Are You In Midlife (Or Older?) And Seeking To Lose Fat Using GLP-1 Meds (e.g. Ozempic)? You May Need To Focus More On Strength & Protein (Less On Carbs & Cardio).
Recently I have been working with a few midlife and older adults seeking to lose body fat by using the new weight loss drugs - like Ozempic or Mounjaro.
These people are on a journey in changing their mindset about food and exercise. Indeed, as one client has said, one of the most valuable (yet confronting) mindset adjustments brought about by this process is seeing how much food you actually need - as opposed to how much we find ourselves wanting (with the non-stop food noise buzzing our brains).
(Aside: What a strange reality we have built for ourselves, hey!? Where a massive overabundance of cheap, delicious food is a big health issue).
As I walk with them in this journey, I see some common threads. Some common sub-optimal ways of approaching food and exercise.
I'm stepping them out here, primarily for the sake of these clients, but also so that you may benefit.
ISSUE 1: PRIORITISATION OF CARDIO EXERCISE (AT THE EXPENSE OF STRENGTH TRAINING)
Being children of the 1960s and 1970s, these clients were young people during the aerobics era, the 1980s jogging boom, and the peak of "big carbs" - where grains were massively valorised in public health messaging.
Because of this, they often view exercise as being about burning up energy (or "fat burning").
And while it is true that purposeful exercise does contribute to fat loss in this way, it is only a modest effect. The actual amount of calories burnt during training can be quite small.
And yet, exercise (strength and cardio) can have a profound indirect effect by changing your body's metabolic flexibility, enhancing your inbuilt ability to run on fat for fuel at rest (or when doing low key movement). It can also enhance your body's appetite regulation.
But the main downside of this sweat-fest mindset towards exercise, is that it relegates strength training to a low priority. Maybe because a properly executed strength training session doesn't look much like an aerobics class, basketball game or triathlon?
If strength and muscle building takes a back seat while you’re taking GLP-1 agonists, that's an issue.
Strength training helps people maintain or gain muscle mass. Muscle tissue is important for health (muscle is now regarded as being partly a gland - because it secretes health promoting substances like myokines).
But, critically, muscle tissue is important in losing fat - and keeping it off.
Muscle needs more energy than fat to maintain itself, which means a more muscled person has a higher basal metabolic rate - they need more energy to simply run their core body functions.
A more muscular version of yourself can eat a more satisfying amount of food, and can take it in their stride more readily when they have an occasional indulgence.
(It's not realistic to think you'll have a permanently restricted and highly restrained approach to food when you have so much yummy-ness at your fingertips 24/7. And besides, isn't food one of the best parts of life?)
Excessive loss of muscle is one reason why, in the past, people who have lost a lot of fat through diet alone often bounce back up to their original weight (or higher) once they stop dieting. The loss of muscle means they need even less energy to fuel their body than their pre-diet selves.
Another side effect of muscle loss is that it can limit your movement capabilities.
When you lose muscle mass and muscle strength, you are more susceptible to episodes of musculoskeletal pain (like acute low back pain). Loss of strength can limit movement skill, which shakes out as reticence to throw yourself into jobs around the house or going for long walks. You may experience less confidence in your everyday movement, and you have to overcome more inertia to take part in energetic recreational activities (for example, you're less likely to kick the footy at the family BBQ). And, importantly, muscle tissue plays a big role in preventing some of the major maladies of advancing age (like falls, osteoporosis and fractures).
What's the bottom line?
If you don't treat strength training as a priority when you're on weight loss drugs, you may limit the positive effect of these meds on your body composition or make it harder for yourself to come off them one day (if you decide that's the right call for you).
Cardio is still really important (possessing good cardiorespiratory fitness is massively beneficial for your health) but if it comes at the expense of strength training, that's far from ideal.
Let strength work be your foundation; the form of exercise you prioritise. When you do that, it's easier to fit the cardio in, too.
ISSUE 2: UNDERFEEDING - AND INADEQUATE ATTENTION TO PROTEIN
In practice, some people on weight loss medications seem to see food as being primarily about energy.
In their mind, the primary function of the drugs is to allow them to reduce their energy intake without extreme hunger.
There's a lot of truth to this but it misses some important nuance.
If energy intake is limited too much and there is insufficient protein in the diet, there can be excessive muscle and strength loss (which is an issue as stepped out above).
The amount of protein you need when seeking to build muscle can be quite confronting. Researchers suggest that adults undergoing resistance training need about 1.5g per kilo of bodyweight per day - and maybe even more among older adults, due to the effect of age on our ability to grow muscle.
If you've never tracked how much protein you currently eat, I think you'd be very, very surprised to see how challenging this can be given our modern diets.
