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Everywhere I go, I get asked about GLP-1s and weight loss. A client jokingly suggested that Erewhon must be handing them out with their smoothies.
I’ve taken to calling this moment in history, “The Great Shrinking.”
I don’t mean that as a judgment but rather as an observation about scale.
In just a few years, drugs like Ozempic and Mounjaro have gone from niche diabetes medications to becoming a full cultural phenomenon fueled by the transformation of Hollywood celebrities and social media’s insatiable coverage of them.
“In just a few years, drugs like Ozempic and Mounjaro have gone from niche diabetes medications to becoming a full cultural phenomenon.”
According to a KFF poll, one in eight Americans is taking a GLP-1 medication for weight loss, diabetes, or another health issue. The ripple effects are showing up everywhere. Morgan Stanley analysts estimated that GLP-1 adoption could reduce U.S. caloric consumption significantly enough to impact the food and beverage industry at scale.
The restaurant industry is already reporting a measurable decline in spending as people simply eat and drink less. There are now GLP-1-friendly meals on menus. Morgan Stanley found that nearly a quarter of users quit drinking alcohol entirely because the medication dials down cravings across the board, not just for food.
The food industry is adapting faster than the healthcare system is.
The conversation around GLP-1s is getting louder, while simultaneously, the noise around food, for the individual patient, gets quieter.
This is not a trend. It’s a physiological shift happening across millions of bodies in real time. As a health optimization expert, I have a front row seat. And the patients I’m most concerned about are women in midlife — being offered GLP-1s without the preparation to receive them.
“A GLP-1 prescription can be a powerful tool, in context.”
A GLP-1 prescription can be a powerful tool, in context, which is what I hope to impart. I reached out to registered dietitian Ashley Koff, a clinician and nutritional expert on GLP-1s and author of “Your Best Shot: The Personalized System for Optimal Weight Health — GLP-1 Shot or Not,” and drew on my own experience with clients, to close the gap between the generic information that’s being handed out and what your body actually needs to leverage a GLP-1 medication.
What’s a GLP-1, anyway?
GLP-1 stands for glucagon-like peptide-1, a hormone the body produces naturally, primarily in the small intestine, in response to eating. When released, it signals the pancreas to produce insulin, tells the brain you’re full, and slows the rate food moves through the stomach. In a healthy body, it does its job and clears the system within minutes.
The medications most people know by brand name, such as Ozempic, Mounjaro, Wegovy, or their compounded equivalents, Semaglutide and Tirzepatide, work by mimicking this hormone. The critical difference is duration. Where your body’s own GLP-1 lasts minutes, the injectable versions stay active for 24 hours or up to seven full days, depending on the formulation.
That extended window of appetite suppression is what makes them so effective. It’s also what makes preparation to use them non-negotiable.
“That extended window of appetite suppression is what makes them so effective. It’s also what makes preparation to use them non-negotiable.”
I asked Koff why so many patients hit unexpected turbulence after their first dose.
“If there is already delay or challenges in stomach acid, bloating, or imbalances in microbes, this will reveal itself with the use of the medication,” she says.
Flooding a compromised digestive system with a synthetic hormone, even one the body recognizes, without first understanding if the system is working, is where things go sideways.
For women in midlife, that risk is compounded. Declining estrogen has already rewritten the rules, driving up appetite and food noise with less satiety from the same meals. This leads to more inflammation, visceral fat, and blood sugar instability even if nothing in the routine has changed.
The big reveal
Most people starting a GLP-1 expect some nausea, at least with their first doses. What they don’t fully understand is what the nausea is actually telling them.
“Unlike our own hormones, which last for 2–5, maybe up to 30 minutes, the medications stay on for one day or seven full days,” says Koff. “Their mechanism of action is to delay gastric emptying, so this will impact digestion in anyone.”
Apparently, the prescription insert doesn’t do a good job of explaining the why. According to Koff, the side effects most patients chalk up to the drug are actually diagnostic information — important signals about the state of the body before the medication arrived.
“The side effects most patients chalk up to the drug are actually diagnostic information — important signals about the state of the body before the medication arrived.”
Constipation, for example, isn’t always a drug reaction. It’s usually a preexisting motility problem that the medication just made impossible to ignore. Fatigue and suppressed heart rate variability (HRV) often point to a nervous system already running in overdrive. Rebound weight gain after stopping the drug, one of the more demoralizing outcomes, typically reflects an ecosystem that was never optimized underneath. It’s an example of the medication doing all of the work that the body never learned to do itself.
Even food aversion, described as the loss of pleasure around eating that some patients find distressing, is worth paying attention to beyond the obvious, given what we know about the relationship between nourishment, satisfaction, and long-term metabolic health.
None of these are drug problems. They’re information from the body and, in perimenopause, they may already be lurking under the surface. The question is whether anyone is connecting the dots.
Protein maxxing is not the answer
We are in the middle of a protein maxxing moment. Every bar, bowl, and snack is leading with grams. But, eating more protein is only half the equation.
Two years ago, I made DEXA scanning a standard part of my practice. My clients were skeptical at first because it was yet another number to track. But it turned out to be the single most effective way to shift them away from the scale and toward something that actually mattered.
Total weight is an opaque metric. The ratio of fat to lean mass, especially in the arms and legs, visceral fat, and bone density, are much more important. Those numbers tell a completely different story about a patient’s metabolism and body composition.
