GLP-1 Medications: Is It Right for Me? Top 5 Questions Answered by an Endocrinologist

In this episode of Hormones & Hope, Dr. Chhaya Makhija addresses the most commonly searched and most misunderstood questions about GLP-1 medications and weight loss. 

Dr. Makhija explains why weight loss is never just about fat, why muscle matters far more than we realize, and how GLP-1 medications can support — not replace — foundational lifestyle changes like strength training, nutrition, sleep, and stress management.

You’ll also learn why stopping GLP-1 medication can lead to weight regain, when dose reduction or discontinuation may be appropriate, and how clinicians monitor progress beyond the scale using body composition and metabolic markers.

This episode is a reminder that your health is not a trend, it’s a long-term commitment shaped by biology, behavior, and informed care.

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Transcript

00:00
as they're losing body fat percentage, guess what? They're gaining muscle. They're losing weight. They're gaining muscle. Right? And say if you're gaining muscle, you may not see that drastic change in your weight, but the body fat percentage is reducing. The visceral fat is reducing. So your body composition is getting more leaner. It is getting healthier. You have less visceral fat. That is less inflammation in your body. Right? That is supposed to be your health goal. When you're on GLP-1  medications,

00:30
If you go the right way in terms of right usage, not just for cosmetic purposes, you are focusing on your lifestyle foundations, you are focusing on your sleep, your muscle, your fiber, your protein, consistency, and that is overlapped with the use of medications. You are going slow and steady. There is no doubt that you will gain a very healthy body composition and

00:56
you will not see ongoing muscle loss. You'll actually start seeing gains because you're putting in the work for it.  Welcome to Hormones and Hope,  a podcast where we bridge science and wellness  to help transform your health.  I'm your host, Dr. Chhaya Makhija,  or you can call me Dr. Chhaya,  a triple board certified endocrinologist and lifestyle medicine physician and founder of Unified Endocrine and Diabetes Care.

01:23
Each week we dive into the powerful intersection of clinical medicine and real life lifestyle strategies to help you feel stronger, live longer, and show up as your most vibrant self inside and out. So let's get empowered. Hello and welcome. Welcome to another episode on Hormones and Hope. And this is host, Dr. Chhaya Makhija. This is the second episode of 2026. And this is also

01:51
going to be filled with empowerment, knowledge and awareness.  And this time  I decided to look for the most commonly searched questions in my realm of expertise,  most commonly asked questions from my patients  and the most common misunderstood questions amongst these. So we're going to address five questions related to weight,  GLP-1 medications today.

02:16
And then the part two episode is going to dive into details about other questions related to hormones. So stay with me till the end of this episode because who knows? The number five question may be yours or relevant to you or you may have been thinking about it for so long. And this is your time to get the right answers and the right resources. All right. So drum roll and let's dive into it. To give you a better understanding,

02:44
What we're going to focus on is  very specific questions related to weight, muscle loss and GLP-1 medications.  And if this medication is right for you or not.  Number one, do GLP-1 medications like Ozempic, Wigoby, Manjaro, ZepBound  and definitely more coming in 2026 and 2027,  do GLP-1 medications cause muscle loss?  All right, you ready for this?

03:11
There is no yes or no answer. What you have to understand is that GLP-1 medications were FDA approved for treatment of diabetes. And as endocrinologists, we've been using it since that era of 2005, 2007, when we started using GLP-1 medications clinically. So I'm talking about almost 20 years, right? So these medications were discovered, then they were clinically approved for treatment of type 2 diabetes.

03:40
And then, uh near future, we had these medications also available as FDA approved  indications for obesity. And now, in the last five years, we've had more of these come along with FDA approval for  obesity and with improvement in cardiovascular risk outcomes in  renal disease outcomes or kidney  outcomes, as well as for treatment of moderate

04:09
to severe sleep apnea in many individuals.  If you understand the broad context of the FDA approval of these medications, including the fatty liver disease, or now known as the metabolic disease of the liver,  and we have more studies for addiction, for  dementia, and so forth, then who knows? In the next two, three years, you will see more and more indications  which  are

04:36
are relevant to this  specific class of medications called glucagon-like receptor agonist.  Now, to bring you to the actual answer, that is, do these medications cause muscle loss or  weight loss? You have to understand the concept of why these are being used, for what conditions these are being used. These are not cosmetic medications, right? It's not a plastic surgery medication or it's not a  dermatological indication of just

05:06
improving that cosmetic appearance, but it has relevant medical conditions and diseases that it's actually treated for. Now, part two of this explanation is that, you know, do you know what your body is composed of?  And m if you look through a couple of these episodes  from my solo episodes on  GLP-1 and visceral fat, you will get a better understanding  of...

