#38: Can You Build Muscle While on GLP-1 Medications? What Actually Matters

Building muscle while losing weight is one of the biggest concerns people have when trying to improve metabolism, especially for those over 35 and anyone using GLP-1 medications like Ozempic, Wegovy, and Zepbound. In this episode of The Vitality Formula, physician Dr. Marie Livesey explains whether muscle gain is possible during weight loss, what changes with GLP-1 medications, and what actually matters if you want to support metabolism and long-term body composition.

Whether you're trying to lose weight naturally, considering a GLP-1 medication, or already taking one, this episode will help you think beyond the scale and focus on building a stronger, healthier, more resilient body.

If you want a physician-led framework to help you think clearly about weight loss, hormone care, and modern health advice, you can download The Metabolic Clarity Guide .

Connect with Dr. Marie today!
Instagram: @dr.mlivesey
LinkedIn: www.linkedin.com/in/drmlivesey
Website: https://www.livelyholistichealth.com

This podcast is for informational purposes only and does not constitute medical advice or establish a provider–patient relationship.

Transcript

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Losing muscle mass while losing weight is one of the biggest concerns people have when they're trying to improve their metabolism, especially for those using GLP1 medications like Ozempic, Weigovy, or Zeppound. If you're losing weight but feeling softer, tinier, weaker, or worried about losing muscle, this episode is absolutely for you because losing weight and improving body composition and overall metabolic health are not the same. And yes, in case you are wondering, you can absolutely support muscle while losing weight, but there are a few things that matter more than most people realize. Hello and welcome back to the Vitality Formula. I'm your host, Dr. Maria Livsey, physician, metabolism, and hormone health expert, and I help busy professionals take back control of their health in ways that actually fit real life. And today we're talking about a question I'm getting more and more often. Can you actually build muscle while losing weight or while using a GLP1 medication? Because if you spend more than two minutes online, especially in the fitness and health space, you'll hear some very strong opinions. Some people are gonna say, no, it's impossible. You have to bulk first. Others are going to say, just lift the weights, ease eat the protein, take your GLP1. You're going to magic magically transform. And as usual, the truth is going to be more nuanced. Shocker. Because building muscle while losing weight is possible, but they're caveats and there are special things, special, certain things that you have to do, especially if you're over 35, navigating hormone shifts, feeling stressed, sleeping five hours a night, eating very little, you're surviving off of your girl lunch of iced coffee and vibes. Why did I just say vibes? Which respectfully I know is how some of y'all are living. No judgment. I've been there. Iced coffee girl lunch, but not so great for your metabolism. Maybe I'm a little concerned about you if you're like that iced coffee and vibes girl, but no judgment. I was that girl. When most people say I want to lose weight and build muscle, what they're really saying is I want to look and feel different in my body. They usually mean they want to feel less soft, be a smaller size, feel more strong, have more energy, look more defined, more toned, feel strong and feel more confident and comfortable in their bodies. And I think this distinction matters because the scale doesn't tell us all of those things that I just listed off. It'll only tell you your total mass, your total weight. It does not tell you your muscle mass, your body fat percentage, how much water you're retaining, if you have inflammation, and where your weight is being lost from, which is why so many people can lose 20 pounds and still they don't feel great or notice much of a difference because they lost the weight. They probably lost some muscle mass in the process. And as you may or may not know, I'm not trying to talk down to anybody. A lot of people know this, but muscle matters more than aesthetics. It's not just cosmetic. It is a medically, it is a metabolically active tissue that helps support blood sugar regulation, maintain strength, protect mobility as we age, and support metabolism over time. And honestly, especially for women entering their 40s and beyond, muscle becomes even more important because we naturally lose muscle with age. And changing hormones in perimenopause and menopause can accelerate that process. This is one reason I care so much about helping people preserve their muscle mass while improving their metabolic health. Because I don't want you to just be lighter. I want you to feel, I want you to be stronger. I want you to pass the sit to stand test when you're 95, carry your groceries, move your body confidently, travel all of those trips where you need to walk up the cobblestone streets, play with your kids or future grandkids, and maintain your independence long term for as long as possible. Those things all matter to me, and I'm sure they matter to you too. So can you build muscle while losing weight? And the answer is it depends. Sometimes yes, and sometimes no. And honestly, that's okay. For many people, especially if they are newer to strength training, coming back off of time off, improving nutrition, or insulin resistance, there's absolutely potential to build muscle while losing fat. And this is especially true if you're being really strict with the prioritization of protein, your strength training, and you having good recovery while maintaining a calorie deficit without underfueling dramatically. Yes, I realized that was a whole mouthful of things, which is why when you're trying to balance all of that, working with an expert is so important because it is a lot and can feel very overwhelming and become very overwhelming. And for many, if you're in a larger calorie deficit or you're losing weight very quickly, you are going to lose muscle mass. And at that point, a more reasonable goal might be not to build