Muscle, Metabolism, and Mindset: The Truth About Long-Term Use of GLP-1s

Why the Conversation Around GLP-1s Needs to Change

Too often, women taking GLP-1 medications feel judged. If you’ve ever heard someone say, “Just eat less and move more,” you know exactly what I’m talking about.

But here’s the truth: obesity is not a lifestyle problem. It’s a chronic, relapsing, multifactorial disease.⁽¹⁾ And like any chronic condition—hypertension, diabetes, high cholesterol—it requires long-term strategies, not short-term fixes.

That means it’s time to stop asking, "When can I stop taking the medication?" and instead ask, "What can I do to set myself up for lasting metabolic health?"

Why Muscle Is Everything

GLP-1s work by reducing appetite. That means you eat less, and while that can lead to fat loss, it also increases the risk of losing muscle if you're not intentional.

Muscle is the engine of your metabolism. The more muscle you have, the more calories you burn at rest, and the better your chance of keeping the weight off. Lose too much muscle, and you might slow your metabolism in a way that makes weight regain more likely.

So here’s the plan:

Prioritize protein. Aim for 1.3 to 1.6 grams of protein for every kilogram of ideal body weight per day, especially if you’re over 40. Use our protein calculator to find your protein range and be sure you break that amount up across all of your meals and snacks.

Lift weights. Resistance training 2-3 times a week is non-negotiable. Looking for a place to start? Try these two free workouts my trainer, Holly, created.

Get a DEXA scan or invest in a home InBody scale. It helps track body composition so you can monitor fat vs. muscle loss.

Adjust your GLP-1 dose. If too much muscle is being lost (think more than 1 to 2 pounds/week), your clinician should scale back the medication.

Remember: GLP-1s don’t cause muscle loss directly—it’s the caloric deficit that does. That’s why it’s so important to stay fueled and strong.

Obesity Is a Disease, Not a Failure

If you’ve tried everything to lose weight and nothing has worked, I see you.

Maybe you lost weight on a diet only to regain it. Maybe you were told to just work harder. Maybe you even believed it was your fault.

But it isn’t. Obesity is shaped by genetics, hormones, metabolism, environment, and more.⁽²⁾ And in perimenopause and menopause, everything shifts—less estrogen, slower metabolism, more visceral fat.

GLP-1s offer a tool that works with your biology, not against it. They may reduce inflammation, support blood sugar regulation, and help you make changes that feel manageable for the first time in years.

You deserve access to that tool without shame.

Can You Ever Stop Taking GLP-1s?

This is one of the most common questions I hear. I’ve discussed it with Dr. Alexandra Sowa, a board-certified internal medicine and obesity medicine specialist, founder of SoWell and author of The Ozempic Revolution. And the answer is: maybe.

If you build muscle, support your metabolism, and address the root causes of your weight gain, some people can transition off. But for others, especially those with a long history of obesity, PCOS, insulin resistance, or multiple failed diets, long-term use may be the safest, healthiest choice.

And that’s okay.

We don’t stop treating high blood pressure or diabetes when the numbers improve. We keep treating them to maintain those improvements. The same goes for obesity.

Let’s Ditch the Shame and Build a Better Plan

There is no shame in taking medication for a chronic condition. There is no shame in using every tool available to stay strong, healthy, and confident in your midlife body.

Let’s build a better plan together:

• Protect your muscles. Read more on how protein and resistance training support muscle and metabolism here.
• Support your metabolism.
• Find and choose clinicians who understand this isn’t just about the scale. If you’re having trouble finding an experienced healthcare professional, consider Alloy, Midi or Evernow.
• Say no to shame.

GLP-1s are not a shortcut, they’re a support. And when paired with education, strength, and the right medical guidance, they can change lives.

You are allowed to need support. Talk to your healthcare professional about how to protect your muscles, optimize your metabolism, and decide if long-term GLP-1 use is right for you.

You don’t have to do this alone.

Looking for more on how GLP-1s and hormone therapy work together to reduce menopause belly fat? Read Part 1 of this series HERE.