By Todd Norwood, PT, DPT, FACHE and Rajiv R., MD, ABOM
This edition covers:
- New body composition data from Omada Insights Lab
- How GLP‑1s can change physiology and behavior
- Shifting perspectives among benefits leaders
The relationship between GLP‑1s, body composition, and movement is more complicated than a simple “miracle drug” or “muscle loss” story. When you look closely at new data from Omada’s Insights Lab’s ANSWERS Initiative alongside emerging research, a different narrative comes into focus: with the right support, people on GLP‑1s are not just losing weight, they’re changing how they move, function, and feel in ways that traditional metrics often miss.
What Kind of Weight Are People Losing on GLP-1s?
GLP‑1 receptor agonists like semaglutide and tirzepatide have reshaped obesity and diabetes care, delivering average weight losses of 15–20% in clinical trials and improving cardiometabolic risk factors for many patients. That success has triggered understandable concern about what’s happening under the hood—especially around lean mass. Historically, about one-quarter of weight lost in lifestyle‑based programs comes from lean mass, and rapid loss can push that percentage even higher. It’s a short leap from those numbers to headlines warning that GLP‑1s are “melting muscle.”
Omada’s 12‑week GLP‑1 body composition study offers a more nuanced view. The Insights Lab followed 245 adults with obesity who had recently started a GLP‑1: 151 received Omada’s GLP‑1 companion program and 94 took GLP‑1s without Omada support. Both groups used connected body‑composition scales and completed surveys at baseline, six weeks, and 12 weeks.
At 12 weeks, Omada participants lost 6.0% of their starting weight on average, compared with 3.2% in the comparison group—meaningfully more total weight, and above the 5% threshold often associated with improvements in conditions like type 2 diabetes and osteoarthritis. More importantly, the “quality” of that weight loss differed. Omada members more than doubled the reduction in body fat percentage (3.3% vs. 1.6%) and saw a larger increase in percent muscle mass (0.6% vs. 0.3%) than the comparison group.
Movement and Function: The Outcomes People Actually Feel
Most people don’t routinely think about their lean mass; they care about whether they can keep up with their kids, take the stairs at work, or get through a shift without pain. That’s where the combination of GLP‑1s and structured support becomes especially relevant.
People living with obesity or diabetes have a high burden of musculoskeletal issues—about 90% and 58%, respectively, have at least one musculoskeletal condition. Chronic inflammation, fatty infiltration, and tendon changes mean that even after weight loss, muscle efficiency and joint health may lag behind.
In Omada’s study, members in the GLP‑1 companion program reported greater improvements in how easily they could move, be active, and perform everyday physical tasks than those on GLP‑1s alone. They described feeling more capable and less limited, even when body composition shifts were modest. That pattern tracks with controlled trials showing that exercise plus GLP‑1 therapy yields superior gains in physical capacity, inflammation, and metabolic health compared with either strategy alone.
From a practice perspective, the emerging consensus is pragmatic rather than flashy:
- Build in resistance training two to three times per week, progressing volume and load over time.
- Encourage higher protein intake (often at least 1.2–1.5 g/kg/day) to help support lean mass during caloric deficit.
- Adapt programming to tendon, joint, and functional status rather than chasing arbitrary gym benchmarks.
Omada’s approach is one example of how this can work at scale: participants receive individualized, strength‑forward plans from exercise specialists who understand the realities of GLP‑1 treatment, home environments, and musculoskeletal comorbidities.
Mental Health, Food Noise, and Why People Stick With GLP-1s
By reducing “food noise”—the constant internal chatter about eating and cravings—GLP‑1s may make it easier for some people to align their behavior with their intentions. But the same medications can also introduce new challenges: nausea, low energy, and the psychological adjustment that comes with rapid body change.
In the Omada study, participants in the companion program showed greater reduction in depressive symptoms and anxiety, and improvements in overall well‑being compared with those on GLP‑1s alone, as measured by PHQ‑8, GAD‑7, and WHO‑5 scores. They also reported higher confidence in their ability to lose weight and maintain progress—an important predictor of long‑term adherence in chronic disease management.
One noteworthy pattern: increased movement sometimes appeared before large changes in self‑efficacy scores. That suggests a useful reframe for clinicians and program designers: people may not need to “feel ready” before they start moving; small, supported behavior changes can create the momentum that improves confidence.
Over time, this bidirectional relationship—better movement supporting better mood, and vice versa—may be one of the most valuable, and least discussed, benefits of integrated GLP‑1 care.
What This Means for Clinicians and Benefits Leaders
For employers and benefit leaders, the question around GLP‑1s is shifting from “should we cover them?” to “how do we make sure this investment translates into sustainable health?” Clinicians know that GLP-1s have significant benefits for weight loss and many other outcomes (e.g. diabetes control, renal and cardiovascular outcomes, obstructive sleep apnea).
In Omada’s study, members in the GLP‑1 companion program reported greater improvements in how easily they could move, be active, and perform everyday physical tasks than those on GLP‑1s alone. They described feeling more capable and less limited, even when body composition shifts were modest. That pattern tracks with controlled trials showing that exercise plus GLP‑1 therapy yields superior gains in physical capacity, inflammation, and metabolic health compared with either strategy alone.
From a practice perspective, the emerging consensus is pragmatic rather than flashy:
- Build in resistance training two to three times per week, progressing volume and load over time.
- Encourage higher protein intake (often at least 1.2–1.5 g/kg/day) to help support lean mass during caloric deficit.
- Adapt programming to tendon, joint, and functional status rather than chasing arbitrary gym benchmarks.
Omada’s approach is one example of how this can work at scale: participants receive individualized, strength‑forward plans from exercise specialists who understand the realities of GLP‑1 treatment, home environments, and musculoskeletal comorbidities.
Mental Health, Food Noise, and Why People Stick With GLP-1s