When a client tells me they want to lose weight, what they almost always mean is they want to lose fat and add muscle. Those are not the same goal, and the distinction becomes critical on a GLP-1. The medication will help the number on the scale move, but without deliberate intervention, some of the loss comes from lean muscle.
“When a client tells me they want to lose weight, what they almost always mean is they want to lose fat and add muscle. Those are not the same goal, and the distinction becomes critical on a GLP-1.”
All of my clients on GLP-1s are doing strength training two to three times a week and prioritizing protein, amino acids, and micronutrients. We track body composition changes, not just weight.
And yet, surprisingly, some of them still struggled to build muscle even when they met their training and protein targets. The culprit was their ability to digest their food and absorb the nutrients.
I asked Koff to share her nutritional framework that tackled these issues. While the generic advice plastered on Instagram about eating 100g of protein a day and lifting heavy isn’t wrong in principle, it doesn’t address the sequencing.
“GLP-1 guidance is often more protein, higher fiber, and strength training,” she says, “and then when side effects arise, providers double down or add supplements, or even other peptides. This backfires.”
If digestion is already compromised before the first dose, adding more protein while the medication is simultaneously slowing gastric emptying doesn’t build muscle. The protein simply doesn’t get used. Instead, it can worsen digestive distress, drive inflammation, and spike blood sugar, which is the very thing the medication was prescribed to improve.
Koff recommends making “protein pit stops,” which is a great way to explain proper sequencing: smaller doses of protein throughout the day so the gut has a chance to process it properly.
This revision means that patients need to make a shift in their routine by not skipping breakfast or making dinner the biggest meal of the day.
The one-size-fits-no-one problem
GLP-1s are being prescribed at scale with protocols designed for efficiency, not personalization. The result is that millions of people are receiving identical instructions regardless of wildly different digestive baselines, nutritional histories, and underlying conditions.
The part that concerns me the most is not the medications themselves, but the gap between what people are being handed and what they actually need. We are drowning in generic information about GLP-1s and starving for interpretation.
A patient with a robust, well-functioning gut is not the same as someone who has been chronically managing low stomach acid or dysbiosis for years. Giving both of them the same protein target and fiber recommendation and calling it a protocol isn’t precision medicine.
This is why I teach my clients health intelligence. It’s the difference between data and insight, between a number on a scale and understanding what that number actually reflects about your metabolism or body composition. A GLP-1 prescription without that context is like handing someone a power tool with no instruction manual and calling it a hammer.
The cultural conversation glamorizes the outcome of GLP-1s, but it shows none of the challenges or consequences that can occur without proper management.
Don’t get me wrong, I believe the medication can be transformative for many patients looking to improve their weight health, blood sugar metabolism, and inflammation. My hope is that this transformation comes with a carefully dialed-in and personalized plan to ensure it’s safe and sustainable.
Before you start a GLP-1
The first few weeks leading up to your first GLP-1 dose matter more than most people realize. While you don’t need to achieve perfect health before starting, I’d recommend that you understand your baseline.
This means getting a real picture of where your digestion is, what your body can actually absorb, and any symptoms that already exist that the medication may amplify. This way, you’ll be able to distinguish between a symptom attributed to the drug and one that arises from your system underneath.
Here are a few things I have my clients work on:
Know your body composition
This is non-negotiable for anyone on a GLP-1. The scale will change, but it won’t tell you where the losses and gains are coming from. A DEXA scan is the gold standard for measuring body fat percentage, lean mass, visceral fat, and bone density, and is worth doing before you start, so you have a true baseline to track against. In most cities, you’ll be able to find one for less than $150 without a prescription.
If your gym has an InBody scanner, that’s a solid second option. For tracking at home between appointments, the Hume Health scale gives you meaningful composition data without the clinical visit.
Support your digestion
Assess your gut health. Do you experience any bloating, irregular digestion, or low energy after meals? These are worth investigating before starting a medication that will slow gastric emptying further. Digestive enzymes can be a simple, low-barrier way to support your body’s ability to actually break down and absorb what you’re eating, especially protein. Start there before adding more of anything.
Hydrate like you really mean it
GLP-1s reduce appetite across the board, which means many people inadvertently drink less, too. Dehydration compounds fatigue, constipation, and brain fog, which are three of the most common complaints. Make hydration an intentional daily habit, not just water after a workout.
Lift heavy weights
Walking is not enough. In order to preserve muscle mass, patients need to do resistance training 2–3x per week. Both menopause due to declining estrogen and testosterone and GLP-1s create conditions for accelerated muscle loss. The only counter-stimulus is mechanical load. Adding creatine is another easy addition to support lean tissue.
Measure protein per occasion
It’s more than just hitting a protein target; it’s about distributing it throughout the day. Koff suggests 15–30g per “pit stop,” to avoid any nausea and bloating.
It’s clear that the GLP-1 era is upon us, and for many people, these medications are truly life-changing. I’ve watched clients reverse metabolic dysfunction, reclaim their energy, and finally get off the weight loss rollercoaster.
But the patients who get the most out of these medications are the ones who show up prepared. It’s more than just managing side effects. Those who build a steady foundation will benefit from the results of the drug long after their prescription ends.
While GLP-1s might not be available at your luxury grocery store, access is widespread now. And prescriptions are easier to get.
The medication is ready. The question is whether you are.
Celia Chen is a certified health optimization coach, brand consultant and founder of Chenessa, an advisory that offers private coaching, and corporate workshops on menopause, metabolism, and longevity. Follow her on Substack and Instagram for more wellness insights.
