Losing Weight on GLP-1s: Are You Moving More or Less Than Before?

James Hill:
Welcome to Weight Loss And, where we delve into the world of weight loss. I'm Jim Hill.

Holly Wyatt:
And I'm Holly Wyatt. We're both dedicated to helping you lose weight, keep it off, and live your best life while you're doing it.

James Hill:
Indeed, we now realize successful weight loss combines the science and art of medicine, knowing what to do and why you will do it.

Holly Wyatt:
Yes, the “And” allows us to talk about all the other stuff that makes your journey so much bigger, better, and exciting.

James Hill:
Ready for the “And” factor?

Holly Wyatt:
Let's dive in.

James Hill:
Here we go.

Holly Wyatt:
Jim, I have a question for you again.

James Hill:
Oh, no.

Holly Wyatt:
Someone starts a GLP-1 and loses 20% of their body weight. Do you expect them to become more physically active?

James Hill:
I think I would. They weigh less. They were feeling good about themselves. I think it's easier to walk, easier to take the stairs. Your knees may feel better. So why wouldn't you be a little bit more active?

Holly Wyatt:
That's exactly what I would have thought. You lose weight. Movement gets easier. You're just going to be able to. People are going to be able to move more. It seems almost obvious.

James Hill:
All right, Holly. Do we actually have any information about what really happens?

Holly Wyatt:
That is the question. And last time, in the last episode, we looked at what people are actually eating on the GLP-1 medication. So today we're asking, what are they actually doing? How are they actually moving?

James Hill:
So the previous episode depressed me, Holly, because they're not eating better. Are you going to tell me that I better get ready for being depressed on this one?

Holly Wyatt:
Well, let's see. We'll have to see.

James Hill:
And that we're now starting to get some objective physical activity data, not just asking people do you exercise, but actually data that's objective from wearable devices.

Holly Wyatt:
Yes, we're starting to get some information on steps. We're starting to get some information on moderate to vigorous physical activity. We're starting to get some information on sedentary time. And we have three recent studies that come up this question in three different ways, and we're going to talk about them today.

James Hill:
Yeah, I think the first study kind of gives us a snapshot of how much are people taking GLP-1s actually moving?

Holly Wyatt:
Yeah, one point in time. I like that. The second one asks what actually happens to activity before versus after someone starts a GLP-1.

James Hill:
That's a good one. And then the third one, Holly, is a systematic review and meta-analysis. And this is where you look over several studies and try to figure out what's the overall message in those studies. And what does the evidence look like when we consider all these studies together?

Holly Wyatt:
Yeah. So we're going to test an assumption that to me seems very logical.

James Hill:
Very logical.

Holly Wyatt:
But that's why we test things, right?

James Hill:
I'm going to be depressed.

Holly Wyatt:
Yeah. So the question really is, if you lose a substantial amount of weight, which we now can accomplish with these GLP-1s, and that movement becomes easier because you're not carrying around 50 pounds, do you actually move more?

James Hill:
So we're going to consider three studies and three different ways of answering that question.

Holly Wyatt:
All right. Let's see what the data says. Let's start off with what do we know? So, do you want to do the first study, Jim? Do you want to set us up?

James Hill:
All right. So, the first study is a study that was published in 2026, so a recent study.

Holly Wyatt:
Yeah, Jim, it was actually August, so it just came out.

James Hill:
August of 2026. Yeah, it just came out. This is brand new. I mean, we are on the cutting edge of research here. So, what did they do? Now, they used, it was an observational study. They used data in the All of Us research program. Now, this is All of Us is a program sponsored by the National Institutes of Health, where they collect a ton of information on a lot of people. So it's like taking you, Holly, and measuring everything under the sun, putting that together in a data set that researchers can go in and look.

Holly Wyatt:
And that's really how we're kind of moving in the field, collecting a bunch of data and being able to look at it. Yeah.

James Hill:
So these are data that were collected from 2018 to 2022, so fairly recent. They looked at adults 18 or older who were taking a GLP-1 receptor agonist who had validated fitness tracker data. So in this data set, they put fitness trackers on people or some of the people, and that information is in the data set. So they found a final sample of 298 participants, a mean age of just over 52 years. What they looked at was total physical activity, moderate to vigorous physical activity, steps, and sedentary time. So they went into this database, 298 subjects, all taking GLP-1 meds and looked at their activity patterns. The cohort was predominantly female, and nearly two-thirds of them had type 2 diabetes. Now, these people could be on a variety of GLP-1 receptor agonists, liraglutide, semaglutide, dulaglutide, exenatide. So that was not just one med.

