What nobody tells you about Ozempic — a doctor's honest guide

If you're on Ozempic, Wegovy, Mounjaro, or Zepbound — or thinking about starting — there are four things you need to understand first.

Dr. Esra Shermadou, DO · Board-Certified Family Medicine & Obesity Medicine · Sakinah Health, Dayton, OH

GLP-1 medications are genuinely life-changing for many people. I prescribe them regularly, and I've seen them help patients lose significant weight, reduce inflammation, lower blood sugar, and change the trajectory of their health. But medication without the full picture is where things go wrong. Here's the conversation most people aren't having.

Here's something most people don't know: weight loss in any form — diet, bariatric surgery, or medication — can cause you to lose muscle. The faster the loss, the greater the risk, if we're not deliberate about how we approach it.

When you're in a calorie deficit, your body doesn't only burn fat. It also breaks down lean mass — which includes muscle, but also organs, water, and other tissue. On average, about 30% of the weight lost, regardless of method, tends to come from lean mass rather than fat. That number shifts with age, sex, and how aggressive the deficit is.

Why does this matter? Muscle is your metabolism. It stabilizes blood sugar, protects against insulin resistance, and keeps you functional and independent as you age. Losing it now has real consequences later — for energy, bone density, balance, and long-term weight management.

This is not a reason to avoid GLP-1s. It's a reason to take muscle preservation seriously from day one.

Protein Intake

When your appetite is suppressed, it's easy to under-eat — and the first thing to drop is almost always protein. That's a problem, because protein is what your body uses to build and maintain muscle. The target I work toward with my patients is close to one gram of protein per pound of body weight — or at minimum, per pound of goal body weight. For most people, that number is higher than they expect and harder to hit than they think, especially when the medication is blunting appetite.

Protein-rich foods — lean meats, eggs, Greek yogurt, cottage cheese, legumes — need to be the anchor of every meal. If you're skipping meals because you're not hungry, I understand that. But skipping meals in a calorie deficit, without prioritizing protein, accelerates muscle loss. Eat less if the medication guides you there. Eat intentionally when you do.

Strength Training

If you're on a GLP-1 and not strength training, you're leaving the most important piece on the table. Not walking — progressive resistance training. Lifting in a way that challenges your muscles over time. This is the signal your body needs to hold onto muscle while losing fat. Without it, your body has no reason to preserve that tissue. It will use it for energy.

Ideally, I want patients building this habit before they even start these medications. If you're new to it, start simple — two days a week, compound movements: squats, deadlifts, rows, presses. Work with a trainer if you can. And if you're working with a physician on GLP-1 therapy, ask directly: what is the plan to preserve my muscle?

Weight Loss Plateaus on GLP-1s

This is one of the most common things I hear: someone loses 15, 20, sometimes 30 pounds — and then the scale stops. They feel like the medication stopped working. They feel like they failed. They haven't. Over time, your body adapts. Metabolic rate adjusts to a lower weight. The hormonal environment shifts. And if muscle has been lost along the way, metabolism has slowed — because muscle is metabolically active tissue.

There are also cases where the dose needs to be evaluated, where hormonal factors haven't been addressed, or where sleep and stress are actively working against progress. These are physician-level conversations — not just a refill every month.

If your GLP-1 has stopped working, don't adjust the dose on your own. Get a real conversation with a physician who can look at the full picture — hormones, muscle mass, nutrition, sleep, and stress.

You shouldn't have to figure this out alone.

At Sakinah Health, I work with busy adults in Dayton, the greater Dayton area, and southwest Ohio who are done guessing. We build a real plan — weight management with or without medication, hormone optimization, nutrition guidance, and strength training as part of your care.

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