05:33
what is our body composed of? So that's bone, muscle, water, fat. Right? I'm giving it the broader  picture, not including all the organs. And now when you think about that when this body is composed of these four  essential elements that we are covering today, when we have weight loss, it is not just going to be fat loss, right? That weight loss will have some impact on muscle loss.

05:58
This is for any weight loss. I'm not just talking about medication-induced weight loss, but any weight loss, if you are intentionally reducing your calories or really working out on exercise, or if you fell sick and lost weight,  you're bound to not just lose muscle, but there will be some muscle loss with it. Now, when you're using medications like GLP-1,  knowing that what your body composition is, so I highly recommend that if you are

06:27
or if you're thinking of being on GLP-1 medications, go get your body composition test done. It's very simple. You can even buy a scale. You can go to your gym. You can come to my office if you were in California, or you can find centers, which are called DexaFit centers, to get your body composition analysis done. So you have a very good baseline idea. What is my visceral fat? What is my muscle mass in pounds as compared to my weight? And then what is my fat mass or body fat percentage?

06:58
When you start GLP-1 medications, it's better to start  slow and steady and  know what indications, ah for what indications are you starting these medications on, right? So if it's a weight loss, if it's type 2 diabetes, if it's  sleep apnea, if it's fatty liver disease,  there will be weight loss occurring gradually. For some patients, it may be  initially during the first  few weeks of starting this medication.

07:26
In many of my patients, they won't notice much of a change in pounds, but they'll start feeling lighter. The clothes are feeling better.  There is just more energy or  the inflammatory symptoms like joint aching or that energy sensation that's resolved or that's gotten better. Right? These are all positive changes. What does that tell you, my friend? It tells you that there is a shift in our biology, which is happening. It is not just weight loss.

07:56
Okay, so when that shift is happening and you are going to see positive benefits or gains in your health, your goal  is to focus on lifestyle intervention simultaneously when you're on a pharmacological medication. I have handouts on GLP-1.  Journal of American Medical Association has a simple patient handout on what lifestyle interventions are necessary.

08:23
So your muscle strength training exercises, it doesn't mean you need to go to the gym, but can you engage in lunges, squats, any form of chair exercises, any form of push-ups, any form of core exercises  on a consistent basis so that you're stimulating muscle building. You can stimulate muscle building just by being on GLP-1 and exercise. You also have to nourish your muscles and your body and your health accordingly.

08:52
So the goal for GLP-1 medication is not to make you starve  or not to completely shut down the hunger signals. But  a certain level where your calorie intake is reduced, but you're still able to eat a couple of meals  or  smaller meals. And those meals, the quality of those meals matter. The better the quality, the more combination of fiber and protein.

09:19
And of course you can engage in carbohydrates to a certain limit,  limit your fats. There is no doubt that you will eventually see a better body composition as you lose weight. So  my patients don't necessarily just lose  muscle over time to bring about that change in their scale, but their body composition shifts. I encourage them to getting

09:46
into simple exercises to start with.  And  as they're losing body fat percentage, guess what? They're gaining muscle. They're losing weight. They're gaining muscle. Right? And say if you're gaining muscle, you may not see that drastic change in your weight, but the body fat percentage is reducing. The visceral fat is reducing. So your body composition is getting more leaner. It is getting healthier. You have less visceral fat. That is less inflammation in your body. Right?