Holly Wyatt:
And it wasn't just the newest ones. Exenatide is one of the older ones.

James Hill:
These are a little bit older versions.

Holly Wyatt:
Some of them, yeah.

James Hill:
But a major strength of this is that physical activity was measured objectively, not just asking people. So, Holly, what did they find?

Holly Wyatt:
All right. So when we look at steps, you know, we like a good step study.

James Hill:
We do. We like steps.

Holly Wyatt:
So average daily activity, 5,944 steps a day, 24 minutes of moderate or vigorous physical activity, and about 947 minutes a day of sedentary time, which is about, I think, 15.8 hours per day. That's what they were doing. So what does this mean? About 58% were not achieving the recommended steps. 150 minutes per week.

James Hill:
Bummer. You're already starting to depress me.

Holly Wyatt:
So that average, so look at the steps. 5,944 steps per day.

James Hill:
That's not impressive. I mean, gosh, 20 years ago, we found that the average Americans were getting about 5,000 to 6,000 steps. So this is not impressive. I'm sorry.

Holly Wyatt:
Yeah. And this is just one point in time, right? But I mean, so we don't know what they were doing in this study before, after, et cetera. We just know it. But it's not looking good in terms they're not doing a lot of physical activity. They're not meeting the minimum requirements. And so, I think it's showing they're not doing what we would like them to do in terms of the recommendations. And I think another statistic was about 59% of them reached greater than 5,000 steps a day and only seven and a half reached greater than the 10,000 steps per day. So not looking wonderful, at least in this one study.

James Hill:
Be a little careful here because we don't know what they were doing beforehand.

Holly Wyatt:
Exactly.

James Hill:
It could have been an increase, but Holly, I know a lot about steps. I've been looking at steps for years and years and years. And this number of steps is not impressive. So they may have been real, real sedentary to start with, but they have not reached a level of activity that impresses me at all.

Holly Wyatt:
I agree. And so I think one of the questions to think about is, do we assume, and I think I have been, I think this is probably yes for me, that substantial weight loss will naturally lead people to greater activity.

James Hill:
I'm surprised that we didn't see these people being more active.

Holly Wyatt:
We only have one data point here.

James Hill:
One data point, but there's not a lot to get excited about in this.

Holly Wyatt:
Yeah. So, Jim, how much should we make of the study? What are the strengths, and weaknesses of this study?

James Hill:
The clear strength is they objectively measured physical activity. So they didn't ask people how active, they measured it. They measured it in a real world population. They looked at several different measures of physical activity, and they addressed a question that we have very little data on. So it's a step forward, but there's a lot of reasons to be cautioned. But just like with the diet studies, the signal we're getting here, it's a little bit of a concern.

Holly Wyatt:
Right, right.

James Hill:
So what were the limitations?

Holly Wyatt:
Well, I mean, the limitations, I think it's cross-sectional, so we don't have before and after. So we can't say what changed. We're just seeing one point in time. It's a small sample. It's a subset of all of us. So there's something, you know, specific about. It's a subset. There was a lot of type 2 diabetes in this, so that makes it a specific population. The medications were not just the new medications. It was also some of the older, obesity treatments, not just purely from semaglutide and tirzepatide. So we're looking at what you say? 2018 to 2022 was the time period.

James Hill:
So these aren't the most effective drugs.

Holly Wyatt:
Right, right.

James Hill:
[9:56] But I don't know. It's hard for me to believe that the new medications are going to do anything different.

Holly Wyatt:
All right. Well, let's, Let's look at the next study that gives us a little bit more. This actually has not been published in a paper. This was presented at Endocrine in 2026, but it's going to give us two data points. So I wanted to include it. So once again, we're looking at signal.

James Hill:
All right. Tell us about that one.

Holly Wyatt:
I want all the listeners to know we really, we can present things in conferences and that's where we get the first look at it. But then they go through a peer reviewed process and are published in papers and things can change. So you always want to kind of realize you're seeing this first. It may change before it gets actually published in a paper. So these researchers that once again used All of Us data, you're going to be seeing more and more of this, this data set that's out there. How can we use it to answer questions? But this time they ask a little bit different question. They ask what happened to measured activity before versus after GLP-1 initiation. So now we're going to have two data points using the same data set.