muscle, but to preserve what you have because that's still going to be a huge win. Muscle mass during weight loss is going to be the number one reason people feel weaker afterwards, still uncomfortable in their bodies, and struggle to maintain the results long term because the decreased muscle mass is going to mess their metabolism up long term. Okay, let's talk about GLP1 medications. We need to talk about this. GLP1 medications, I love them. They're incredible. I prescribe them on a daily basis, and I've seen firsthand how they improve multiple aspects of health dramatically. But rapid weight loss without intentional muscle support is very concerning. And I've seen a lot of this lately. And what do I mean by intentional? I mean someone checking in on you monthly, at least, at the very least, to ensure you are supporting your muscle maintenance more than initial info session with a doc that's like prioritize your protein, get X grams of protein without actually telling you how to do it, without helping you troubleshoot on how to make meal times work for you. And this is important because GLP ones decrease your appetite and make you feel fuller easier. And carbs for a lot of people are the go-to because they're light. They give you a little quick burst of energy and don't sit heavy on your stomach if you have nausea or reflux. But simultaneously, many people aren't starting strength training if they weren't already doing it while they're on their GLP one, because their energy feels and frankly is lower since they're consuming less food. I often find that for many people, the gym or weights themselves are very intimidating early on in their weight loss journey because they're still not comfortable in their body. And all of this is a perfect storm for muscle loss. Not because the medication is bad or the person taking it is lazy, but because nobody explained how to support the body while using it. And if they did, there was no follow-up or accountability system. I'm seeing people lose a lot of weight, but also lose strength and muscle mass and mess up their metabolism at least short term until we have interventions. And this is not an outcome I want for you because you will also lose energy, worsen your metabolic resilience, and further decrease the likelihood that you are going to be able to maintain your weight loss off of this medication. If your goal is to support muscle while losing weight or using a GLP1, here is what matters most. Number one, protein, and probably a lot more than you think. A simple rule starting out for people who don't have a lot of protein in their diet is 90 grams per day. Do some people need a lot more than this? Yes. However, when someone is consuming less than 50 grams of protein per day, it is way too intimidating to say, okay, consume 120, 30, something grams of protein right off the bat and leads them to not trying at all if you put a number that high. And there are some cases, like people who have kidney disease, where less protein is recommended, which is why it is so important to work with somebody like myself who is skilled in getting a detailed medical history and baseline assessment before ever starting interventions. Macro coaches are fine for the 20 somethings without medical conditions, trying to change their body composition and lose weight. But for those with metabolic disease, yes, it's a disease, working with a skilled professional is important to reach your weight loss goals and your overall metabolism and health goals without compromising other aspects of your health. Number two, strength training. No, you don't need to become a bodybuilder or enter a weightlifting competition. But even two or three 40 45-minute strength training sessions per week are going to help you preserve your muscle mass and in turn your metabolic rate, aka that metabolism that we like to talk about. Number three, we're gonna lump a few things into the category of recovery. So if you were in my podcast studio, you would just send me do these cute little quotations with my fingers. So this includes your sleep and your stress. When we don't have a hold of these things, eating right, exercising, thinking, functioning as a human all becomes infinitely more difficult. And your body experiences hormonal changes that negatively impact your metabolism. And last but not least, patience. We live in an instant gratification world where we can have our Amazon packages on our doorstep the same day, but weight loss, body composition, health changes, they do not work like that. Slower does not mean that you're doing something wrong. And in some cases, it actually means that you're gonna results are going to be more sustainable. When we work together, you can guarantee you will hear me say the cheesy but such true age-old adage: good things take time. An important mindset shift is that weight loss and a better metabolism does not equate to getting smaller and that you can maintain or build muscle while losing weight with the right strategy. When we think about our weight and metabolism, the goal should be yes, look at me telling you what your goals should be. Supporting your body that will allow you to do the things. Yes, I know this is big. Insert your dreams here: mountain biking, hiking, easily walking up cobblestone hills in cute little towns in Europe, playing football with your grandkids, the York dreams that you want in the long term. And being smaller but weaker may not allow you to do those things. If you take anything from this episode today, let it be this. Take a step back from your desire to lose weight and think about your long-term goals for your life and where your life needs to be to support it. If this isn't something you've done in a while, get into my DMs on Instagram, which I've linked for ease in the show notes, and I will send you one of my favorite notebooks so you can journal on this. No, no costilla, there's no strings attached. I just want to send you a cute little notebook so that you can work through this for yourself. That's it for today on the Vitality Formula. Thank you so much for spending this time with me today. Until next time, take care of yourself. Remind yourself that smaller doesn't mean better. And as always, I'm cheering you on.