The hottest of hot topics just got even hotter!
Read time: 7 minutes
Life's mad, isn't it?
If you had told me when I woke up on January 1st with a rough hangover in the south of England that in April you'd be writing your newsletter from an apartment on the south coast of Albania,
I'd have told you to go get your medication checked π
But eh, life is a box of surprises!
I didn't do a whole bunch of research, and got quite the shock when I found out that there's no train system here, so I had to get a 4 1/2 hr bus trip down the coast π«
But I had the entire back row to myself, plus a fully charged iPad with a ton of episodes on it, so it wasn't that bad of a journey.
And talking of bad journeys, that's exactly what I'm getting into with this week's newsletter.
But not the typical nightmare journey where you miss your flight or sh*t your pants on a taxi, no, I'm talking about painful weight loss journeys that can actually cause you more harm than good, and the hottest craze in health is playing a key role.
Let's get stuck into it...
There's a conversation happening right now that I think is critically important, and I'm not hearing nearly enough of it in the mainstream health space.
GLP-1 weight loss jabs, you know them, the hottest trend to hit the health and fitness scene in a very long time.
Ozempic. Wegovy. Mounjaro, you've definitely heard of at least one of them.
They're everywhere. In the news. In your social media feed. In conversations at dinner parties and boardrooms alike. And the results, on paper at least, look impressive.
In clinical trials, these drugs have produced average body weight reductions of up to 15% at 12 months in real-world settings, with some dedicated trials reporting losses approaching 20% in selected populations (1).
That's nothing to be sneezed at. The results are very much and potentially life-changing.
But here's what I want to talk to you about today. A question that those on the jabs are avoiding like I'm avoiding alcohol for the foreseeable future.
What are you actually losing on these jabs?
Because the number on the scales is not the whole story. Not even close.
First, let's make something very clear ‡
Not all weight loss is equal.
Now, before we go any further, I want to say that this newsletter isn't a hit piece on GLP-1 jabs, so please don't report me to them for hate crimes π
I'm also not here to scare you off them, and I'm not dismissing the fact that for some people in the right context, they can have a place, and a very effective one at that.
What I am here to do is make sure you have the full picture, as I do with each one of my newsletters.
Research published in Nature Reviews Endocrinology found that up to one-third of the weight lost on GLP-1 drugs is what scientists refer to as 'non-fat mass', which includes muscle and bone.
Read that again.
Up to a third of what you lose isn't fat.
It's the stuff your body actually needs to function, perform, and age well.
This is where the alarm bells should be ringing slightly.
Now, to be fair, this isn't unique to GLP-1 jabs.
The same thing happens with crash diets, extreme calorie restriction, and weight loss surgeries like gastric bands.
Rapid weight loss, regardless of how it's induced, tends to strip the body of more than just fat. Something I'm guessing you weren't aware of.
But the scale and speed at which these jabs work make the issue particularly worth paying attention to - hence the need for this email.
If you're currently on these jabs, or you're contemplating starting, let's talk about what you're actually losing.
1) Muscle mass
Muscle is not just for aesthetics or the gym. It's your metabolic engine.
It regulates your blood sugar.
It drives your resting calorie burn.
It keeps you mobile, functional, and independent as you age.
And of course it helps you look sexy in a figure-hugging dress (unless you're 92kg and 6 ft 5 ππ»ββοΈπ)
Muscle plays a critical role in blood sugar control, and lower muscle mass is directly linked to poorer glucose regulation.
Poor blood sugar control, by the way, is associated with type 2 diabetes, increased risk of heart attack and stroke, nerve damage, and a host of other complications you absolutely want to avoid, to say the very least.
And then there's sarcopenia, the progressive, age-related loss of muscle mass and strength that is an absolute sh*t show you want to avoid.
Sarcopenia is one of the most underappreciated threats to healthy ageing!
After the age of 30, adults can lose between 3-8% of their muscle mass per decade.
After 60, that rate accelerates considerably.
Now layer in a period of rapid weight loss that strips away an additional chunk of muscle on top of that natural decline, and you start to see the problem.
We are not just talking about looking less toned.
We are talking about a measurable increase in your risk of falls, fractures, and loss of independence in the years and decades ahead.
In one of last year's newsletters, I spoke about the very real danger to life that falls pose in later life, so it's something we all have to take extremely seriously.
So it's a price worth thinking very carefully about.
2) Bone density
Then there's the all too real threat to your bones, which is equally concerning, if not more so, when you break it down (you catch that? π)
A randomised clinical trial published in JAMA Network Open in 2024 investigated the effects of GLP-1 treatment, exercise, and both combined on bone mineral density.
The findings were striking!
The study found that participants in the fat loss jab only group experienced significant reductions in hip and lumbar spine bone mineral density compared with those who exercised, despite similar levels of weight loss (2).
The hip and the lumbar spine, for context, are exactly where bone fractures carry the highest risk of serious complications, and in older adults, the highest risk of mortality.
Losing bone mass increases your risk of fractures, and this risk doesn't just show up at 70 or 80. The bone density you lose in your 40s and 50s is bone density you simply may not get back.
The JAMA study did, however, offer a very important counterpoint, and I'll come back to this shortly.