10:16
is supposed to be your health goal. In this short  one question which was,  GLP-1 medications like Ozempic, Vigo, Vimajaro, Zeppound cause muscle loss? I gave you a very nuanced answer that any weight loss can cause muscle loss. Be it medication, be it reduced calorie intake, be it sickness, be it know being on chemotherapy agents, right?  But when you're on GLP-1  medications

10:44
If you go the right way in terms of right usage, not just for cosmetic purposes, you are focusing on your lifestyle foundations, you are focusing on your sleep, your muscle, your fiber, your protein, consistency,  and  that is overlapped with the use of medications. You are going slow and steady. There is no doubt that you will gain a very healthy body composition  and

11:11
you will not see ongoing muscle loss. You'll actually start seeing gains because you're putting in the work for it. So when you decide to opt for going on a medication, for me,  it should be for my patients that you're committed towards your health. You're committed towards knowing your health goals, which are truly meaningful and truly healthy. And now you can definitely see gains in your health at large. Okay.

11:40
So that was one of the nuanced answers that you will not find just on uh Google or AI search, but this is especially for you so that you could get empowered and make the right decision. All right, my friend, now coming to question number two. This is also very commonly asked by my patients community  or  even when I get emails that can lifestyle changes alone replace GLP-1 medications? Okay, so.

12:08
Go back to question number one and answer number one if you tuned in right now or if you're watching on YouTube. But the question  is also  very specific. It's lifestyle versus GLP-1 medications and I'm going to give you a nuanced answer. There is no yes and no. Lifestyle changes by itself  or even if you go on medications, you don't lose lifestyle changes. You have to optimize them.

12:33
You have to improve them. You have to amplify your lifestyle interventions for the medications to work at its best. Okay? So we are not losing lifestyle interventions and focus on that in any phase of our life.  That's the simple answer. Now, since you asked me a question that just by itself lifestyle change  can help with weight loss um and I avoid GLP-1 medication. So this is where it gets nuanced, that is, it gets personalized, right?

13:03
um Don't you have  doubts about  these medications? I'm pretty sure you do. And many of you may do. Some of you might be taking these medications. Some of you might be in that  decision making phase where you're thinking, should I, should I not? I've tried everything, you no matter what I eat, no matter what I do, no matter how much I exercise, no matter if I am skipping a lot of meals, my weight is not budging, right?

13:31
So that's why it's nuanced, it's personalized. Every person, every biology is different. You have genetics, you have environmental exposure, you have family history, have ethnicity. There may be insulin resistance, which is not completely  resolved or treated with lifestyle interventions because there is this ethnic and family history component to it. There may be exposure of steroids or certain medications  in your past history that is causing you to

14:00
not move further in terms of your body composition or weight in a healthy zone. So in those scenarios, this is where science comes into play that lifestyle by itself may not be enough for many of the humans  and this also includes diseases that you're dealing with. So if you have  obesity or overweight based on the BMI, that is a body mass index category,

14:28
That's not just the only reason that GLP-1 medications  will help you. What's more important is, you know, what's my body composition?  Even if,  my BMI is 25,  but I have tremendous amount of insulin resistance, there is pre-diabetes or type 2 diabetes, there is a strong family history of heart disease or  metabolic disorders like diabetes or fatty liver disease,  you get your body composition done and lo and behold,

14:58
the visceral fat is skyrocketing. There is barely any lean body mass. And I commonly see this picture, especially in South Asians, Indians, Pakistanis, Bangladeshis, Middle Eastans, right? These individuals  may come into that category of BMI of 24, 25, but  metabolically they're unhealthy. And if they're doing their best in terms of nutrition,  exercise, muscle strength training,  sleep is adequate and good quality,

15:27
The stress response  is well controlled. are behavioral modifications that are happening. There is no smoking. There is limitation or no alcohol  if I were  that person.  And there is not enough room to work on lifestyle interventions while the person has been consistent. Where will that person go? How will that person reduce their risk of having a heart disease?

15:53
type 2 diabetes or having obesity related complications in the future, even obesity, this is where GLP-1 medications really complete the picture. Okay? So it's not that someone failed or someone's guilty, but their biology and the background, the biology that we are composed of, as I told you, it's multiple components and many of the biological pathways we don't even know. We are still learning in science.

16:23
And those scenarios, these medications have been life changing.  They have been able to reduce the risk of so many complications.  And that's why it's nuanced. So when you ask a question, that is GLP-1 medication for me, or did I fail by  not doing adequate or by doing adequate interventions, but you know, this is how my life is going to be, that's the place you don't want to be. You want to get the right information, the right awareness.

