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BooksVol. 14Available

I Lost Weight on a Shot. Now What?

Life on GLP-1 and After It: Keep the Muscle, Keep the Results

by An Thanh Tùng

Kindle edition Paperback

ASIN B0HNKS9ML7 · B0HNK3ZPC1

About this book

The medicine is the scaffolding, not the house.Chapter 1

An evidence-labeled, plain-language guide for people on a GLP-1 weight-loss medicine such as semaglutide or tirzepatide, and for people about to stop. How to keep muscle, eat when you're not hungry, handle side effects, stop with a plan, and keep your results.

What you'll learn

  1. Ch. 2The scale can't tell fat from muscleCount your chair stands every month to know whether you're losing fat or strength.
  2. Ch. 3Your job is to eat enoughThe medicine takes care of eating less. Start every meal with a palm-sized portion of protein.
  3. Ch. 4Two strength sessions a weekThe most valuable thing to build while the scaffolding is up, because it stays after the medicine stops.
  4. Ch. 6The weight comes back on a known pathKnowing the road ahead lets you act early instead of panicking late.
  5. Ch. 8Draw your red line before you stopStanding on the scale is not the time to make a plan.
  6. Ch. 11Quiet cravings aren't a new habitThe medicine doesn't teach you another way to comfort yourself. Find it while the cravings are asleep.

How the book is organized

  1. Part IWhile the Scaffolding Is Up
  2. Part IITaking the Scaffolding Down
  3. Part IIIWhat Nobody Tells You
  4. Part IVYour House

Look inside

Pages from the book

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  • How to read this book
  • Chapter 1 opens
  • Every claim carries a label
  • Try it at home
  • If you remember one thing
  • The evidence at a glance
  • A printable worksheet

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Worksheets from this book

Full library
  • Worksheet Three Numbers: A 12-Month Tracker 2 pages · Ch. 1 · PDF 47 KB Get the PDF
  • Worksheet Protein by Hand and a 3-Day Diary 2 pages · Ch. 3 · PDF 39 KB Get the PDF
  • Worksheet 12-Week Strength Program 2 pages · Ch. 4 · PDF 47 KB Get the PDF
  • Worksheet Three-Level Side-Effect Chart 2 pages · Ch. 5 · PDF 39 KB Get the PDF
  • Worksheet Handover Plan and Red-Line Sheet 2 pages · Ch. 7 · PDF 47 KB Get the PDF
  • Worksheet What to Bring to Your Doctor 4 pages · Ch. 7, 10 · PDF 49 KB Get the PDF
  • Safety card Safety Flags at a Glance 2 pages · PDF 33 KB Get the PDF
  • Reference table If You Notice… Read… 2 pages · PDF 50 KB Get the PDF
  • Reference table Medicine Dictionary 3 pages · PDF 46 KB Get the PDF