What happens when you stop taking them?
This is where it gets even more important to understand.
The STEP 1 trial, one of the largest clinical investigations into semaglutide, followed patients for a year after they stopped taking the drug.
What they found was that participants who stopped semaglutide regained approximately two-thirds of their prior weight loss within one year of stopping (3).
The fat came back!
But the muscle and bone density lost during the intervention?
That doesn't automatically return with the weight regain.
So in a worst-case scenario, you end up heavier than before, and structurally weaker than before, with some brittle ass bones.
That is not a trade most people would knowingly make.
Why this gets more dangerous the older you get...
In your 20s, your body is relatively forgiving. You can bounce back. Recovery is fast. The margin for error is wider.
This goes for workouts, relationships, and hangovers!
But from your 40s onwards, the equation changes.
Your natural hormone levels begin to shift. Oestrogen and testosterone, both of which play a significant role in maintaining muscle and bone, start to decline.
Muscle protein synthesis (your body's ability to build and maintain muscle tissue) becomes less efficient. You need more stimulus, more protein, and more intentional effort just to maintain what you have.
Bone density typically peaks in your late 20s to early 30s and then gradually declines. For women, particularly, the drop around and after menopause can be significant.
What this means practically is that a period of rapid, drug-induced muscle and bone loss in your 40s or 50s doesn't just set you back temporarily...
It can permanently alter your physical trajectory in ways that compound dramatically by the time you hit your 60s and 70s.
Again, that should be the opposite of music to your ears. What would that be? Cats on a chalkboard or listening to me rap 8 Mile by Eminem π
Falls. Fractures. Cognitive decline linked to low muscle mass. Loss of independence.
These are not abstract future problems. These are outcomes that begin to take shape with the decisions being made right now.
So what actually works?
Ya gotta go old school!
The fundamentals of sustainable fat loss haven't changed.
They're not exciting. They're not going viral on social media. But they work. And critically, they work without costing you your muscle and bone in the process!
The same JAMA study referenced above also found something important. The combination of exercise and fat jab was actually the most effective weight loss strategy while also preserving bone mineral density at the hip and spine, unlike the jab alone.
Let that sit with you for a second.
The exercise didn't just protect the bone, it allowed the drug to work better AND protected the body from its downsides.
That is the power of doing the basics right.
Talking of doing the basics right, you can't go wrong with this lot:
1. Resistance training β the single most important thing you can do
Research consistently shows that resistance training is one of the most effective ways to preserve muscle mass during weight loss.
2-3 sessions per week. Progressive overload over time. Compound movements such as squats, deadlifts, rows, and presses. This isn't about building a physique. This is about protecting your body's structural integrity for the next 3-5 decades and beyond. Research shows that regular resistance training is associated with a 15-27% lower risk of all-cause mortality, with the greatest benefit seen at around 60 minutes per week (4). That number alone should be enough.
2. Prioritise your protein β every single day
Eating enough protein is a key factor in reducing the amount of muscle lost during weight loss. Aim for 1.3g to 2.2g of protein per kilogram of bodyweight daily. Your body cannot store protein the way it stores carbohydrates and fat. If your intake is consistently low, it will pull from your muscle tissue to meet its needs. Eggs. Meat. Fish. Greek yoghurt. Cottage cheese. Legumes. These are your foundations. Get your protein right, and you give your body a fighting chance of holding onto what matters while shedding what doesn't.
3. Increase your NEAT β movement beyond the gym
NEAT stands for Non-Exercise Activity Thermogenesis. It's all the movement in your day that isn't structured exercise. Walking to meetings. Taking the stairs. Standing at your desk. Carrying your shopping. Doing the birds and bees dance. Simple daily habits like using the stairs instead of the lift, carrying shopping in fewer trips, and walking at a slightly quicker pace are all effective strategies for maintaining muscle and metabolic health during weight loss. Aim for 8,000 to 10,000 steps per day as a baseline, going towards the 12-14k mark to really take things up a level!
4. Be patient. Fat loss that lasts takes time.
Rapid weight loss, whether from drugs, very low-calorie diets, or extreme restriction, accelerates muscle and bone loss. Sustainable fat loss of 0.5 to 1kg per week preserves far more lean tissue. Yes, it's less dramatic and won't generate before-and-after photos in 12 weeks, but it WILL produce a body that is genuinely healthier, stronger, and more resilient, not just lighter on the scale. The tortoise wins this race!
The bottom line
GLP-1 jabs are not the enemy.
But they're also not a shortcut to long-term health, and they should NEVER be treated as one.
The evidence is clear...
You cannot drug your way to a strong, lean, and resilient body. That is still built the old-fashioned way.
With consistency, progressive challenge, and a diet built around real food.
If you're currently taking or considering a GLP-1 medication, the research suggests one thing very clearly: pair it with exercise.
The data shows that it not only enhances the results but also actively protects you from the bone loss that the medication alone can cause.
And if you're looking for sustainable fat loss without the jabs, the answer is the same.
Move. Lift. Eat enough protein. Be consistent. Repeat.
No version of long-term health bypasses the fundamentals.
And remember, if you have any questions on anything covered today, just hit reply.
That's what I'm here for.
Chat soonβοΈ
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