James Hill:
So you get a before and after. So this is important.

Holly Wyatt:
Yes. So they had in this data set, 1,950 adults with obesity who initiated...

James Hill:
So a little bit higher sample size.

Holly Wyatt:
A little bit higher. And they were initiating, they were starting GLP-1 therapy. So not cross-sectional in terms of they, you know, been on at different amounts of time. These people were initiating therapy. 753 had wearable data for the step count analysis.

James Hill:
So that's about the same as the last one.

Holly Wyatt:
Yeah. And that's when you have these big data sets that are collecting data, you're going to have mixed mixture, right? You're going to have a portion that collects some and portion that collects others. So that's kind of how these data sets are always going to be. The mean age was 52.7. So about 53 years. Was that about the same? I think that was similar.

James Hill:
Yeah, 52, I think.

Holly Wyatt:
Okay. 78% female. Now, here's interesting. 82% had musculoskeletal pain. So, they purposely, I think, had a group.

James Hill:
That would be important.

Holly Wyatt:
A group that reported musculoskeletal pain. And I like that because my assumption was you lose weight, the pain gets better, and, you know, you're going to move more. That was my assumption. Also, about 48% had type 2 diabetes. And part of that reason, probably because you can get these drugs, you know, as an indication if you have type 2 diabetes.

James Hill:
Yeah, it makes sense.

Holly Wyatt:
Yeah. So, Jim, tell us what happened. I know that you're going to, this is your...

James Hill:
Do I have to?

Holly Wyatt:
Yes, you have to.

James Hill:
Before they started the GLP-1 medications, they were getting an average of 5,047 steps. Afterwards, Holly, they were getting 4,487 steps. It was a significant decrease of 560 steps per day. So, after taking the medication, physical activity declined significantly. I am so depressed.

Holly Wyatt:
And it was significant in terms of how we look at the data.

James Hill:
It was significant. Their moderate to vigorous physical activity declined from 27.9 minutes a day to 22.2 minutes a day. They were spending less time in physical activity. And this was significant. They did statistics on all this, so this wasn't trivial. They saw a bigger decline in men than women, and they did see that people with musculoskeletal pain had greater step reductions than those without.

Holly Wyatt:
I don't get it. But, I mean, yeah, it was opposite what I would think, I guess is what I'm saying.

James Hill:
You know, at this point, I would have taken it with no change and been happy, but a decrease? Why? What is that about?

Holly Wyatt:
Yeah, they didn't move more, they actually moved less. I mean, let that sink in, Jim.

James Hill:
All right. Again, this study has not been peer-reviewed.

Holly Wyatt:
Exactly.

James Hill:
It's still a fairly, it's one study, but the signal we're getting here is cause for concern. I would have bet that we would have seen a slight increase in steps once these people went on the medication and started feeling better and had less weight and everything.

Holly Wyatt:
I would have put significant money on this in Vegas. I would have.

James Hill:
That's why I don't send you to Vegas. But again, it's depressing. Now, Holly, there was no control group. I mean, I'm looking for some silver lining here. There was no control group, but... And again, we need those studies with the control group. But I got to tell you, this is a little depressing.

Holly Wyatt:
Tell people why the control group is important. We don't know why this decreased.

James Hill:
So what you would have liked to see is a group that didn't go on GLP-1. Maybe it was time of year. Maybe you got a lot of people who started in the summer and went to the winter. So that's why you would need a group that didn't get the GLP-1 meds to say, did they decrease over that period of time. But it's hard for me to believe that that would have happened that much, over 500 steps per day. Wow.

Holly Wyatt:
So does this finding challenge that assumption that activity automatically rises after treatment?

James Hill:
I think it big time challenges it. Now, again, it's not definitive.

Holly Wyatt:
Yeah.

James Hill:
But boy, it really raises the question of are we assuming some things about, GLP-1 meds, weight loss and lifestyle that maybe aren't going to be backed up with data?

Holly Wyatt:
So this one depressed me. This study depressed me. And so I started thinking. And so one thought I just had, now this study doesn't support this. Just one thought I had is, could it be fatigue or nausea, be driving them maybe not to move as much? Or could lower food intake maybe affect how people are feeling from an energy standpoint? I mean, I'm just guessing here now. These are just hypotheses. These are not factual. I don't know. Something. Why is it decreasing is a question.

James Hill:
Yeah, and this study is stronger than the last one. So like the last one is subjective physical activity, little bit larger sample size. You have the pre-post. So you actually measure them before and after, And in that sense, it's stronger, but they came up with even a more negative finding.

