By Julia Craven
Kerry Krauss didn’t take the decision to start a GLP-1 lightly. She exercises regularly. She eats nutritious, whole foods. She’s trained for and run marathons. And she became prediabetic anyway. Krauss wore a continuous glucose monitor to try to find a solution. In spite of her best efforts, her fasting glucose levels remained elevated.
“That was a turning point for me,” she says. “I realized that lifestyle alone wasn’t enough to overcome the underlying biology driving my insulin resistance.”
Krauss, who is also a board-certified OB-GYN and the senior medical advisor at the femtech company Natural Cycles, understands how genetics, hormones, and metabolism intermingle and create a complex picture of health. She coaches patients about this every day. It took a minute to apply that clinical understanding to herself, though. Once she did, Krauss was able to stop viewing less-than-ideal metrics as personal failures and, instead, see them as medical conditions that required treatment.
“Once I reframed it that way, the decision became much clearer. Starting a GLP-1 wasn’t about pursuing a certain number on the scale,” she says. “It was about protecting my long-term health. Instead of blaming myself for something I couldn’t fully control, I chose to use a tool that could help me.”
Part of long-term health for women who are on GLP-1s, and even those who aren’t, is maintaining muscle mass.
GLP-1s like Ozempic and Wegovy can be controversial for a few reasons. There are cultural aspects, particularly for women, who are more likely to be judged for changes they make to their bodies. And there’s the science, which shows that weight lost with GLP-1s can come from lean muscle mass, not just fat. While this is a concern for men and women alike, it’s more acute for women, especially those who are perimenopausal or menopausal.
“Most people that I see who have lost 50 to 100 pounds on a GLP-1 are not doing the recommended five days a week of one hour of cardiovascular exercise, and are not doing the two to three days, 20 minutes per day of upper, lower, and core resistance exercise training,” said Dr. Caroline Apovian, co-director of the Center for Weight Management and Wellness at Brigham and Women’s Hospital.
A recent study showed that GLP-1 users became less physically active while taking the medication, raising additional concerns of lean muscle-mass loss. To be fair, any rapid weight loss takes muscle along with fat; the same has long been true of crash diets and bariatric surgery. GLP-1s just made dramatic weight loss common enough that the tradeoffs now apply to millions of people — about one in eight are currently taking one.
For women transitioning into menopause and taking a GLP-1, the losses compound — so much so that a joint medical advisory explicitly identifies perimenopausal or menopausal status as a risk factor for sarcopenia during GLP-1 therapy. “Muscle is one of the most important organs you have for your metabolism, your brain, and balance,” said Dr. Caroline Collins, the chief of concierge medicine at Emory Healthcare, referencing the increased risk of falls and bone breaks in older women. “Maintaining the muscle you have is critical for health, and the only way to do that is with strength training.”
Decades of exercise science and years of new GLP-1-focused research back this up. In the S-LiTE trial, a year-long study out of the University of Copenhagen, people who paired regular exercise with their GLP-1 lost more fat than those taking the drug alone and gained lean muscle mass. It was a win-win. Collins added that since menopause and obesity tend to leave muscle marbled with fat, the muscle that remains after weight loss may be of better quality since the drugs reduce that intramuscular fat.
This doesn’t mean you need to get ripped like a gym bro; doing the recommended amount of resistance training, says Apovian, is plenty. Krauss agreed: “Building a sustainable exercise routine is something I’ve worked on for most of my adult life,” she says. “Like many women, I’m balancing a demanding career, family responsibilities, and everything else that comes with daily life. Over the years, I’ve learned that consistency matters far more than perfection.”
The other half of the equation is protein. Apovian recommends between 1.2 and 1.5 grams per kilogram of body weight, roughly 80 to 100 grams a day for most women.
When Krauss started taking a GLP-1, strength training became the foundation of her week, and she let cardio take a supporting role. She also made sure to keep her protein intake up on the days the drug left her with little appetite. Along her journey, something interesting happened. For years, exercise and nutrition were ways to burn calories and lose weight. On the GLP-1, that noise hushed, and she was able to create sustainable routines that supported her physical and mental well-being.
“Exercise stopped feeling like a punishment,” she said, “and started feeling like an investment in my long-term health.”
A year in, Krauss says she’s in the best shape she’s been in for years.