GLP-1s, Obesity, and Menopause: Benefits and Risks

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Rapid weight loss with GLP‑1 medications affects more than just body fat; it also reduces fat-free mass, including muscle, bone, connective tissue, and fluids. Typically, about 75 percent of weight loss comes from fat, with roughly 25 percent coming from fat-free mass, says Sriram Machineni, MD, an endocrinology, diabetes, and metabolism expert at Montefiore Health System in New York City.

Menopause already increases a woman’s risk of muscle loss (sarcopenia) and bone thinning (osteoporosis), so women using GLP‑1 medications during this transition should be especially vigilant. “Weight plays a tremendous role in bone density,” says Chervenak. “Women who lose large amounts of weight are at an increased risk for bone loss.”

Muscle loss is also a concern, particularly when physical activity is low, as there’s less stimulus for muscles to grow, says Dr. Machineni.

To minimize the risks of bone and muscle loss, experts recommended focusing on both protein intake and strength training.

You should include protein at every meal and snack, aiming to consume 1 to 1.5 grams of protein per kilogram of body weight daily, says Sangeeta Kashyap, MD, assistant chief of clinical affairs at New York-Presbyterian/Weill Cornell Medical Center. For example, a person weighing 150 pounds (68 kilograms) should try to eat roughly 70 to 100 grams of protein per day. Good sources of protein include eggs, Greek yogurt, chicken, fish, beans, and protein shakes.

When you’re on a GLP-1 medication, it’s also especially important to strength train at least two to three times per week, targeting all major muscle groups by using your body weight, dumbbells, resistance bands, or machines.

Push-ups, rows, squats, hip bridges, deadlifts, and lunges can be particularly effective exercises for strengthening major muscle groups simultaneously.

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