised regularly in years.

You don't need to jump into five high-intensity workouts each week.

You don't need to punish yourself with exercise because you've struggled with weight management.

And you don't need to be in shape before you begin training.

In fact, that's precisely why good coaching matters.

Someone starting a strength program while taking a GLP-1 may have different needs than an experienced lifter.

They may be adapting to a changing body weight, reduced appetite, fluctuating energy levels, or a history of joint pain.

A reasonable starting point might be two or three weekly strength-training sessions, adjusted to the individual's ability and recovery.

Start With the Fundamentals

A well-designed strength program should develop the basic movement patterns we use throughout life.

Squatting, hinging, pushing, pulling, carrying, and controlling our trunk are all valuable skills.

We might begin with a supported squat or a kettlebell deadlift.

As technique, strength, and confidence improve, the exercises become more challenging.

Over time, we're not just accumulating workouts.

We're developing physical capacity.

And that progress is measurable.

You can lift more weight. Perform additional repetitions. Move with better control. Recover more comfortably between sessions.

Those improvements give you something to work toward that has nothing to do with the bathroom scale.

Building Habits That Support Long-Term Health

One of the challenges with any major lifestyle change is consistency.

Most people already know that exercise is good for them.

They know that eating nutritious food matters.

They know they should probably sleep more.

But knowing something and consistently doing it are two different things.

That's why I place so much value on structured training and a supportive environment.

When someone has an established class schedule, a coach who understands their goals, and a group of people they enjoy exercising alongside, showing up can become part of their routine.

Not because every workout is easy.

And not because motivation is always high.

But because they've created a system that makes consistency more achievable.

There's also research suggesting that exercise can play a useful role in weight maintenance following medication treatment.

A 2024 randomized trial follow-up examined outcomes after participants discontinued a year of treatment involving exercise, liraglutide, both interventions, or placebo.

Participants who had completed supervised exercise generally maintained their weight-loss improvements better than those who had received liraglutide alone.

The study used liraglutide, not newer medications like semaglutide or tirzepatide, and the exercise intervention wasn't exclusively resistance training. So we shouldn't assume these findings apply identically to every GLP-1 treatment program.

But they support something I believe is important.

Developing regular exercise habits has value regardless of whether someone continues medication long term.

And for many people, continued medication may be a necessary and appropriate part of treating a chronic condition. Exercise doesn't replace that medical need.

The objective isn't to exercise so that you can eventually stop taking medication.

It's to build a healthier, more capable body while making the most of the treatment that's appropriate for you.

How We Approach Strength Training at Ascent

When we built a gym inside Ascent Health & Performance, we wanted to create an environment where clinical care, rehabilitation, and strength training could work together.

We weren't interested in building a facility where every workout revolved around burning the maximum number of calories.

We wanted to help people get stronger, move better, improve conditioning, and develop the capacity to participate in the activities they enjoy.

For someone taking a GLP-1 medication, that philosophy fits naturally.

Our coaches can help establish an appropriate starting point, teach fundamental movements, and progressively develop strength as someone becomes more comfortable with training.

Our chiropractic and physical therapy teams can contribute when pain, injury, or movement limitations create additional challenges.

And our small-group training environment provides structure, accountability, and the energy that comes from working alongside other people.

We're not managing someone's medication.

That's the responsibility of their prescribing clinician.

We're helping them develop the physical qualities that medication alone doesn't train.

Whether someone is losing weight with medical assistance, pursuing a strength goal, returning after an injury, or simply trying to become more active, the approach is fundamentally the same.

Meet people where they are.

Establish a starting point.

Progress intelligently.

And create a reason to keep showing up.

Don't Just Focus on Losing Weight. Focus on What You're Building.

I'm genuinely encouraged by the progress we're seeing in medical weight management.

For people who have struggled for years with obesity and its associated health concerns, having more effective treatment options is a significant advancement.

We should embrace that progress.

And I think we should also recognize the opportunity it creates.

What if someone begins a GLP-1 medication, experiences meaningful weight reduction, and uses that period to establish a consistent strength-training routine?

What if they discover that they enjoy lifting weights?

What if they become more confident in their movement, improve their endurance, and start participating in activities they previously avoided?

What if the experience changes not only their body weight, but their relationship with physical activity?

That, to me, is an exciting possibility.

Because the goal of improving health shouldn't be limited to what we can measure on a scale.

It should include what our bodies allow us to do.

Medication can be a powerful tool for improving health. Strength training helps us build the capacity to enjoy it.

And there's absolutely no reason those two approaches can't work together.

Research and References

1. Lincoff AM, et al. (2023). Semaglutide and Cardiovascular Outcomes in Obesity without Diabetes. New England Journal of Medicine.
2. Look M, et al. (2025). Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study. Diabetes, Obesity and Metabolism.
3. Eisa N, Barood O. (2026). Lean Mass Changes With Incretin Therapy Versus Lifestyle Intervention. Diabetes, Obesity and Metabolism.
4. Mozaffarian D, et al. (2025). Nutritional priorities to support GLP-1 therapy for obesity. American Journal of Clinical Nutrition.
5. Jensen SBK, et al. (2024). Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined. eClinicalMedicine.