This article was originally written by the Sequence clinic team (now known as WeightWatchers Clinic).

Are diet and exercise still needed while on a weight loss medication?

Published July 14, 2023

For many members, this is far from the start of their health journey. Years of tracking every calorie and trying diet plans that weren’t sustainable have led to taking a different approach to weight loss. A weight loss medication isn’t a “magic drug”, but it can make it easier to make the lifestyle changes needed to lose weight and improve your health. You may have heard other members talk about, or may have experienced yourself, the effect these medications have on quieting the so-called “food noise.” This may include reducing obsessive thoughts about food, stress or emotional eating, cravings, etc. Having fewer of these thoughts creates space to plan balanced meals and incorporate activity—which is vital to support your health— without all of the distractions.

Many, but not all, weight management medications work by mimicking hormones that regulate your appetite and food intake, making you feel less hungry and full more quickly, which makes focusing on your nutrition even more important to ensure all nutrient needs are met.

Looking beyond the number on the scale

Sure, weight loss may be the goal, but it’s important not to lose sight of other outcomes like improving your overall health and reducing the risk of disease. It’s still crucial to focus on your diet to ensure you are getting all of the nutrition your body needs. Another factor to consider is the type of weight you are losing. This is also referred to as your body composition, or the percentage of fat mass to lean mass within the body.

Lean mass includes the weight of our bones, organs, skin, water, and muscle— essentially everything except for adipose (fat) tissue. As we lose weight, it can be easy to lose muscle along with excess fat tissue. It’s important to try to maintain as much of our muscle as possible throughout this process. Having a higher composition of muscle isn’t just about looking good either; it is critical for our long-term health.

Why is having more muscle mass important?

  • Higher percentages of muscle mass have been associated with fewer falls and fractures as we age. This is due to our skeletal muscle, or muscle connected to our bones, that allows us to perform all body movements. Keeping your bones healthy requires adequate amounts of muscle.
  • Having more muscle increases our energy expenditure— meaning the more lean mass we have, the more energy we burn at rest throughout the day.
  • Muscle is required to maintain blood sugar levels by clearing glucose from the blood. Having more muscle mass has been associated with improved insulin sensitivity and a lower risk of developing diabetes.

Maintaining muscle mass during weight loss

So, we know maintaining our lean mass is important, but how exactly do we do that? The two main ways we can prevent the loss of muscle are through physical activity and dietary protein.

Physical activity supports maintaining lean muscle

Physical activity, whether it be endurance training, like walking, or strength training, like weight lifting, is an integral part of any weight loss journey as it helps maintain muscle and it can help promote weight maintenance following weight loss. Beyond those benefits, it just makes you feel good! Getting in some daily movement can improve your mood, energy, sleep, and reduce stress. Exercise doesn’t have to mean killing yourself in the gym either. Going for a short walk on your lunch break or a leisurely bike ride can have a really positive impact on your health.

Here are just some of the benefits of physical activity:

  • Physical activity can minimize the loss of lean body mass during weight loss while reducing body fat
  • It can strengthen your muscles and bones
  • Exercise improves your heart health by lowering blood pressure, improving insulin sensitivity, and lowering cholesterol
  • It gives you a natural boost in your mood and lowers your stress levels

Eating adequate protein contributes to increased muscle mass

Muscle fibers are made up of proteins and, like other tissues within the body, they are continuously being broken down and rebuilt. To maintain and build muscle, we have to consume more protein than what is being broken down. Protein is responsible for many other functions in the body too— like tissue repair, making antibodies to protect us against infection, hormone regulation, maintaining fluid balance, and transporting/storing nutrients.

We recommend consuming at least 1-1.2g of protein per kg of current body weight.

What other nutrients are essential for our health?

Beyond getting adequate protein, we want to ensure we are getting enough fiber, vitamins, and minerals in our diet to optimize our health. Eating a diet high in fiber can lower cholesterol, improve blood glucose, increase the frequency of bowel movements, and help with satiety. It is recommended to get at least 14g of fiber per every 1,000 calories consumed. Fiber is found in fruits, vegetables, beans, legumes, nuts, seeds, and whole grains. We recommend increasing fiber slowly and getting adequate fluids to prevent bloating or discomfort. The National Academy of Medicine recommends ~72 oz daily for women and 100 oz for men. But you may find that you need more depending on the medication you’re on and your diet.

Vitamins and minerals, also called micronutrients, are another key component. Micronutrients are found in all whole food sources, but getting enough fruits and vegetables ensures we get a variety of these nutrients. It is recommended to get 3 servings of vegetables and 1-2 servings of fruit daily.

A balanced diet also includes carbohydrates and healthy fats—yes, we can have it all!

When choosing sources of carbohydrates, look for unrefined, high-fiber carbohydrates like fruit, vegetables like sweet potatoes, quinoa, lentils, brown rice, and whole wheat pasta/bread. We recommend these sources make up about ¼ of your plate.

Heart-healthy fats are another great way to satiate hunger. Most meals will already have a source of fat, like your salad dressing, cooking oil, egg yolk, cheese, salmon, and steak. Otherwise, we recommended adding sources like avocado, olive oil, or nuts and seeds. As these foods pack a lot of nutrients in a small volume, we recommend ~1-2 tbsp of oil or ½ avocado as a serving size.