Two Very Different Journeys

Unless you have been living under a rock, you know that GLP-1 weight loss drugs like semaglutide (Wegovy and Ozempic) and tirzepatide (Zepbound and Mounjaro) are everywhere. Exercise, the tried and true method, sweat, squats, and steps, has been here all along, and it isn’t going anywhere.

Both can lead to weight loss, but they do not work the same way. And the differences go far beyond the number on the scale.

So which one is best? Or how do you use each one best?

This topic has become increasingly common in my day-to-day. I have multiple members of my gym and friends using medication to speed weight loss. Some are working with coaches to track loss and intake levels to help control muscle loss. Others are more focused on the scale. My single piece of advice is that if you are taking these medications, make sure you are hitting the gym and working on a strength-specific program. The data is alarming regarding the muscle loss that occurs with these medications.

Both can lead to weight loss, but they do not work the same way. And the differences go far beyond the number on the scale.

How Much Weight Do You Really Lose?

GLP-1 medicines in clinical trials show that people lost 15 to 21 percent of body weight in about a year. That is 30 to 40 pounds for someone starting at 200 pounds. In the real world, where people stop early or take lower doses, the average is closer to 9 to 12 percent.

Exercise alone typically leads to smaller changes, about 3 to 7 percent of body weight. But here is the twist. Even when the scale barely moves, exercise reliably reduces waist size and body fat and improves health.

The big takeaway is that GLP-1s are unmatched for pure scale loss. Exercise is unmatched for health improvements, even if the scale barely budges.

What Kind of Weight Comes Off?

With GLP-1s, most of the loss is fat, but muscle mass can drop too, up to a quarter or more of the total loss. Without resistance training and protein, this can leave people smaller but weaker.

Exercise burns fat while preserving or even building muscle. This is crucial for metabolism, strength, and preventing the “deflated” look.

Beyond the Scale

Heart health: Semaglutide lowered heart attack, stroke, and cardiovascular death risk by about 20 percent in people with obesity and heart disease, even without diabetes. Exercise, however, has decades of proof that it lowers blood pressure, improves cholesterol, and cuts the risk of death from all causes.

Bone health: Rapid weight loss from medication or diets can thin bones. Exercise, especially strength training, helps protect them.

Mood and energy: Exercise is a proven antidepressant, anxiety reducer, and sleep booster. Medications can improve how people feel about their body, but they do not replace the mental health benefits of movement.

The Loose Skin Question

People often ask, do GLP-1 drugs cause more loose skin than exercise? The truth is, it is not the method; it is the amount and speed of loss.

Large, fast losses from surgery, medication, or crash diets increase the odds of loose skin. Age, genetics, and years spent overweight also play a role. Exercise helps by improving skin elasticity and thickness, but it will not erase major folds.

Risks and Realities

GLP-1s: Common side effects include nausea, vomiting, and digestive issues. Rare but serious risks include gallbladder problems and pancreatitis. They are also expensive, often more than one thousand dollars per month, and many people regain weight when they stop.

Exercise: Injuries can happen if you go too hard too fast, but overall risks are low and benefits are broad. The main hurdle is consistency.

Cost and Access

GLP-1s are pricey, insurance coverage varies, and supply is inconsistent.

Exercise is nearly free, beyond shoes, weights, or a gym membership.

Pros and Cons at a Glance

GLP-1s
Big and fast weight loss
Improves heart outcomes in high-risk patients
Appetite suppression
Risk of side effects, high cost, and the need to keep taking
Muscle and bone loss risk without training
More loose skin if weight loss is rapid and large

Exercise
Slower and smaller weight loss
Improves heart health and lifespan even without weight loss
Builds habits, skills, and long-term fitness
Low risk, low cost
Preserves or builds muscle and bone
Gradual changes may reduce skin issues

The Best of Both Worlds

The strongest approach is not either or. It is both.

Use GLP-1s for appetite control and fat loss. Pair them with strength training, protein, and aerobic work to protect muscle, bones, and skin quality. If you are not on medication, exercise alone will still pay off in health, energy, and longevity, benefits no injection can replace.

Practical Tips:

Do resistance training two to three times a week to protect muscle and bone.
Aim for 150 to 300 minutes of cardio a week to support heart health.
Eat protein at every meal, about 25 to 40 grams, which is critical on medication and helpful without.
Hydrate, sleep 7 to 9 hours, and protect your skin.
Set realistic expectations. Large and fast losses often result in loose skin, regardless of the cause.

Takeaway

GLP-1 drugs are powerful tools, but they are not magic bullets. Exercise is still the foundation of health, strength, and longevity. If weight loss is your goal, medications can help you get there faster, but exercise ensures you're happy with your outcome.

See you in the gym!