GLP-1 Medications and Weight Management in Midlife
GLP-1 Medications and Weight Management in Midlife
What the Evidence Shows and How We Think About It
Written by Dr. Madeleine Clark, ND MSCP
GLP-1 receptor agonists have become an increasingly common part of conversations around weight management. But you may be wondering - what do they actually do? and how does that actually fit into a patients life?
While these medications can be effective tools for some individuals, particularly in midlife and menopause, they are not a standalone solution and require thoughtful consideration, especially when muscle health and long-term function are part of the goal.
In this blog, we summarizes what the research shows about GLP-1 medications, weight change, and body composition, with a specific focus on postmenopausal women.
What are GLP-1 receptor agonists?
GLP-1 receptor agonists are medications that act on appetite regulation by influencing hunger signals and satiety. They have demonstrated effectiveness for weight management, particularly in individuals with obesity or polycystic ovary syndrome (PCOS).
Clinical trials show that GLP-1 receptor agonists can lead to meaningful reductions in body weight and waist circumference. In some studies, approximately five percent weight loss has been observed within the first twelve weeks of treatment, with continued changes occurring over longer periods. When combined with metformin, weight loss outcomes appear greater than with either intervention alone.
Often, I have patients who come to me and say they tried a GLP-1 but didn’t’ lose any weight within the first few months. I often are reminding them these medications are typically intended for long-term use, and results unfold gradually rather than immediately- with meaningful results typically achieved at 1 year of use.
How effective are GLP-1 medications?
Across randomized controlled trials, GLP-1 receptor agonists consistently outperform placebo for weight reduction. Combination therapy with GLP-1 receptor agonists and metformin shows the largest effect, followed by GLP-1 monotherapy (GLP-1 therapy alone).
It is important to note that gastrointestinal symptoms are very common, particularly early in treatment, and dose changes and monitoring are often required to address them.
Weight regain after discontinuation is another concern. Research shows that individuals may regain up to two-thirds of the weight lost within one year of stopping GLP-1 therapy. This rebound is thought to be related to changes in satiety hormones, gastric emptying, and neuroendocrine signalling.
GLP-1 medications and muscle mass
One of the most important considerations in midlife and menopause is how weight loss affects lean mass (or muscle mass)
Research consistently shows that approximately 20–30 percent of weight lost on GLP-1 therapy comes from lean mass, translating to an absolute loss of roughly 0.86 to 1.41 kilograms of lean tissue in many studies.
Why is this an issue?
Lean mass or muscle mass is metabolically active tissue (it takes up a lot of energy/calories to maintain it), which keeps us metabolically healthly. Muscle mass is also an important consideration for aging - we all will experience age-related declines in muscle mass as we get older. The degree to which we lose this muscle mass in our later decades, is one of the biggest predictors of independent living.
Special considerations in menopause
Postmenopausal women experience accelerated muscle loss, estimated at approximately 1–1.5 percent per year.
If we lose muscle mass, but stay the same weigh (increase fat mass), we may be experiencing sarcopenic obesity. We may also experience early sarcopenia (losing our muscle mass). For menopausal women the muscle mass is not only important for independent living (discussed above) but also for maintaining bone density, preventing fractures and falls, maintaining balance, and preventing metabolic concerns like type II diabetes and metabolic syndrome.
Low dose GLP-1 therapy may be helpful or appropriate, but because of the importance of maintaining muscle mass, it should be combined with lifestyle strategies that preserve muscle mass.
Mitigating muscle loss during GLP-1 therapy
When GLP-1 receptor agonists are used, muscle-preserving strategies are essential. Research highlights the importance of:
Resistance training
Adequate protein intake
Consideration of targeted nutritional supports
Ongoing monitoring of muscle strength and function
How this fits into our approach to weight management
At Crafted Balance, we approach weight management through a broad, systems-based lens.
We address weight only when patients bring it forward as a goal of care. We do not prescribe weight loss.
Instead, we focus on supporting overall health through movement, nutrition adequacy, sleep, stress regulation, and addressing underlying hormonal, metabolic, or medical concerns that may be influencing body changes.
This perspective is especially important when considering tools like GLP-1 receptor agonists. Medication may be appropriate for some individuals, but it is never the entire plan. Long-term health depends on preserving muscle, supporting metabolic function, and maintaining mobility and independence as we age.
If you’d like to understand how we approach weight management more broadly, including weight neutrality, lifestyle foundations, and long-term health, you can read more here:
Weight Management: How We Approach Weight at Crafted Balance
Need more support?
GLP-1 medications are not a universal solution. In midlife and menopause, holistic plans that take into account your entire health history, all your health concerns, realistic expectations, and comprehensive muscle-preserving strategies are critical.
As a Naturopathic Doctor, this is why I love to work within the world of midlife - because we can touch on the spectrum of interventions from lifestyle to supplementation to medication - to ensure that you have a plan that touches on all aspects of your health.
Interesting learning if this is the right approach for you?: book a complimentary meet and greet appointment.