Every time I open Instagram, it seems to only take a few seconds of scrolling for me to be served a post for a GLP-1 medication like Ozempic, Wegovy, or Zepbound.
Sometimes it’s an ad featuring a montage of before-and-after photos, along with a clip of a woman boasting about how “life-changing” the drug is and how “easy” it is to get online. Other times I’ll see someone I’ve followed for years—an acquaintance, a celebrity, or a content creator—posting photos where they’re suddenly several sizes smaller, a weight loss so dramatic it likely wouldn’t have been possible without pharmaceutical assistance.
And it’s not just my algorithm. Bodies seem to be shrinking IRL too—and GLP-1s are part of the reason why. Between February 2024 and October 2025, the number of American adults who reported taking GLP-1s for weight loss more than doubled, constituting roughly 12% of the population, according to Gallup polling.
The ever-increasing popularity of GLP-1s bubbles up conflicting feelings for me. On the one hand, it’s none of my business which medications people take or what they choose to do to their bodies. No one owes me an explanation for how and why they decided to pursue weight loss, and I don’t think it’s always problematic.
But on the other hand, it’s a real mindfuck that it feels like overnight so many people’s bodies have shrunk to fit a mold that society deems more desirable. It’s especially triggering when the body belongs to someone who used to tout self-acceptance and the evils of diet culture.
Perhaps I find this shift particularly challenging because, as a millennial, I saw thinness glamorized and disordered eating normalized in the media during my most formative years and know the damage it can do to our collective well-being. Now that modern medicine has made weight loss easier than ever, it’s hard not to backslide and internalize the message that we should all prioritize being smaller, despite the potential risks to our mental and physical health.
On paper I’m an ideal candidate for the medications. I live with polycystic ovary syndrome (PCOS), a hormonal disorder that is often coupled with insulin resistance and makes weight loss notoriously difficult. GLP-1s have been studied and prescribed specifically for people with PCOS, and the results look encouraging.
My body mass index (BMI) is approximately 33, and anything above 30 is categorized as obese. I’m aware BMI has a racist history and is a poor measurement of health (it doesn’t account for muscle mass, for one). But unfortunately, BMI is still used in clinical settings, especially to prescribe GLP-1s.
And yet, I’ve opted out—not because I feel sanctimonious about pursuing my weight-loss goals without medication (which I am), or because I think taking GLP-1s is somehow “cheating” or “taking the easy way out” (I don’t, and it’s not), but because even though doctors have suggested I try the drugs, I’m concerned about certain effects of a treatment that’s only become mainstream for weight loss fairly recently.
How do GLP-1s lead to weight loss?
At a high level these drugs mimic glucagon-like peptide-1, or GLP-1, a hormone our bodies naturally produce in the gut. When we eat it kicks into gear, signaling the pancreas to release insulin, which helps regulate blood sugar levels.
However, when you inject a GLP-1 (or pop a pill—oral Wegovy recently received FDA approval), the medication essentially hijacks the gut-brain signaling system that regulates hunger and satiety. It amplifies the body’s natural “you’re full” messages and quiets signals that drive appetite. The drug also causes food to linger in the stomach, which prolongs the feeling of fullness. At the same time it targets appetite receptors in the brain to dial down “food noise” and cravings. This powerful combination has made these medications incredibly popular—and highly effective.
For example, a 2022 study found that people taking a weekly injection of tirzepatide (commonly sold under the brand name Zepbound) lost between 15% and 20% of their body weight over 72 weeks. For a 200-pound person, that’s about 40 pounds. In contrast those losing weight through diet and exercise alone only saw a reduction of 3% over that time period, the same study found. If a person weighs 200 pounds, that translates to just six pounds.
Why I’m saying no to GLP-1s
So if I’m a good candidate and I’m looking to improve my body composition, why would I pass up a medication that’s clinically proven to be much more effective than diet and exercise alone? These are a few of the main reasons.
I spent most of my life fighting a war with my body and chasing thinness. As a teen I went through periods of such severe dieting that I would miss my period and pass out in class. The years of fad crash diets, weight fluctuations, restriction, and endless cardio took a toll. By 2020 I was left feeling exhausted, with an extra 30 pounds to lose.