16:52
understand what these medications do and then talk to your clinician that would this be a right choice for me. Another nuanced answer but I came for this specific episode just because I wanted to make sure that you get a clear picture of how clinicians are guiding our patients for GLP-1 medications, the clinicians who are experts and have been using these medications for a long time. Okay my friends,

17:21
As I tell you  more about these medications, obesity and weight, um if you have more questions relevant to this topic,  don't hesitate to  email my team and I would be happy to make another episode for you. You'll find the email in our show notes, both on YouTube as well as wherever you listen to your podcast. uh And the website is unifiedendocrinecare.com.

17:48
where you can just email us through there or you can use our contact form to give me that information too and I'll be happy to create another episode to answer most of your questions in our next episode. Okay, so now question number three. Will I regain weight if I stop GLP-1 medication? All right, to tell you a fact,

18:14
This question literally ranks number one  in my clinic  when patients  are seeking more answers if they're on GLP-1 medication for any of the indications that I talked to you about, not just related to weight. So our question is, will I regain weight if I stop GLP-1 medication? Well, now by question number two and answer number two, you know well that this is also going to be a nuanced answer.

18:41
ah The answer is yes, you will regain weight if you decide to stop GLP-1 medication. That's a very simple answer. Now the nuanced answer is, will I regain all the weight that I've lost?  Do I really need to stop GLP-1 medication?  You know, is there a need? Is there an indication? Because you need to know why did I start GLP-1 medication, right? So the medical indications that we talked about earlier, okay.

19:10
We're not just related to weight loss. GLP-1 medication is not something that, oh yeah, let me use it for two months or a few weeks and get down to this 10 pound weight loss and bingo, I can stop the medication. This medication ain't cosmetic. This medication is not an antibiotic course. This medication is not a painkiller that you take as needed and decide that I don't need it, I'll stop it, right? It's a medication, it's a hormone.

19:37
which is helping to shift the biology or the physiology in such a manner where if we have a condition, a disease, a chronic metabolic issue,  it is helping to reshift that biology so that we are not  dealing with complications or we are progressing towards treatment. uh When it's being used to treat a chronic condition, I'm not saying that you cannot

20:04
completely treat the condition or stop it. Now I'll give you two  aspects. In many of my patients, especially in their midlife  or women in the menopause, post-menopausal phase, when they experience a shift in their biology, centralized weight gain, more insulin resistance, there is pre-diabetes,  and they've optimized their lifestyle interventions. They've been working on it for months to years. They have  utilized hormone replacement therapy, if that's helping them.

20:34
not all of them,  and there is this increased risk of complications. They have higher visceral fat. That's when if they are adding GLP-1 medications as a support  and while they're using it for the next nine months, 12 months, we are assessing have you been building mass? You're losing body fat percentage. Is your A1c back to normal?

21:00
is your insulin level back to normal, your glucose looks good or your glucose tolerance looks good.  You've built more muscle, your more lean body mass rather than fat mass.  Visceral fat is the lowest at its level  and if you  feel very comfortable that there have been so many behavior modifications in terms of your  intake, in terms of your cravings,

21:27
And now if you're deciding with me, if I'm your clinician, your endocrinologist,  then we talk about, can we reduce the dose?  When I have them reduce the dose or whatever GLP-1 medication they're  on, then we still monitor the body composition. We are still monitoring the parameters uh other than weight.  And if you are not budging much, you're not regaining a lot, glucose numbers are good and

21:56
You are still continuing your lifestyle interventions, your behavioral modifications.  There is no uptake in your uh calorie intake, which is significant, or you're not feeling like  the cravings  are  coming back and you're feeling like you need to eat more. And that's a safe place to decide, can we rain down further and assess, right? So what are we assessing here?

22:23
I really didn't tell you that I'm just looking at weight and if you're regaining two or three pounds, then we cannot stop. But I'm seeing all of these clinical parameters, including your body composition, including your blood work, if that's just a subtle difference, because I said initially that weight regain is going to happen, but it may not be a complete regain. It could probably be five pounds. Maybe it could be 10 pounds plus and minus in case if you've lost 30, 40, 50 pounds.