Holly Wyatt:
Yeah, yeah. I don't know. I think we're going to really have to look at this.

James Hill:
We can't, at this point, say that the decline was definitively due to GLP-1 treatment, but boy, it sure raises some questions. So, does the systematic review help us here, Holly?

Holly Wyatt:
I don't know. We're going to see. Let's see. So, the third paper that we're going to talk about is a systematic review and exploratory meta-analysis. This came out in 2026. So this is all new data we're trying to, you know, put together. And they were putting together multiple studies like you talked about and exploring whether these GLP-1 treatments affect an objectively measured physical activity in adults with overweight or obesity. So looking at this, it looks like they had seven studies from six independent trials.

James Hill:
Right. And they had objective measures of physical activity.

Holly Wyatt:
Right.

James Hill:
Roughly the same number of people, 924. And again, they had steps, they had sedentary time, light through vigorous intensity physical activity. Some studies included structured exercise, and some studies only measured exercise capacity, like VO2 max, which is a measure of cardiometabolic fitness or a walk test.

Holly Wyatt:
And they excluded those. Yeah, they excluded those gyms.

James Hill:
Because what they wanted to do is study what people actually did in the real world, not what they were capable of doing.

Holly Wyatt:
Yeah. So it wasn't asking, can people exercise?

James Hill:
It's what are they actually doing?

Holly Wyatt:
Right.

James Hill:
So even if your VO2 max increases and you don't exercise, those are two different questions.

Holly Wyatt:
Got it.

James Hill:
So Holly, what did they find?

Holly Wyatt:
Well, I'm going to start out with... I'm going to start out with saying five of the seven studies.

James Hill:
Yeah.

Holly Wyatt:
So that was 71.4% reported lower physical activity in the GLP-1 groups compared with controls.

James Hill:
Five of seven. That's reasonably convincing.

Holly Wyatt:
It gets your attention. But once again, we have to be careful. Only one of those studies found a statistically significant reduction.

James Hill:
Because they were relatively small samples. So again, it should be taken as preliminary, but boy, one study, two studies, three studies that are all pointing us in the wrong direction or the right direction with the wrong answer.

Holly Wyatt:
And that study that did have that statistically significant reduction, they found about 1,144 fewer steps per day.

James Hill:
Wow.

Holly Wyatt:
And I think that was in liraglutide. So once again, some of these are looking at the older medications, but we're still seeing once again, that signal of going the wrong direction.

James Hill:
Off the top of your head, can you think of any reasons why you think the newer medications might be different?

Holly Wyatt:
No. Maybe producing greater weight loss. I still think that if you get the weight off your joints, you should want to be able to take the stairs. So I don't know if maybe the amount of weight loss. I don't know.

James Hill:
So there's a pattern, but the pattern isn't the same thing as showing there's an effect.

Holly Wyatt:
Exactly. Yeah.

James Hill:
So they pooled these trials, Holly. So in other words, there's a statistical procedure for looking at them, pooling them, and trying to get an answer based on the combination. What did they find there?

Holly Wyatt:
I think they found that it wasn't statistically significant. So once again, we don't have enough data.

James Hill:
Metemizing the bad news?

Holly Wyatt:
Well, kind of. You know, I think you have to look at this. We definitely need more data.

James Hill:
So when they pooled it, they couldn't verify that physical activity actually declined, but there was clearly no increase. Is that correct?

Holly Wyatt:
Right. We can't walk away from this paper and say GLP-1s make people less active. We can't say that.

James Hill:
But we can't say that they make them more active.

Holly Wyatt:
Yeah, yeah. I think that's, at this point, at least in the groups and the studies that we've shown now, we may come up with some other things. I do think there was an interesting difference, though. They did try to look at the difference between free living physical activity and prescribed exercise intervention. Did you see that in there, Jim?

James Hill:
Yeah. So tell me why you think that's important.

Holly Wyatt:
Well, because why is this occurring? Is it because people can't exercise? Is it because there's some reason why these medications are making their ability to follow an exercise prescription or to exercise more difficult? Or is it more just about kind of spontaneous activity? You know, trying to get at where this is occurring and why, I guess.

James Hill:
So the question is, if we wanted to intervene and increase exercise and we had one group on GLP-1 meds and one group not, it's possible that the group on GLP-1 meds would actually be better at achieving and adhering to the prescribed exercise. That we don't know, but that would, boy, that would be a really good study, Holly.