Chances are you're not hitting that target. I'll assume you're not doing it until you can prove otherwise.
To hit this target, you normally need to have some kind of protein source at every meal.
If you're a meat eater, here's what it may look like for you:
eggs or some protein powder with breakfast;
lean meat like chicken breast - and not simply deli meat - in a salad with lunch
a decent cut of unprocessed meat with dinner - e.g. a good serving of white fish
I know that for me, most of my days DON'T look like this.
Now, I don't think you need to obsess over this or catastrophise if you have a low protein day.
But I do think you need to focus on getting in a regular amount of decent quality (and quantity) protein in your diet at most meals.
And it will serve you well to be patient with the rate of fat loss you're hoping to achieve. Going too fast may undercut your long term results by leaving you undernourished (you need vitamins and minerals from your food, too) and under muscled.
One of the practical difficulties with this is that, in contemporary Australia, carbs are often the base of our meals.
This is for all sorts of reasons:
rice, pasta and bread is cheap, convenient and delicious
carb based foods are easily packaged up to travel to work or school
fussy kids will often eat carb based meals, so we make that our default setting
carb based meals are simple and customisable
Australian cuisine borrows a lot from Asia and Italy and we're all familiar with stir-fry and pasta (even if the Italians and Asians don't eat this way!).
It's good to flip this and make protein the base. This will take time to learn, but if you persist it could become more intuitive. Here's some ideas:
increase the amount of meat and reduce the proportion of carbs (e.g. have one and a 1/2 salmon steaks instead of just one then have 1/2 a cup of rice instead of a full cup)
turn muesli into a garnish on top of greek yoghurt mixed with some protein powder (so the protein is the main event and not the muesli)
eat a large portion of scrambled eggs and avocado without the toast
use salads instead of carbs with meat (e.g. stir fried beef strips with seasoning on salad veggies with a few croutons)
When eating out, request steamed veggies instead of rice (e.g. broccoli, cauliflower) and have extra meat if you can
Turn to pasta and rice substitutes (zucchini noodles, cauliflower rice) or legumes (e.g. canned chick peas) when meals call for a carb base
In summary: make sure you don't drop your protein and total energy intake too low.
ISSUE 3: UNDERESTIMATING THE EFFORT NEEDED IN STRENGTH WORK - AND THE REQUIRMENT FOR QUITE A BIT OF REST
One of the reasons to not limit your food intake (especially carbohydrate) to an extreme level is that you need some energy and motivation to push yourself a decent amount in training.
You especially need to learn to push your limits when lifting weight.
Why? Because that what it takes to build strength and muscle. And, very commonly, people don't push themselves at the necessary intensity.
I see this especially among women, who sometimes approach weight training like it's aerobics - constantly moving around doing stuff but none of it is especially effortful.
One of the women I have been working with (who's in her 50s) recently gained 1kg of muscle (as measured by a body scanner) during a 4-week period simply by working closer to her limits when she did strength training. I had only one session with her before I told her she needed to raise the intensity. She then had to travel for a few weeks. When she came back, she reported the muscle gain after implementing that advice while away - with no other obvious changes.
In my experience, women also tend to take insufficient rest breaks between sets.
It's probably because men are lazy (or are we just efficient?) and women are busy, busy, busy getting stuff done in life.
In the end, it doesn't matter why, and whether you're male or female - you need to have a decent rest between sets if you're looking to build muscle or gain strength.
How much? A good rule of thumb is to watch your breathing: when you're respiration rate is reasonably calm you're probably OK to start another set.
Decent rest is needed to have a good amount of energy and motivation to send this signal to your body: "body, we're going to be doing this from now on, so you better adjust and learn to cope".
You need to deliver heavy tension to the muscles in order to send that signal.
When the body receives the message, it adapts in the direction of the stressor by gaining muscle mass and increasing strength. If you don't give your body a reason to change, it will stay the same.
Now, when it comes to lifting weight that's heavy for you, it is very important to do it safely.
I like to talk about "learning then loading".
First of all, you need to learn decent lifting technique and body mechanics. The time this can take varies among individuals.
Once you've done a good amount of learning, and your body is coping well (no significant aches and pains and no excessive fatigue) you can start loading.
It's important to not add too much load too soon. Don't try to progress in massive increments - be content with small increases. These build up and compound with time.
To put on muscle, you need each work set to be quite challenging. See this article for more information on muscle gain.
Well, there you have it. If you're using a GLP-1 medication to facilitate fat loss, be sure to:
1/ Prioritise strength training
2/ Get enough protein and total energy to build - or at least preserve - muscle (remember: food is more than merely energy / you still need NOURISHMENT)
3/ Prepare to push yourself in strength training, and once you're ready, be sure to load your muscle quite heavily