GLP-1 + Weight Loss Q&A with Ashley Koff

Q. It feels like everyone’s taking Ozempic now, even people who look perfectly healthy. Is there any other real reason to go on it if you’re not struggling with your weight?

Looking “perfectly healthy” does not mean that the body is operating healthfully. The first step in a weight-health approach (versus the longstanding approach of a weight or health focus) is moving on from total weight as an effective marker of anything. “Weight health” means your body’s weight composition—fat, muscle, bone and water—reflect the body’s operational health. We can’t know this with only total weight or appearance.

Our weight-health hormones (GLP-1, GIP, PYY, CCK) regulate weight health—our levels of fat, muscle, bone, blood sugar, appetite, hydration, and more. Their suboptimal function translates to impaired weight health. Regardless of appearance, a person may use a weight-health hormone replacement like semaglutide or tirzepatide (the ingredients in the branded medications like Ozempic, Zepbound, Wegovy) as a tool to help them optimize their weight health. 

These medications are a biosimilar form of our own internal weight-health hormones. The key difference is that instead of staying active for 2–5 minutes, the medications (by design) last 24x7 and therefore lead to a dramatic increase and sustained hormone levels at the receptor sites throughout the body. 

In addition to treating excess fat loss, these medications are approved for sleep apnea and diabetes. Many people also choose to use them to quiet “food noise” that contributes to disordered eating, to help prevent diabetes by improving blood sugar control in pre-diabetics, to reduce visceral fat in the liver even when overall body fat is within a healthy range, and to lower unhealthy levels of inflammation. 

The medication is a tool, not a solution. We all need properly functioning weight-health hormones, and that’s achievable with a personalized plan—whether or not you use a GLP-1 medication. 

For anyone using the medication, this is essential. While it offers benefits, it can also disrupt weight-health hormone balance—issues that often existed beforehand, which is why the medication was needed in the first place. Therefore, both short- and long-term success depend on optimizing internal weight-health hormone function. 

Q. What are the real risks of GLP-1s? And are there certain people who should avoid them at all costs?

Speaking of cost, the ability to sustain the cost of the medication and the practitioner to provide ongoing assessment and optimization of a personalized plan is a huge risk factor, as insurance often doesn’t cover one or both. As someone treating hundreds of patients on these medications, let’s unpack other risks. 

You have to stay on them forever. I don’t have a crystal ball about anyone’s life or health so I can’t say for sure one way or not. But I can share that if you use the medication and it has benefits, but your weight-health ecosystem worsens (muscle loss, metabolic slowdown, nutrient depletion, digestion worsens etc.), then you won’t be able to come off of them without weight regain. They are a hormone replacement. They likely suppress your own hormone production, especially at higher doses. I use a plan to wean and monitor, then a maintenance dose, then experiment with being off the medication if that works for the patient. 

They cause you to lose muscle . . . or hair. Don’t blame the medication; they don’t directly cause muscle or hair loss. When that happens, it’s usually the result of a non-personalized or incomplete nutrition and lifestyle plan. For example, a person might be told to eat more protein, but if their digestion isn’t allowing them to properly absorb and use it, muscle and hair loss can occur. The same is true when nutrient imbalances are present, either because they existed beforehand or developed while on the medication. And if strength training and recovery aren’t well-matched to that person’s needs, the body won’t be able to build or maintain muscle or bone.

They increase risk of . . . several conditions, from ocular stroke to thyroid cancer to “frozen stomachs.” There are alarming headlines about these, but they need more context. For example, while a smaller ocular nerve could raise the risk of certain strokes, that’s true regardless of medication use. Likewise, though thyroid cancer has appeared in some studies, clinicians I follow have not seen this in patients taking Ozempic or similar drugs. The same goes for digestive problems. Since these medications slow stomach emptying, people already using proton pump inhibitors (PPIs) or other digestive aids may need a more personalized plan to prevent worsening symptoms. My overall advice is to work closely with your practitioner to assess personal risk and build a plan to reduce it—through lower doses, regular screenings, and ongoing monitoring of digestion, body composition, and nutrient levels.

Q. Do people who stop taking Ozempic tend to gain back the weight they’ve lost? Shouldn’t there be some responsibility from those prescribing it to educate their patients on better lifestyles?

Regaining weight is likely unless there’s a plan to recalibrate how the body’s own weight-health hormones function once the medication is stopped. The same thing happens when you stop a statin, a proton pump inhibitor, or almost any medication without first addressing the root cause of why you needed it. I believe the responsibility is shared—among the patient, the practitioner, the media, and the companies selling the medication or GLP-1 optimizer supplements. 

As a patient, take responsibility and make sure whoever prescribes the medication helps you assess and create a plan to maintain your results. If your financial or health situation is changing and you know you’ll need to stop the medication, reach out early to avoid stopping suddenly without a weaning or maintenance plan.

If you’re with a company that sells these medications and you rely on AI evaluations or practitioners who don’t have the time—or the incentive—to provide thorough, ongoing assessments, you must clearly tell customers that they’ll need this support elsewhere.

If you’re with a supplement company or not a licensed medical practitioner, it’s essential to stay within ethical and legal boundaries. Marketing should never blur the line into medical education or recommendations that could mislead people into thinking your products will work the same way as prescription medications.