Holly Wyatt:
Yeah. So there were two studies that looked objectively, or they measured outcomes specifically related to prescribed exercise intervention. Things like…

James Hill:
They did. So they looked at this.

Holly Wyatt:
Yeah. They looked at exercise adherence and prescribed exercise duration, and they found no significant difference between the GLP-1 and control groups.

James Hill:
What? Oh, my God.

Holly Wyatt:
Yeah. But once again, the way this is, you know, I'm still holding out some hope.

James Hill:
I know. All listener, all this is preliminary, but the consistency of the preliminary data is discouraging.

Holly Wyatt:
Yeah. So I think we need to emphasize that this only came from two studies. But I do think it's intriguing when we start to think about the difference between just kind of lifestyle activity or spontaneous physical activity, even things like NEAT versus planned exercise. And where if we are seeing a decrease, where that might be, which would help us understand maybe why we're seeing it.

James Hill:
Yeah. So, Holly, even a no change, I could sort of understand, well, the drugs didn't do anything, but a decrease. I'm having trouble really accepting mechanistically why physical activity should decrease. And again, it's not definitive that, but again, I think the take-home message here is in all these studies, we found no real support for the idea that physical activity is naturally increased when you start taking these medications.

Holly Wyatt:
Yeah. The authors of this did kind of also get into this kind of hypothesis of what might be going on, which I think you can't help but think about how do we explain this or if we keep seeing this signal. I think they came up with some ideas here. One of them was that weight loss is associated with reductions in the fat-free mass and muscle, resting energy expenditure, which maybe contributed somewhat to some of these studies. What else, Jim? They came up with the idea that fatigue, and that's one thing I thought about, that kind of change in motivation or fatigue perception could potentially affect free living activity. You tend to maybe be on the couch a little bit more because you're tired. I don't know.

James Hill:
Holly, I have to tell you, none of these impress me. I mean, I understand. You're grasping at ideas here, but I'm sorry. None of these I find really compelling that would convince me there's a reasonable reason why this happened. I still think we don't know. First of all, we have to confirm that these preliminary findings hold up in more vigorous studies, but, I think we're still struggling to figure out why this may be the case. But that's the fun part of science is we have something here totally unexpected. Now let's figure out what's going on and why. But I'm sorry, I don't buy any of these as great explanations.

Holly Wyatt:
Well, I don't either, Jim, but I want something, right? I want to understand.

James Hill:
Me, too. I mean, you depressed me enough on the last episode about nutrition, and now physical activity is just, I mean.

Holly Wyatt:
And here's why I think if you can understand what's going on, then we can design interventions to specifically get at it. And that's why.

James Hill:
That's the good part. The good part is that this is the case without any intervention. And again, you and I have been big fans of saying you need some lifestyle intervention. And I think the one thing that you can put to bed, well, not definitively, but certainly the data suggests, just going on GLP-1 medications is not going to cause you to develop a healthy lifestyle, or it's not going to cause a large number of people to develop a healthy lifestyle. So in my book, Holly, that means that GLP-1s are effective, but you need something else along with that to affect lifestyle.

Holly Wyatt:
Yeah, I feel like now we can say it doesn't automatically without thinking about it. You're not going to just spontaneously start to move more. This data makes me feel like that's probably what's going to happen, at least in a large number of people. There's probably individuals who are getting out there and starting to move more. So I think we can summarize paper one. Many adults taking GLP-1s were not meeting physical activity recommendations. If you remember, they weren't.

James Hill:
Right. That was pretty clear.

Holly Wyatt:
Okay. Paper two, that was one kind of real-world pre-post-analysis. Steps and physical activity decreased after GLP-1 initiation. But we don't know why. We didn't have a control group. And paper three, controlled evidence does not establish that GLP-1s reduce overall physical activity. It does, however, raise a possibility of a signal that lower free living activity while structured exercise participation appears largely unchanged. So it does a signal that maybe it's decreasing in that kind of activity, that free living activity, not the exercise part. It doesn't show for sure that it's a reduction in overall physical activity, but we're not seeing a increase.

James Hill:
So no matter how you torture the data, there's not a lot of positive here to suggest that the GLP medications alone are influencing people to move more.

Holly Wyatt:
Yeah. Well, we can't say they make you less active. We can't say that they make you more active for sure.