After things started getting back to normal after the pandemic, I set out to make a change. But I took a much different approach to improving my body composition than I had in the past. I started tracking macros with a focus on how I was fueling my body instead of drastically cutting calories. While weight loss is technically achieved through expending more energy than you take in, eating too few calories for too long can actually slow down your metabolism over time.
I started eating more than I’d ever allowed myself to when I pursued weight loss in the past—and I was still seeing progress. It turns out that I needed those calories to fuel my weekly strength workouts and my busy, active life. (My daily step count is usually at least 10,000.) I planned my meals around hitting protein goals, didn’t eliminate any specific foods, and enjoyed dining out.
The result? While it’s taken years and my trajectory has not been perfect, the overall composition of my body keeps improving: I’ve been steadily increasing muscle mass while decreasing body fat. Muscle plays a key part in glucose regulation and can help reduce insulin resistance, both of which are especially relevant for those of us with PCOS. I’ve also gone down about two clothing sizes, losing over 15 pounds.
Most importantly, I feel better, and I’ve completely transformed my relationship with food. I can finally enjoy eating without guilt, and I listen to and respect the physical hunger cues I used to ignore. After spending so much of my life intentionally restricting calories and beating myself up for going over my self-imposed limits, I’m afraid to take medication that I worry could lead me to fall back into that unhealthy cycle.
My fears aren’t unfounded either. Evelyn Attia, MD, director of the Center for Eating Disorders at NewYork-Presbyterian, says people who’ve struggled with eating disorders or restrictive dieting should avoid taking GLP-1s. “There could be a quick and dangerous misuse of something that someone does not need...and they can get themselves into a very dangerous set of behaviors,” she tells SELF.
When you lose weight you’re almost guaranteed to shed lean body mass in addition to body fat. But when you drop pounds quickly—as many people do while taking GLP-1s—you risk accelerating muscle loss. In fact, there’s been an influx of people reporting just that, as a recent Vox article explored. Reddit is also full of threads with people on GLP-1s discussing how they feel weak as a result of muscle loss.
Data on this topic is limited—and much of the research conducted on it so far has been funded by pharmaceutical companies, FWIW. Still, major trials on two GLP-1 drugs (tirzepatide and semaglutide) offer some information about the impact of these medications on muscle loss, according to a 2025 analysis in Obesity Reviews. The researchers behind the review found that, on average, across both trials, participants lost 10% or more of their skeletal muscle over 68 to 72 weeks.
To contextualize those numbers, the researchers say this is on par with 20 years of aging-related muscle loss in adults 30 and older, who lose an estimated 3% to 5% of muscle mass per decade. However, they also say that a decent amount of muscle loss is par for the course for anyone losing weight rapidly, specifically highlighting those who have had bariatric surgery, and not necessarily specific to GLP-1s. (That being said, it bears repeating that more research in humans needs to be done on this topic. But an animal study suggests that muscle loss could possibly be less dramatic than expected.)
Muscle loss among those taking GLP-1s is something Gabrielle Lyon, DO, a family medicine physician and author of Forever Strong, has noticed as well—and she says the effects could potentially be detrimental. “In our excitement for treating obesity, we’re going to trade it for sarcopenia,” she says. Sarcopenia, the clinical term for loss of muscle mass and strength, is typically associated with aging patients. But it’s also a risk for those who lose weight quickly, according to Dr. Lyon.
The effects of sarcopenia are further complicated if you decide to stop taking a GLP-1 and then gain weight, Dr. Lyon says. That weight is most likely to be largely composed of body fat, with little lean muscle mass, according to the Obesity Reviews article. This can damage metabolic health and lead to complications like heart disease and type 2 diabetes, as well as increase the risk of falls.
Though the right lifestyle modifications (like eating enough protein and consistent weight lifting) can help maintain or even build muscle mass, including while taking a GLP-1, I prefer to stick with what I know works for me. Lifting heavy weights and getting stronger isn’t just something I’ve done for aesthetic reasons; I’m also cognizant of the health benefits, especially as I age.
The clinical term anhedonia refers to the loss of pleasure in activities that used to bring you joy. It’s a hallmark sign of depression, and I’ve been on some form of antidepressant since I was 14 to actively combat this feeling (which is more than just sadness). Yet, there have been reports that it’s a potential side effect of GLP-1s, including a recent story in The Cut.
