GLP-1 Receptor Agonists – The Benefits and Body Challenges Post Weight Loss

In this article, we talk about the positive and negative impacts of drugs like Ozempic and Mounjaro and Wegovy.   How GLP-1 inhibitors work, how they affect our bodies and the impact of rapid weight loss on skin.

The Rise and Rise of GLP-1 Inhibitors

Over the last 18 months, the rise in usage of GLP-1 Inhibitors (Glucagen Like Peptide) such as  Mounjaro, Ozempic, Wegovy, and Victoza has skyrocketed.

This seeming miracle in a syringe has transformed the way that people are choosing to lose weight and has benefits far exceeding the obvious weight loss. The most interesting data is emerging on the effects of GLP’s on inflammation in the body, microdosing and compulsive behaviours and addictions.

Primarily these weight loss drugs were used to treat Type 2 diabetes due to its regulation of insulin and glucose levels and those requiring chronic weight management.  This has now transferred to the general population looking for a way to control their appetite and lose weight without significant cravings or feelings of loss.

Weight is lost at a fairly rapid rate initially  with around 5-10% of bodyweight in the first 3 months and an average of 15%-20% in the first year.  This rapid loss can have both positive and negative effects on the body.

The benefits of GLP-1 Receptor Agonists for Weight Loss and More

One of the great benefits of these drugs are that they target the dangerous visceral fat at a higher rate than subcutaneous fat. Visceral fat is the fat that is stored around your vital organs such as the liver and impact the body in the following ways:

• raises cholesterol,
• interferes with insulin management ,
• promotes inflammatory responses
• puts you at a greater risk of  cardiovascular disease, stroke, autoimmune diseases, hormonal issues, cognitive decline and more.

With so many far reaching benefits, you can see why the use of these drugs has increased over the last few years.  Whilst the positive effects on the body are beyond argument, we are seeing more and more cases of people now needing to manage the effects on their skin and also side effects on the body that can be easily prevented.

As previously with gastric band surgery, weight (and lean muscle) is lost at such a fast rate that the skin cannot keep up and appears loose and saggy.  Women, particularly, are experiencing sagging not only in their faces but more and more often on their buttocks, thighs and abdomen.

The buttocks are made up of main muscles (glutes) and supporting muscles such as the piriformis, along with these muscles is a layer of fat which helps shape and soften the area, for women this tends to be around 20%-35%.  The fast weight loss means that the tissue is unsupported, and the buttocks will start to appear saggy, even in those who are actively working out. Muscle loss can also occur with rapid weight loss, further contributing to the problem

We commonly see issues in the following areas:

• Stomach – the skin is loose and can often hang similar to post pregnancy
• Thighs – skin once held up with muscle and fat can appear to sag especially around the knees and the top of the thighs
• Breasts –  fat is a main component of breast tissue and once lost, breasts can appear empty and sagging
• Face – fat loss on the face can result in the patient looking gaunt, vertical lines can appear on the lower third of the face and jowls can develop

We have seen a large increase in patients coming into clinic following hair loss after taking GLP1 Inhibitors.  This hair loss (Telogen Effluvium) happens when hair follicles enter the resting phase (telogen)  too quickly, this leads to rapid hair shedding.  Rapid or significant  (15% to 20% of body weight) loss can trigger hair loss and thankfully is often temporary.  Ensuring that you are getting essential nutrients in this time will limit the hair shedding and promote regular hair growth.  We have had good results in clinic using Exosomes and Growth Factors to protect the hair follicles during this time.

Preventative Measures – how to protect yourself on your weight loss drug journey

Whilst it is difficult to know how much weight you will lose, it will always be more beneficial to drop weight at a consistent and manageable rate.  It is often tempting with any diet or health kick to want to lose as much weight as possible as quickly as possible – this can wreak havoc on our internal systems which can then kick into a starvation protection state.  Slowing down the weight loss not only allows the body to readjust without hitting the panic button, but also gives your skin time to spring back.

It is incredibly important to protect your muscles and bones during weight loss, it is quite common to lose lean muscle during as you are taking weight loss drugs and we often overlook this as we focus on the scales dropping and our clothes feeling looser.

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Along with sagging skin and poor body composition, loss of lean muscle has a number of detrimental effects on the body.

