New type 2 diabetes medications are so extraordinarily effective at creating weight loss that they have patients wondering: “Do I still need to exercise?”
The new drugs, which belong to the larger family of GLP-1 and GIP/GLP-1 receptor agonists, offer remarkable glucose control and weight loss for people with type 2 diabetes.
Dulaglutide (Trulicity) helps the average user lose 10 pounds.
Semaglutide (Ozempic) helps the average user lose 15 pounds.
Tirzepatide (Mounjaro) helps the average user lose a whopping 27 pounds, a result on par with bariatric surgery.
Tim Church MD, MPH, PhD, believes that these drugs are so effective that they essentially “take care of weight loss” all by themselves. And that means it’s time to acknowledge that users of GLP-1 receptor agonists don’t really need to exercise to lose weight anymore.
But that certainly does not mean that they don’t need exercise — on the contrary! Exercise’s benefits for people with diabetes remain unsurpassed, and physical activity may even have special benefits for patients experiencing rapid weight loss with a drug like Ozempic.
Dr. Church is the chief medical officer for Wondr Health, and an expert on obesity and weight management. Over a decade ago, he helped lead studies that contributed to our understanding of how the body compensates for calories burned during exercise — and why it’s so difficult to lose weight with exercise. Now, he wants to reimagine the purpose of exercise in a post-Ozempic world.
Church co-authored a recent perspective published in Obesity, the official journal of The Obesity Society. His letter calls for clinicians to refocus on the many holistic benefits of physical activity in patients using these powerful weight loss medications.
Type 2 Diabetes and Muscle Loss
Weight loss has incredible benefits for people with type 2 diabetes, but one particular concern with drugs like Ozempic is the possibility that they may cause an unhealthy amount of muscle loss. Though the data is meager at the moment, some clinical trial results have seemed to suggest semaglutide users might lose more lean muscle mass than normally expected from diet-induced weight loss.
Church thinks this could be a big deal for people with diabetes:
“Diabetes is a disease of the muscle. What’s the number one consumer of blood sugar in the human body? It’s skeletal muscle. When you talk about insulin resistance, it’s happening in the skeletal muscle.”
“It’s all about muscle — maintaining as much healthy muscle as possible. It’s critical.”
Lifting weights is likely to help you retain lean mass even as you rapidly slim down. Many different studies have found that resistance or strength-building exercise helps prevent muscle loss during weight loss, including in older and overweight people. Resistance training also offers comprehensive health benefits to people with type 2 diabetes, including improved insulin sensitivity, lower cardiovascular risk factors, and mental health boosts.
“You want to do something to be sure you’re preserving as much muscle as possible.”
“You don’t have to join a gym,” says Church. “There’s a bazillion YouTube programs, and you only need a couple of dumbbells or resistance bands. We’re not asking you to be Mr. or Mrs. Olympia. It’s actually easier [than cardio]. The people in our study were lifting about twice a week, 20-30 minutes each time. People fell in love with lifting weights. We couldn’t get them out of the gym.”
“If you lose weight and simultaneously work on making healthier muscle? There’s nothing more important you can do.”
Exercise Helps You Lose Even More Weight
Normally, it takes an extreme amount of exercise to drive real weight loss — as much as 300 minutes (5 hours) per week. That’s because the body has multiple ways of compensating for the calories you burn when working out — it slows down your metabolism and ramps up your hunger. But drugs like Ozempic and Mounjaro change the calculus:
“That all gets circumvented by these medications,” says Church. “You get no compensatory eating. It’s one more reason to get a little bit of exercise — those calories you burn exercising go straight to weight loss.”
How Much Should You Exercise?
So how much should you exercise if you’re using a GLP-1 or GIP/GLP-1 receptor agonist? Church points directly to the Centers for Disease Control and Prevention’s (CDC) physical activity guidelines: 150 minutes of moderate-intensity aerobic activity and two or more days of muscle-strengthening per week.
“Now’s the time to double down on the federal treatment guidelines for general health, because I think they’re perfect for somebody who’s taking these medications. And they’re achievable, by the way.”
A study of liraglutide tested the effect of moderate physical activity on people using diabetes drugs for weight loss. Liraglutide, a GLP-1 sold as Victoza for diabetes and Saxenda for weight management, helped adults without diabetes lose an average of 15 pounds. But when study participants added moderate physical activity, roughly similar to the level recommended by the CDC, they lost an additional six pounds.
“To me, what’s so empowering,” Church says, “is that because these medications take care of the weight loss, we don’t have to tell people anymore that they need 300 minutes a week of exercise. Guess what? That’s a lot. That’s a lot of work. I love to exercise, but I don’t do that much.”
How to Work Out, and Why
The CDC exercise recommendations are not difficult to meet, says Church: “Just get anything. Anything! Two or three days a week, if you can get some walking in, and if you can do just a little bit of weight training.”
“Find something you love. Is it ballroom dancing? Is it golf? Whatever it is, embrace it, run with it!”
Even if you’re already losing weight due to your medication, exercise remains an almost unsurpassed therapy for type 2 diabetes and overall health.
“The impact of exercise on type 2 diabetes can’t be overstated. From the standpoint of quality of life, blood sugar control, survival — and that’s with or without weight loss. Regular exercise reduces your stress. You sleep better. It reduces the symptoms of depression. You’re just more functional. You’re not leading your best life if you’re not exercising.”
Jakicic et al. Physical Activity in the New Era of Antiobesity Medications. Obesity. October 17, 2023.
Villareal et al. Weight Loss, Exercise, or Both and Physical Function in Obese Older Adults. New England Journal of Medicine. September, 2011.
Frimel et al. Exercise Attenuates the Weight-Loss-Induced Reduction in Muscle Mass in Frail Obese Older Adults. Medicine & Science in Sports & Exercise. March 3, 2009.
Figueroa et al. Effects of Hypocaloric Diet, Low-Intensity Resistance Exercise with Slow Movement, or Both on Aortic Hemodynamics and Muscle Mass in Obese Postmenopausal Women. Menopause. September, 2013.
Flack et al. Exercise for Weight Loss: Further Evaluating Energy Compensation with Exercise. Medicine & Science in Sports & Exercise. November, 2020.
How Much Physical Activity Do Adults Need? Centers for Disease Control and Prevention. June 2, 2022.
Lundgren et al. Healthy Weight Loss Maintenance with Exercise, Liraglutide, or Both Combined. New England Journal of Medicine. May 6, 2021.