James Hill:
So, Holly, when we did the segment on nutrition, we pointed out why it's so critical that we get good nutrition. Does it matter on physical activity? So you lose weight, you keep the weight off, you're not physically active. So what? Is that important?

Holly Wyatt:
I think it's just like the nutrition, and I think it now matters more. So now it's like, I mean, just like nutrition matters more now. If we're talking about for the rest of your life, we know the importance of physical activity and, you know, for heart health, for everything, for so many things, for mental health, for everything. And now we have these great tools that are causing the weight loss, but oh, that weight loss and these tools don't seem to be helping with that physical activity piece.

James Hill:
So a population that used medications to reach a “healthy body weight with low levels of physical activity,” is that success?

Holly Wyatt:
Not in my book.

James Hill:
Mine either.

Holly Wyatt:
I mean, I don't know that I have.

James Hill:
Mine either. Well, I think you're optimizing weight, but I don't know that you're optimizing health. Yes, you can say the weight loss, reduced chronic disease, et cetera, et cetera. Quality of life, metabolic health, other things need physical activity. So I don't think it's success with weight loss alone without an increase in physical activity.

Holly Wyatt:
I mean, I guess that's a question.

James Hill:
And certainly, as you and I have shown over and over and over, if you're going to stop the medications, it's almost impossible without increasing physical activity. And everything that we've learned studying people who succeed long term at keeping their weight off is they find a way to incorporate a lot of regular physical activity every day.

Holly Wyatt:
If you really looked at if you could lose weight and stay inactive versus not lose weight and be active, that brings back that question again. I mean, ooh, it's a hard one.

James Hill:
I know, it's a hard one. And keep in mind, we're just beginning to get data here. We need lots more data. And maybe with more rigorous, larger studies, we find something different. But I'll have to say that even though these are small preliminary studies, the consistency of the findings is impressive.

Holly Wyatt:
Okay. But I'm going to say something positive now because I just thought of this.

James Hill:
It's about time.

Holly Wyatt:
I'm going to say something positive. Okay. Now that we're starting to have this data, we're starting to see this. If you know this, there are things you can do if you're aware that you're not going to naturally start moving more. The data doesn't support that we start moving more without a strategy, without really thinking about it. You have the opportunity to think about it and change it for you.

Holly Wyatt:
So that could be something positive. So let's move, Jim, to the section. I think we did this for the diet piece, too. What should they do? How do we put kind of pie in the plate for them? So they're depressed. We've got, you know, looking at these signals. What could they do?

James Hill:
And again, we came up with five tips, just like we came up with five tips for nutrition.

Holly Wyatt:
Exactly.

James Hill:
First of all is pay attention to activity as its own outcome. We have talked over and over. The scale is a wonderful, useful device, but it's not the only measure of success. Don't use the scale as a proxy for how active or fit you are. Ask yourself, am I moving more? Am I getting stronger? Is my endurance or function changing? And appreciate the need to increase your physical activity separately from your need to lose weight.

Holly Wyatt:
Yeah. And now it's easier than ever to monitor more than one thing. You can be monitoring your weight and you can be monitoring...

James Hill:
Lots of wearables range from very inexpensive to very expensive. So choose a monitor. It's easy to monitor your physical activity.

Holly Wyatt:
And the next one is think about both structured exercise. So kind of planned structured exercise and the rest of the day, meaning what you do just throughout the day, that lifestyle kind of activity. And I think this is important because we're not sure where this reduction is occurring. Is it in the exercise piece? Is it in the rest of the day? So right now, I would think about both the planned workout and the physical activity just accumulating across your day, just your normal kind of life events. They're not identical, but at this point, I would be looking at both of them.

James Hill:
Yeah, yeah, I agree. The third one, Holly, this one really relates to mind state. So as your body weight decreases, think beyond how much weight I'm losing to what can my body do? It's a different way of thinking about it. Yes, you want to monitor your weight and you're happy with weight loss, but also think about and take satisfaction in the increased things that you can do in terms of your strength, your fitness, and your mobility.

Holly Wyatt:
This is a perfect and. You can still look at how much weight I'm losing. That's a goal.

James Hill:
We're not saying don't do that.

Holly Wyatt:
It's an and. Look at that and. What can I do with my body now? And don't assume that your body's going to naturally do it. Think about it and structure and have some strategy for it. I love that one. Number four, I would say include resistance exercise.

James Hill:
Yes.