• Slower metabolism and weight re-gain. Lean muscle is metabolically active, it burns calories even when you are not active.  Protecting this muscle means that you will be less likely to regain weight if you stop taking weight loss injections.  Losing muscle can increase insulin resistance making you a higher risk for diabetes and other metabolic syndromes.
• Increased risk of osteoporosis and weak bones
• Muscle and bone health are linked, there is a higher chance of developing Osteoporosis following rapid weight loss, especially in menopausal women making you more prone to fractures and breaks.
• Decreased strength and mobility

Aside from the obvious strength benefits, you may have issues with balance, fatigue and be more likely to be injured in a fall.

How to check muscle and bone loss?

Our weight loss is easily visible, we can watch the scales move, feel our clothes fitting differently, friends and family will start to comment.  Our internal losses are not as easy to spot.  Body Composition Scales are a really excellent way to keep an eye on how we are doing and make any necessary adjustments, you can often find these in the gym, both Nuffield and Virgin Active have them.    There are now great options for home scales such as the Garmin Index S2 which shows of course your weight but also BMI, Body Fat %, Skeletal Muscle Mass, Bone Mass and Body Water %.

How to prevent muscle and bone loss

Nutrition – make sure that as you are eating less, you are still getting the nutrients that your body needs, this is essential for good bone and skin health.  No matter how much you are eating, always try to get a good mix of essential nutrients.  This will make sure that your skin, hair, bones and muscles are not impacted by the weight loss.

Protein shakes (whey protein) are a really useful way to stay hydrated and get the protein your body needs if your appetite is reduced.  This will keep your skin, hair and immunity in top shape.

NMN supplements help the cells responsible for creating collagen to function properly, this will make the skin more resilient to change and firmer during your weight loss, it will not ‘tighten’ the skin on its own but maximise its condition.

Creatine – this is an essential resource for muscle strength and energy and a great companion to protein shakes.

Bones – Supplement with bone healthy options such as Vitamin D3, K2, Calcium and Magnesium.

How can we tighten up skin that has already sagged? Traditional body treatments such as Emsculpt will not be as effective as the muscles, even if lifted, will not tighten the loose skin.

Non Surgical Options

CO2 Laser

This laser is excellent at ablating and tightening excess skin on the face and body.  This is our preferred option for tightening crepey,  loose skin on the stomach, arms and is very effective on the face and eyelids. Read more

Radio Frequency

The deep penetrating heat from the RF contracts and tightens up skin and muscle and is also excellent at smoothing out cellulite which can be more visible after weight loss.  We use this option to to work on  thighs, buttocks, arms and for those who do prefer no downtime on the face. Read More Here

Regenerative Medicine

There has been a significant rise in the use of Exosomes, Polynucleotides and PRP/PRF (Platelet Rich Plasma & Platelet Rich Fibrin) to rejuvenate the skin.  We have been using these in clinic to promote collagen and elastin production and plump the skin either on their own or in conjunction with laser therapy.

With PRF, we take a small amount of blood, centrifuge it and extrude the plasma, we can then introduce this back into the body to promote collagen and elastin growth.  A great option for the arms, hands, decolletage, legs and body or anywhere with a high risk profile as the plasma is safe to use everywhere.

Bio-revitalisers

Products like Profhilo were previously used only on the face and can now be used on the body to promote plump, healthy supple looking skin.  It contains high and low molecular weight Hyaluronic Acid for lifting and plumping the skin and is often used around areas prone to sagging such as knees, arms and abdomen. Read More

Surgical Options for Sagging Skin

If you have lost over 25kg you may need to look at surgical options as there will likely be a limit to the amount that will spring back.  Generally, people are looking to address issues in their abdomens, thighs and arms.

Abdominoplasty –  tummy tuck, often used if the patient has an ‘apron’ of skin on the abdomen,

Brachioplasty – Removing excess skin from the elbow to the underarm

Thigh Lift – surgery can be performed on the inner thigh, outer thigh or a vertical lift for severe sagging.

Treating Sagging Skin at Home

In-clinic treatments will most likely be required  but there are some great options to improve the quality of your skin and help tighten up at home.

Anteage – Home Needling Kit – using both the mechanics of the microneedling and the powerful growth factors to tighten skin – See More Here

SkinBetter Science – Alpharet Overnight cream.  This retinol is a best selling product for tackling texture on the face and body See More Here

Revision Bodifirm– Elasticising and nourishing body cream, great for thighs, upper arms and decolletage, designed for the body.  See More Here