GLP-1 medications like Ozempic®, Wegovy®, and Zepbound® are everywhere.
Headlines promise massive weight loss. Celebrities swear by them.
But are you a candidate? And even if you are—should you take one?
As a cardiologist and endurance athlete who helps patients optimize healthspan, I’ve been prescribing GLP-1s for several years. I’ve learned that these medications can change lives, but only when used in the right context, with the right plan.
From the Lecture Hall to Your Inbox
On July 25, I presented a deep-dive lecture on GLP-1 agonist therapy and cardiovascular risk reduction at the All-Alaska Medical Conference.
This post isn’t that full lecture. That’s coming soon—broken into a multi-part newsletter series with charts, trial breakdowns, and case examples.
Today, I want to give you a simple, focused framework to decide:
Should you consider a GLP-1?
Start Here—What’s the Goal?
Before thinking about what to take, ask yourself…
Do I want to live longer—or live better?
Am I trying to lose weight, reduce meds, or prevent disease?
Have healthy lifestyle changes failed—or were they never truly supported?
The real goal isn’t “weight loss.”
It’s mobility, confidence, cardiovascular risk reduction, and metabolic resilience.
Who Might Actually Benefit?
You might be a candidate if:
You have Type 2 diabetes + cardiovascular or kidney disease
You’ve had a heart attack or stroke, and your BMI is ≥27
Your BMI is ≥30, or ≥27 with conditions like hypertension, prediabetes, or sleep apnea
You’ve hit a true plateau after 3+ months of consistent training, nutrition, and recovery efforts
GLP-1s reduce cardiovascular events—even in people without diabetes.
The SELECT trial showed a 20% reduction in heart attack, stroke, and CV death in people with obesity and established cardiovascular disease and without diabetes.¹
The REWIND trial showed a 12% MACE reduction with dulaglutide, even in those with only moderate CV risk.²
In my practice, I’ve prescribed GLP-1s to athletes, patients with ASCVD, obesity, diabetes, heart failure, and CKD, but only after we’ve committed to the full picture: at least 3 months of structured nutrition, aerobic development, and strength work.
Lifestyle First, Always
Even if a GLP-1 is on the table, I start with the following:
PFP Eating – Plants, Fiber, Protein
→ 25–30g protein/meal, 25–30g fiber/dayDaily movement + strength training
→ Reduce sedentary time, build lean massSleep 7–8 hours/night
VO₂ max-focused training
→ Zone 1–2 base + smart doses of Zone 4–5Advanced risk screening
→ Lipids, CRP, insulin, CAC, or even CCTA for plaque
No drug builds mitochondria.
No injection preserves muscle or strengthens your heart.
Medications can help—but they can’t replace your engine.
If You Start a GLP-1, Know The Following
Start low, go slow — titrate every 4 weeks
Muscle is protective — strength train + hit 100g protein/day
GLP-1 is a tool, not a crutch — keep walking, lifting, tracking
Have a plan to reassess — usually 6–12 months
Know your exit strategy — lower dose, taper, or maintain if needed
Insurance & cost matter — always check before starting
Real Questions I Hear Every Week:
“Will I have to take this forever?”
Maybe—but not always. If your lifestyle foundation is strong, we may taper.
“Is it cheating?”
No. It’s a cast for a broken metabolic system. But eventually, you need to rehab the muscle.
“Will it hurt my heart, thyroid, or gallbladder?”
Rarely—and only without good monitoring. Work with someone who knows both the drug and the data.
GLP-1s can be transformative.
But only for the right person, with the right mindset, at the right time.
The real medicine?
Consistency. Movement. Muscle. Mindset.
That’s how you Train for Life.
Subscribe for future deep dives on:
GLP-1 trial comparisons (SELECT, REWIND, SOUL)
GLP-1 vs SGLT2: who gets what and when
What’s coming next (tirzepatide, retatrutide, triple agonists)
Patient case studies and protocols from my practice
References:
SELECT Trial: Lincoff AM et al. N Engl J Med. 2023;389:2221–2232.
REWIND Trial: Gerstein HC et al. Lancet. 2019;394(10193):121–130.
Kristensen SL et al. Lancet Diabetes Endocrinol. 2019;7(10):776–785.
Lee MMY et al. Diabetes Care. 2025;48:846–859.
Upcoming Articles:
Why “Heart-Healthy” Advice Isn’t Good Enough Anymore
Cancer Screening 101: My Strategy as a Cardiologist & Father
How I Train My Kids (And What I Don’t Do)
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One other caution - In the Physical Therapy clinic we notice many of our patients on these drugs lose substantial muscle mass. I believe I’ve seen literature that puts muscle loss at 25-33% of the total weight loss.
Great practical article and top of mind for patients and I think also for clinicians seeking to educate their patients or to lose weight and stay active themselves! I do wonder about the muscle loss tales we hear, lab monitoring needed (cadence etc)