22:53
And that may not negatively affect your health,  but it's so individualized. It depends on your biology. It depends on your genetics.  There is a component of patients,  subgroup of patients where I am  helping them to wean down the GLP-1 to discontinuing it. And another set of  example is when patients with PCOS, females, m are planning to conceive or they're coming in for

23:21
um in fertility amenorrhea and as we are treating them with GLP-1 medication because of their weight or pre-diabetes type 2 diabetes and metabolic conditions uh and many of them are able to conceive  or many of them are undergoing  procedures like IVF or IUI. We have to wean down and discontinue GLP-1 medications. know, almost  the safest would be two months prior to these procedures.

23:50
So that's another time that we actually use these for a shorter duration and then discontinue. But what's important is to monitor that woman during pregnancy, during the postpartum period, after that because they do have a higher risk of weight regain or gestational diabetes, pre-diabetes and so on. So you need to know  why do I need GLP-1  medication. You need to know what's your biology. need to know what...

24:18
what your health and your body demands. And that is the best when you have a discussion with the right expert, with the right endocrinologist, with the right obesity medicine  specialist, if you're seeing one, so that you are able to make right choices and right decisions at that particular phase of your life. And it's a shared decision making where you're looking at resources, your understanding in and out of  the medication, your health or the chronic condition that you're dealing with.

24:47
and of course your foundation of lifestyle interventions, muscle preservation, muscle gain,  nutrition, your sleep,  the metabolic support, your supplements, right ones, will be so essential to help you decide that do I need GLP-1 medication?  Ongoing versus is this going to be  a small set of number of years or months? It's very individualized. But most of the time, if you're taking this for

25:15
uh obesity type 2 diabetes.  These are  ongoing medications so that your numbers are way better or back to normal and it prevents complications.  Okay, so that was another detailed nuanced answer  and the key takeaway here is that sustainability depends on what you build, right?  It doesn't mean that I take GLP-1 and that's all going to be enough for

25:43
sustaining good health, but what am I building along with the use of these medications that dictates a lot of your uh future health course and also the decision making.  All right, we're almost nearing  the next question, which is question number four. Is long-term use of GLP-1 medications safe?  So as we discussed, is it a short-term versus a long-term medication?

26:10
Now we are diving into is the long-term use of GLP-1 medication safe. Now,  as you know, what we discussed in specifically answer number one, that these medications, we've had them since 2005, 2007, and as endocrinologists, we've been using it  since that time, especially starting with type 2 diabetes and myelitis 20 years.  Okay? So the data that we have is for 20 years uh in many of these patients. uh

26:39
Simple answer, yes. uh Originally in diabetes care, more than 15 years, we also have cardiovascular outcome data showing  reduced events  and stroke risk in very high-risk patients.  But like these medications  are prescription medications  and they are used for a specific medical disease or condition.

27:05
you still need to undergo proper screening. You still need to undergo proper lab evaluation. Highly, highly, highly recommend a body composition analysis periodically. In my patients, I may do it every six to eight weeks. You can buy home scale so that you're monitoring your body composition at least a month or so so that you know you're on track  and  you are always heading towards progress. The dose titration is important. That is, you don't just want to

27:36
keep titrating the dose higher and higher up just because you want a specific result. But patient-specific tolerability, what's your gut telling you? How's your bowel movement? What's happening to your nausea? What's happening with that fullness sensation?  Are we curbing the appetite completely, which is a no-no because that's not the intention, that's not the goal, and that's not healthy. So all these are very important for dose titration for clinical monitoring. So that's why I highly recommend to see a physician expert

28:05
when you are on GLP-1 medication, and especially when you're taking it for a longer period.  In this, I also talked about monitoring for  side effects and the common side effects for the GI side effects, but the others like hair loss or skin changes can happen if you're not  supplementing yourself adequately with nutrition or not necessarily treating it, or you may witness hair loss, but understanding the physiology and seeing that how

28:33
that cycle can change and again become normal is also very important, right? uh I also have a GLP-1 handout and the links will be in the show note. uh And you can use that. It's a free download so that you know where to start with and what are the common side effects  that  you should be aware of even if you're a physician or you're prescribing,  healthcare professional has given it to you. Okay, underlying.