Holly Wyatt:
Resistance exercise is relevant when we lose a lot of weight because strength and physical function matter. And that's, to me, regardless of what the scale is doing. So this is something you can add in for multiple reasons. So I would be doing that.

James Hill:
And we've talked before about the combination of a higher protein intake and resistance exercise is probably, as far as we know, the best thing you can do to minimize loss of muscle as you lose weight. All right, number five is start from your actual baseline. This whole thing of 10,000 steps, we've talked about that before. That came from a marketing campaign. There's nothing magical about 10,000 steps. What you want to look at is increasing. And to do that, start where you are and look at increasing from where you are. You don't have to get to 10,000 steps to get enough activity. What you wanna do is to increase. And to do that, you need to understand where you're starting from, your baseline.

Holly Wyatt:
Yeah. So those are five things you can do kind of based on this data that can help. I think the big takeaway for me is don't assume your physical activity, your activity level is going to increase as you lose weight. That's the big take home for me. And so I'm not going to assume that and I'm not going to assume that for my patients. We need to work on it specifically so that it does increase because it may not do it automatically.

James Hill:
Okay, you want to do some listener questions?

Holly Wyatt:
Let's do a couple.

James Hill:
All right, I'll do the first one. We've already talked about this, if medication is helping me lose weight and improve my health, why should I care about physical activity?

Holly Wyatt:
Hey, it's worth doing again, Jim.

James Hill:
It's worth doing again. Physical activity has so many benefits on physical and mental health over and above weight loss. Weight loss is wonderful, but increasing fitness, strength, physical function, cardiometabolic health help you do more of the things that you matter. It increases your quality of life. And the GLP-1 era may actually help us separate exercise for weight loss from physical activity for health and function. So it is critically important.

Holly Wyatt:
I agree. All right. Second question. If losing 40 or 50 pounds makes movement easier, why wouldn't I naturally become more active? Well, that is the big question. But one thing when I looked at this question that I thought about is it might for you. So because we're looking at averages here, we can say in general, it doesn't do it for everybody. That doesn't mean it doesn't do it for you, but I wouldn't want to assume it. I would want data. I would want to know that my steps went up, that my planned minutes of activity went up. I would want to know that. I wouldn't just assume it. I would measure it. No study necessarily tells you what's going on with you, but it can make you aware that you need to pay attention to what's going on for you.

James Hill:
All right, I'll do one more. This is a quick one. Could eating much less on a GLP-1 medication be one reason why people move less? And my initial thought was to say no, but you know what? That's actually an interesting question. If you're eating less, maybe you have less energy to fuel exercise. So even though my inclination is I don't think that's the reason, it's certainly plausible, and that's a good research question.

Holly Wyatt:
I do too. I think that's a good research question and people feel differently, in terms of their energy, but also just in terms of overall. I like that one. All right, let's do some rapid fire real quick. I'll go first. Oh, this is an easy one. I don't even know. Weight loss or fitness, Jim.

James Hill:
[38:33] I'm going to use my standard answer. Yes

Holly Wyatt:
Yeah, yes.

James Hill:
Both. They're not the same. You need both.

Holly Wyatt:
You need both.

James Hill:
All right. Free living activity or structured exercise?

Holly Wyatt:
I'm going to take a page from you. Both.

James Hill:
That's right.

Holly Wyatt:
They tell us different things. All right. 10,000 steps. Is that the magic number?

James Hill:
No, no, no. We got to get those 10,000 steps out of our head. More is better. Start where you are and increase.

Holly Wyatt:
Yep.

James Hill:
All right. Here's a softball for you, Holly. Can we say that GLP-1 meds make people less active?

Holly Wyatt:
No, not yet, right? The evidence doesn't establish that. We're seeing a signal, though, that it's not getting better. It's not increasing. We can't definitively say that yet. So, Jim, can we assume major weight loss will make people more active?

James Hill:
Oh, I wanted to say yes, but the evidence just doesn't support it. It's not definitive. So the question is still open, but the evidence we have suggests that that's not the case.

Holly Wyatt:
Yeah.

James Hill:
All right. Last one, Holly. One thing you'd tell someone starting a GLP-1 med tomorrow.

Holly Wyatt:
All right. I like this one. Don't wait until you've lost the weight. Measure where you are. Know where you are right now. Don't assume that losing weight, you're going to increase your physical activity. Build strength. Start to do it from the very beginning. Be aware and have a plan.

James Hill:
Vulnerability. That's next up.

