A lot of people say that GLP-1 medicines should be the last resort for weight loss. However, they may actually need to be first resort for those at high risk.
09.07.2025 22:56
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A lot of people say that GLP-1 medicines should be the last resort for weight loss. However, they may actually need to be first resort for those at high risk.
"I turned down free airport food on the flight out, and didn’t even think about the free brownies in the United club lounge. This was a HUGE a-ha moment for me.
Also I'm staying active because I WANT TO not because I HAVE TO!"
- one of my patients taking a GLP-1 medicine
5 truths about losing a lot of weight
1. You need to get into a calorie deficit
2. Lift weights to not lose muscle
3. You don’t need to do cardio, but it may help keep the weight off
4. It’s not going to be easy and you may need medicine to help
5. Food choice matters
You generally have to take GLP-1 meds indefinitely just like you generally have to keep exercising and following your diet to keep weight off.
Astonishing I know.
To sum up my recommendations for every single patient:
1. Resistance training 2-5x/week
2. A diet with many plants and lean protein (carbs and fat according to goals and preferences)
3. Aerobic training 2-5x/week
4. 7-8 hours of sleep per night
5. Walk and laugh a lot in between
If a doctor gives out testosterone without doing a full work up then you don’t have a doctor you have a steroid dealer.
We don’t shame those who need hearing aids to help them hear.
So why do we shame those with obesity who need help with their appetite?
“I feeling like I’m eating to live instead of living to eat now.”
“I’m finally free from all the food thoughts.”
- patient who started a GLP-1 med last month
Weight stigma is harmful.
Excess weight (adiposity) can be harmful too.
Not mutually exclusive.
“You’re are just brainwashed by mainstream media.”
- guy who is brainwashed by alt-right podcast
Who needs April Fools’ Day when people still believe:
1. Artificial sweeteners are worse than sugar
2. Obesity is due to a lack of discipline
3. GLP-1 meds are just a bandaid
4. LDL cholesterol doesn’t cause heart dz
5. Carbs are inherently fattening
Is obesity due to fast food and lack of wanting it enough?
Me: Vaccines are good
Deplorable: That’s because you make money from them!
Me: I don’t make a dime from them
Deplorable: Well you’re still a terrible doctor!
If you believe obesity is a choice then you also believe heart disease is a choice and hypertension and type 2 diabetes are a choice.
The top 5 supplements for losing a large amount of fat:
1.
2.
3.
4.
5.
Just kidding. They are none.
“I used to like you when you weren’t political.”
Well I mean I didn’t think science was political but here we are.
They’re taking the SSRIs, they’re taking the vaccines, they’re taking the drugs from the people that live here.
On this week’s DocsWhoLift podcast, @drnadolsky.bsky.social and I discuss how bad the @hims & @Hers #SuperBowl ad was.From an outside perspective, the ad may have seemed good.But when you dig deeper, it was actually really bad.Listen to learn. podcasts.apple.com/us/podcast/d...
“You need to lose weight. You’re unhealthy.”
Person tries to lose weight with diet/exercise. Loses weight then regains
“You didn’t try hard enough.”
Person hires coach. Loses weight. Regains
“You didn’t want it bad enough.”
Person gets medicine. Loses weight and keeps it off
“That’s cheating!”
"You're just mad about RFK because you're not going to make as much money!"
LOL rest assured it will have little bearing on my income. I worry about vaccine hesitancy increases and more measles and other preventable communicable disease outbreaks.
No not everyone needs a GLP-1 med to lose weight.
Yes most people who use them will likely need to continue taking them.
No they aren’t going to solve everyone’s obesity (at this time anyway).
Yes they can have side effects.
No they shouldn’t be used for vanity only
No RCTs sorry. Mostly a selection and survivorship bias.
99.9% of doctors: “Do not confirm RFK jr. He will harm our country.”
Jeff, the guy with an American flag and eagle as his profile picture and a bio that says Patriot: “Nuh uh your just scared he will take your big pharma money!”
My GLP-1 DEXA/strength study just enrolled the first patient.
This first study is observational, but will have RCTs in the future to see how various strategies like resistance training and levels of protein alter (or not) body composition changes while taking a GLP-1 medicine.
I have a few hundred patients who are PhD or MD grads. They know how to lose weight. They just struggle to actually do it not because of knowledge but because of biology (appetite).
“ I know what to do to lose weight. I just need help actually doing it.”
What most of my patients say
“If you just prescribed a keto or carnivore diet, your patients wouldn’t need a GLP-1 medicine.”
- someone who clearly hasn’t worked with many people
In order to Make America Healthy Again we MUST bring down the costs of GLP-1 meds.
So frustrating
There are new amazing drugs for helping you eat fewer calories and lose weight.
There are 0 meds currently that take the place of exercise both aerobic and resistance training.
They are trying to develop muscle building/preserving medicines but the act of exercise likely won’t be replicated soon.