28:59
There's important message that these are not cosmetic medications. These are actually metabolic medications. And that's why they're FDA approved for metabolic diseases like type 2 diabetes, obesity,  overweight, high BMI with other risk factors, fatty liver disease, and so on.  They have to be used appropriately.  And in general, they are effective and safe.  So working with a clinician who understands.

29:26
your biology, understands endocrinology, who understands GLP-1, who understands and knows obesity medicine. ah That's the person, that's the healthcare profession you want to work with, not just influencers or trends that are happening out there in the world. So  safety comes when you are aware. Safety comes when you are using it appropriately and not necessarily just  avoiding the right knowledge. All right.

29:55
My friends, now we go to question number five. So this one was  one of my favorite questions and always discussed at most of my visits with patients when you're talking about  metabolic health, when you're talking about diabetes, obesity, prevention, know, patients with  centralized weight gain because of that midlife changes or shifts in their hormones. The question is, what matters more, the number on the scale or your body composition

30:25
And I have a clear answer for this body composition, body composition, body composition. That's the most important one. Okay. Again, I would recommend to just go  listen to the last few episodes and especially the one on GOP-1 which talks about Vigovio Zempic Manjaro and the introduction of these  medications if you wanted to learn about what body composition is, why it is that important.

30:52
but it actually tells you, that is body composition tells you about health. Two people can weigh exactly the same.  160 pounds, 160 pounds. Five, nine, that is five foot nine inches, five foot nine inches, but  one person or person A may have more body fat mass, more visceral and less lean. The other may have  more lean mass.

31:19
more bone mass, more muscle mass and less body fat, less visceral fat, right? Metabolically, this person is healthier, that's person B, rather than person A, even though their height and weight is the same. That is my short answer for you, that number on the scale is not as meaningful as your body composition. Now, why do we focus on muscle so much?  It's because we know about it.

31:48
You know, when we learned about diabetes, type 2 diabetes, especially in medical school, residency and also during fellowship,  it is one of the foundational  metabolic disorders which is directly linked to insulin resistance. And insulin resistance  can be reversed, can be improved by  using our muscles. So as simple as, you know, walking after your meals helps improve your insulin sensitivity, brings your blood glucose down.

32:16
Your muscle uses fuel in the form of glucose.  And if the muscle can contract adequately, it uses those resources  and  it helps to avoid too much insulin circulating in your body, which is hyperinsulinemia. Right? Your muscle is like an anti-inflammatory organ. Your muscle is an endocrine organ.

32:41
It can release anti-inflammatory, that is factors or markers which are against inflammation and help you make feel better.  Muscle when activated and utilized, walking, exercise is amazing for your mental health. There is just no side effect. Of course, you don't want to overdo it without the right nutrition, but that is also very much dependent on what  your choices are, what your fitness level is, right?

33:07
So if I could change  one thing about how we measure progress in the medical world, which I already do for my patients, it would be stop chasing weight loss, but start chasing, start focusing on health goals, the real health goals, which is your strength, your energy, your metabolic resilience.  How can I be more resilient? How could be more strong? How could I feel more energetic?

33:33
And of course, that involves a lot of  complement of the improvement in our body composition. So beyond the scale, beyond the scale in pounds and kilograms is where health lives.  And that is what I'll end this episode today  on GOP-1 metabolism as well as weight. If today's episode helped you to find more clarity, helped you to reduce your

34:02
expectations or redirect your expectations in the right manner, know about your real health goals, then please like, subscribe to our channel. We are on YouTube as well as Spotify and Apple where you're listening your podcast today. Next episode, we will be diving into myths relevant to thyroid and normal labs as well as the autoimmune thyroid realm. Until then,

34:29
Definitely stay curious, keep following along, spread this message  or the episode with your friends, your family, whoever can benefit and remember your health  is not a trend. It's a long-term commitment and your goal is always work in progress.  Signing off, this is Dr. Mekija.  Thanks for hanging out with me on hormones and hope.  If you've loved this episode,  me a favor, hit subscribe.

34:59
Share it with someone you care about  and drop a review if you're feeling generous.  Want more tools to support your hormones and health?  Head over to unifiedendocrinecare.com.  We've got free guides, resources and more waiting for you.  Until next time,  stay curious, stay kind to your body and keep your hormones happy.