We know GLP-1 affects the brain’s reward system, so it stands to reason that the brain mechanism that makes some people indifferent to food may also make them indifferent to other pleasures, like sex, hobbies, or spending time with loved ones.
The experts I spoke to said the potential connection between anhedonia and GLP-1 needs further study. But the anecdotal stories reported in The Cut and on Reddit are enough to make me hesitate. I personally wouldn’t want to live a life devoid of pleasure, whether that’s a Levain chocolate chip cookie or sex with my husband.
I take a daily cocktail of prescribed medication to treat my mental health conditions. Since GLP-1s work by slowing stomach emptying, I’ve been concerned these drugs could prevent my stimulant and mood stabilizers from reaching my brain at the intervals they need to.
This is another topic that the doctors I spoke with said needed further study, but Virginie-Anne Chouinard, MD, staff psychiatrist and director of research at the McLean Hospital OnTrack Program, says recent research has shown promising results.
One study evaluated a small group of people with schizophrenia taking both the antipsychotic medication clozapine and semaglutide (the GLP-1 medication in Ozempic and Wegovy). Not only did the researchers find that the GLP-1 helped patients lose weight (weight gain is a common side effect of antipsychotics), but they also determined that the participants’ concentration of clozapine stayed the same and their psychotic symptoms didn’t worsen. Another similar small randomized trial yielded positive results as well.
Dr. Chouinard says people who are on psychiatric medications like lithium that require regular monitoring should get blood level checks, as clinically recommended, especially if they go on a GLP-1. But she says the studies conducted so far to assess the impacts of combining psychiatric medication and GLP-1s are “reassuring.”
Even though the findings from these studies are comforting, it took me years to find the right combination of meds to treat my mental illnesses. I take my mental health very seriously, so I’ll be keeping an eye out for more research on this subject.
Gastrointestinal distress is a commonly reported side effect of GLP-1s, impacting roughly 40% to 70% of patients. Symptoms include nausea, vomiting, diarrhea, and constipation. Research also suggests GLP-1 users are over two times more likely to experience GERD than those not taking the medication, and their risk of developing gallstones increases by nearly 50%.
As someone with a history of Crohn’s, a type of inflammatory bowel disease (IBD), I already deal with a lot of GI issues. Although the intensity and persistence of these symptoms can vary greatly and there are ways to lessen symptoms for most people, I really don’t want to tack on more tummy troubles or potentially exacerbate what’s already going on. That being said, it’s worth noting that GLP-1s may actually be beneficial for IBD patients who are stable, since weight loss can lessen inflammation, which can worsen symptoms of these conditions, Holly Lofton, MD, clinical associate professor of medicine and director of the Weight Management Program at NYU Langone Health, tells SELF.
Folks have reported other side effects that concern me as well, such as hair loss, which can result from rapid weight loss. Clinically, this is known as telogen effluvium and has been seen in some GLP-1 patients.
After all my research, I haven’t sworn off GLP-1s forever—but for now they’re a no for me.
When I began researching this piece, I thought it would solidify my decision to never take GLP-1s. But as I talked to experts in the field and read the research, it poked some holes in my arguments. While, for now, I’m choosing to pursue my health and fitness goals without the help of medication, down the road GLP-1s might be a good option for me under the right supervision if anything major changes with my health.
Pursuing weight loss without pharmaceutical assistance is a much slower process, but I’ve established long-term healthy habits, feel great, and know this is the right approach for me, at least for the time being. I’m running my own race, and it’s not healthy or helpful to compare my journey to anyone else’s. (Which is why I block weight loss ads when they pop up on my social feeds.)
I’d give anyone considering GLP-1s the same advice. Just because I’m choosing not to use one of these medications right now doesn’t mean that’s the correct move for you. Consult your doctor before making any decisions, and wherever you land, I hope the motivation comes from wanting what’s best for yourself—not from shame or peer pressure.
Related:
- Can You Ask If Someone's Taking a GLP-1?
- People With PCOS Are Taking GLP-1s for Their Symptoms. Here’s What to Know
- Here’s Exactly How Much Protein to Eat If You’re on a GLP-1
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