Holly Wyatt:
All right, I'll go first, Jim.

James Hill:
Okay.

Holly Wyatt:
You ready? We've spent decades studying physical activity and weight. Did you expect people to naturally become more active when we finally had treatments capable of producing this much weight loss? What did you really think, Jim?

James Hill:
Holly, I really thought we were going to see… I didn't think it was going to be major, but I thought that with less weight and people feeling better, I thought we were going to see some increase, and I'm disappointed that we didn't.

Holly Wyatt:
Yeah, I did too. I really did.

James Hill:
All right, I'll do one for you.

Holly Wyatt:
Okay.

James Hill:
If the medication can produce substantial weight loss without exercise, how do we help people understand why physical activity still matters?

Holly Wyatt:
Oh, Jim, this is a hard one. I mean, this is what scares me. If you had said what kind of scares me about this data, this is what scares me because people are going to be successful with losing weight with these GLP-1s. They don't have to increase physical activity to be successful at weight loss. We talk a lot about, yes, they may need to be successful at weight loss maintenance if they go off the meds, but this is a different question. How do we convince them that physical activity matters?

James Hill:
Yeah, yeah.

Holly Wyatt:
Because so many times the carrot was the weight loss for the physical activity for so many people.

James Hill:
Many, many years ago, I remember writing that humans evolved to eat and rest. You eat whenever food's available, and you rest when you don't need to move. And we created an environment where food's always available, and there's no need to move. So I don't think there's this natural drive to move. And if we create an environment where you can maintain the weight you want and you don't have to move, I think it's going to be a real challenge getting across that message.

Holly Wyatt:
But I think one of the key for that was our environment was such to rest when you can, but you naturally had to move more.

James Hill:
That's right. And now you don't. You don't have to move in today's environment.

Holly Wyatt:
Our physical activity was high, because it naturally had. So when you could rest, you would rest. And now we're in a totally different environment. So I don't know how we…

James Hill:
Yeah, I think it's going to be one of our greatest challenges. I think we're going to be more successful at helping people improve nutrition on the meds than we are at helping people increase their physical activity. But it's so critically important. We have to figure out how to do that.

Holly Wyatt:
Yeah, it's kind of like we're back to square one. It's very similar to the nutrition. It's like it matters more now. We've got to somehow…

James Hill:
Lifestyle matters more. That's the message we have to get out.

Holly Wyatt:
And then we've got to convince people and we've got to help people be able to do that.

James Hill:
All right, Holly, put the pie on the plate for this episode.

Holly Wyatt:
Oh, Jim, I feel like we kind of have already. We gave you some strategies. I think we know that GLP-1 medications produce substantial weight loss now. I thought it was logical that if people became lighter and movement was easier, they would naturally become active. But the emerging evidence says that we shouldn't assume that. And I think we talked about some of the studies today that kind of give us that signal. I don't think we can say that GLP-1s make people inactive, but we also can assume that losing a large amount of weight will automatically make someone active, which may change the job of lifestyle treatment, which I think is what we were talking about at the end. Weight loss makes movement easier, but it just doesn't guarantee that the movement will happen.

James Hill:
The GLP-1 medications are a huge leap forward, but again, they have to be packaged with a more comprehensive weight management lifestyle change plan. And right now, that's not readily available for people. The meds are readily available. The lifestyle plans aren't. That's where our field needs some effort right now.

Holly Wyatt:
And if I was sitting there as a listener, you know, we've hoped that the medications would solve the problem and you wouldn't have to think about what to eat as much and you maybe wouldn't have to think about moving more. And I think we're starting to say that's not the case.

James Hill:
You just have to think about it in a different way.

Holly Wyatt:
Exactly.

James Hill:
All right. Thanks, everybody.

Holly Wyatt:
All right, guys. See you soon.

James Hill:
We'll see you next time on Weight Loss And. Bye. And that's a wrap for today's episode of Weight Loss And. We hope you enjoy diving into the world of weight loss with us.

Holly Wyatt:
If you want to stay connected and continue exploring the “Ands” of weight loss, be sure to follow our podcast on your favorite platform.

James Hill:
We'd also love to hear from you. Share your thoughts, questions, or topic suggestions by reaching out at weightlossand.com. Your feedback helps us tailor future episodes to your needs.

Holly Wyatt:
And remember, the journey doesn't end here. Keep applying the knowledge and strategies you've learned and embrace the power of the “And” in your own weight loss journey.