Anti-obesity Medications and Menopause: Expert Insights

is the clinical director at knownwell Health, a weight-inclusive, patient-centered healthcare organization. With over 30 years of experience, she supports clinicians in treating patients through in-person and digital counseling. An internationally recognized expert in nutrition, metabolism and fitness, Adair is a sought-after speaker and media resource, appearing on CNN and Discovery TV’s “Ultimate Goals.” Adair is also a member of the ACE Scientific Advisory Panel.

How do anti-obesity medications (AOMs) support weight loss in women going through menopause, and what should exercise professionals know about their effectiveness?

First, let’s look at how menopause may lead to weight gain, and then we’ll explore how AOMs might help when used appropriately.

Changes in hormones, especially a drop in estrogen, can influence how the body stores fat and lead to weight gain or fat gain. Age-related loss of muscle mass plays a key role in the natural decline of metabolic rate (because muscle is a more metabolically active tissue than fat). This means the body burns fewer calories as muscle is replaced by fat tissue. If activity levels also decrease, caloric expenditure drops, and weight gain may follow unless eating habits adjust. 

Beyond that, research is exploring how menopause may also affect hunger and fullness cues, which could make maintaining one’s weight even more challenging. Sleep, stress and other psychosocial factors may also play a role, making the maintenance of a healthy weight even more complex.

So, how can AOMs—particularly GLP-1 medications—help women in menopause? The same way they do for others who meet the criteria for these drugs, by reducing appetite, slowing digestion and signalling the brain to feel fuller longer.

As more women use AOMs to manage appetite and cravings during menopause, how can health coaches and exercise professionals tailor their support strategies while staying within their scope of practice?

Early research on GLP-1 medications mainly focused on how they help people eat less, but scientists are now exploring how these medications affect food cravings and preferences.

For example, in the Step 5 trial, people taking semaglutide (a GLP-1 medication) reported fewer cravings for dairy and starchy foods, less desire for salty or spicy foods, and better control over their eating habits. These findings suggest that weight loss on GLP-1s may be influenced by changes in food choices, not just intake reduction. Research is also exploring whether GLP-1 medications could help reduce other types of cravings, such as those seen in alcohol use disorder. In a trial published in JAMA Psychiatry this year, over nine weeks of treatment, people taking semaglutide drank less alcohol, compared to those taking a placebo. They also reported fewer cravings for alcohol. For those who smoked, semaglutide also helped reduce how many cigarettes they smoked per day.

This is an exciting and emerging area of research, and future studies are needed to help us better understand these effects. In the meantime, exercise professionals can continue guiding clients toward nutrient-dense food choices, just as they always have.

How important is strength training for women on AOMs during menopause to help preserve muscle and promote fat loss?

When decreasing food intake, with or without medications, the body doesn’t just burn fat. It will also break down valuable muscle and other lean tissues.  

Emerging research is starting to examine the powerful role exercise may play for people  taking (and/or discontinuing) GLP-1 medications. Exercise can be critical in preserving muscle mass, which in turn supports metabolism and overall health. While the science is still unfolding, we know that different types, intensities and volumes of exercise will need further study to fine-tune recommendations specifically for individuals taking AOMs. It’s important to note that exercise has always played a pivotal role in helping people achieve or maintain a healthy weight through both energy expenditure and positively influencing body composition.

Staying active, whether someone is taking an AOM or not, has tremendous benefits.

Exercise reduces the risk of chronic disease, protects against osteoporosis, improves insulin sensitivity, enhances mood, promotes restful sleep and keeps the metabolism humming. In short, it remains one of the most effective, empowering and sustainable tools for long-term health at any stage of life.

Whenever food intake drops significantly, energy levels can be affected. People on AOMs often have very low appetites, so it’s important for exercise professionals to help ensure clients are eating enough to stay well-nourished and to support their activity levels. 

Working with an obesity specialist doctor or advanced practice providers (nurse practitioner or physician assistant) and a registered dietitian nutritionist can help clients ensure they’re getting the right nutrition and are ready for exercise while pursuing improvements in their metabolic health. This is especially important for people on any AOM as these drugs can reduce appetite, and many have side effects, making it harder in some people to get enough nutrients to stay strong and maintain muscle.

What role does muscle preservation play in the weight-loss process for women in menopause using AOMs, and how can exercise professionals modify their programs to support these efforts?

Keeping muscle is key, whether someone is taking a GLP-1 medication or not. Strong muscles help with balance, stability, bone health and metabolism, all of which support long-term weight management and overall well-being.

When people lose weight quickly, whether through bariatric surgery, very-low-calorie diets (VLCDs), pharmacological interventions or a combination of these approaches, they will lose some muscle tissue along with fat tissue. The goal is to minimize muscle loss and keep the body strong.

Research suggests that combining exercise with AOMs may help people maintain weight loss after stopping medication compared to those who discontinue the medications without exercise. But there’s still a lot to learn, and individual preferences, activity acceptance, and ability should always be considered when recommending movement.

Want to dive deeper? Check out these CERTIFIED articles: The Connection Between Exercise and Menopause and Menopause and Movement: Empowering Clients Through Evidence-based Support.

What should exercise professionals be on the lookout for if a client discontinues their AOM? How can they adjust training or nutrition strategies to support any changes in their client’s weight?

New weight-loss medications, like GLP-1s, can help people lose a significant amount of weight. However, in real-world use, data shows that about half of people stop taking GLP1s within the first year due to factors like cost, side effects or other reasons. When people stop the medication, research demonstrates that there’s a high risk of regaining weight.

Exercise professionals can play a key role in helping clients build sustainable habits that support long-term success. This includes regular movement, structured eating habits, hunger awareness, and focusing on nutrient-dense, whole foods.

Whenever possible, working alongside other healthcare providers who specialise in metabolic health and obesity can provide well-rounded support, helping clients succeed whether they are on or off these medications.

To learn more about how to effectively support clients taking AOMs and navigate the evolving health and fitness landscape, check out A Guide for Supporting Clients on Anti-Obesity Medications (worth 0.2 ACE CECs). In this course, you’ll explore the mechanisms of AOMs and their impact on body composition. You’ll also learn about the relationships among exercise, behavior patterns and AOMs, as well as the broader societal and economic impacts of these medications.