61 references

Notes and sources

All sources
Ch. 1I Lost Weight on a Shot. Now What?9
  1. Semaglutide for weight loss (STEP 1) Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med 2021;384(11):989–1002. doi:10.1056/NEJMoa2032183.
  2. Tirzepatide for weight loss (SURMOUNT-1) Jastreboff AM, Aronne LJ, Ahmad NN, et al. Tirzepatide once weekly for the treatment of obesity. N Engl J Med 2022;387(3):205–216. doi:10.1056/NEJMoa2206038.
  3. Semaglutide and heart disease (SELECT) Lincoff AM, Brown-Frandsen K, Colhoun HM, et al. Semaglutide and cardiovascular outcomes in obesity without diabetes. N Engl J Med 2023;389(24):2221–2232. doi:10.1056/NEJMoa2307563.
  4. Oral semaglutide approval US Food and Drug Administration approval of the Wegovy pill (oral semaglutide 25 mg), December 22, 2025.
  5. Orforglipron approval US Food and Drug Administration approval of Foundayo (orforglipron), April 1, 2026.
  6. Clinical obesity Rubino F, Cummings DE, Eckel RH, et al. Definition and diagnostic criteria of clinical obesity. Lancet Diabetes Endocrinol 2025;13(3):221–262. Search PubMed
  7. Regain after stopping semaglutide (STEP 1 extension) Wilding JPH, Batterham RL, Davies M, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab 2022;24(8):1553–1564. doi:10.1111/dom.14725.
  8. Regain after stopping weight-loss medicines West S, Koutoukidis DA, Jebb SA, et al. Weight regain after cessation of medication for weight management: systematic review and meta-analysis. BMJ 2026. PMID 41500720.
  9. The 30-second chair stand Jones CJ, Rikli RE, Beam WC. A 30-s chair-stand test as a measure of lower body strength in community-residing older adults. Res Q Exerc Sport 1999;70(2):113–119. Search PubMed
Ch. 2The Scale Went Down. What Went With It?3
  1. Body composition with semaglutide (STEP 1, DXA substudy) Wilding JPH, et al. N Engl J Med 2021;384(11):989–1002. doi:10.1056/NEJMoa2032183. See Chapter 1.
  2. Is muscle loss clinically relevant? Conte C, Hall KD, Klein S. Is weight loss–induced muscle mass loss clinically relevant? JAMA 2024. PMID 38829659.
  3. Muscle on GLP-1 medicines: adaptive or harmful? Linge J, Birkenfeld AL, Neeland IJ. Muscle mass and glucagon-like peptide-1 receptor agonists: adaptive or maladaptive response to weight loss? Circulation 2024;150. doi:10.1161/CIRCULATIONAHA.124.067676.
Ch. 3Eating When You're Not Hungry3
  1. Nutrition on GLP-1 medicines Mozaffarian D, Agarwal M, Aggarwal M, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Published simultaneously in Am J Clin Nutr, Obesity, Obesity Pillars and Am J Lifestyle Med, 2025. PMID 40450457.
  2. Gallbladder disease with GLP-1 medicines He L, Wang J, Ping F, et al. Association of glucagon-like peptide-1 receptor agonist use with risk of gallbladder and biliary diseases: a systematic review and meta-analysis of randomized clinical trials. JAMA Intern Med 2022;182(5):513–519. Search PubMed
  3. Gallstones on the Wegovy label US Food and Drug Administration. Wegovy (semaglutide) prescribing information, revised March 2026.
Ch. 4A Chair, a Pair of Weights, Twice a Week4
  1. Strength training while dieting Sardeli AV, Komatsu TR, Mori MA, Gáspari AF, Chacon-Mikahil MPT. Resistance training prevents muscle loss induced by caloric restriction in obese elderly individuals: a systematic review and meta-analysis. Nutrients 2018;10(4):423. doi:10.3390/nu10040423.
  2. Exercise, liraglutide or both (S-LITE) Lundgren JR, Janus C, Jensen SBK, et al. Healthy weight loss maintenance with exercise, liraglutide, or both combined. N Engl J Med 2021;384(18):1719–1730. PMID 33951361.
  3. One year after stopping (S-LITE follow-up) Jensen SBK, Blond MB, Sandsdal RM, et al. Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. eClinicalMedicine 2024;69:102475. doi:10.1016/j.eclinm.2024.102475.
  4. Physical activity guidelines Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med 2020;54(24):1451–1462. Search PubMed
Ch. 5The 2 a.m. Questions9
  1. Side effects, pancreatitis, low blood sugar, kidney injury, anesthesia, pregnancy, thyroid warning US Food and Drug Administration. Wegovy (semaglutide) injection and tablets, prescribing information, revised March 2026.
  2. Serious digestive events Sodhi M, Rezaeianzadeh R, Kezouh A, Etminan M. Risk of gastrointestinal adverse events associated with glucagon-like peptide-1 receptor agonists for weight loss. JAMA 2023;330(18):1795–1797. doi:10.1001/jama.2023.19574.
  3. GLP-1 medicines around surgery American Society of Anesthesiologists, American Gastroenterological Association, American Society for Metabolic and Bariatric Surgery, International Society of Perioperative Care of Patients with Obesity, Society of American Gastrointestinal and Endoscopic Surgeons. Multisociety clinical practice guidance on GLP-1 receptor agonists in the perioperative period, October 29, 2024.
  4. Tirzepatide and birth control pills Eli Lilly and Company. Zepbound (tirzepatide) prescribing information: oral hormonal contraceptives.
  5. Suicidal thoughts: European review European Medicines Agency, Pharmacovigilance Risk Assessment Committee (PRAC). Meeting highlights, April 8–11, 2024.
  6. Suicidal thoughts: US label change US Food and Drug Administration. Request to remove the suicidal behavior and ideation warning from GLP-1 receptor agonist labels, January 2026.
  7. NAION European Medicines Agency, Pharmacovigilance Risk Assessment Committee (PRAC). PRAC concludes eye condition NAION is a very rare side effect of semaglutide medicines Ozempic, Rybelsus and Wegovy, June 6, 2025.
  8. Thyroid cancer: Nordic study Pasternak B, Wintzell V, Hviid A, et al. Glucagon-like peptide 1 receptor agonist use and risk of thyroid cancer: Scandinavian cohort study. BMJ 2024. doi:10.1136/bmj-2023-078225.
  9. Thyroid cancer: French study Bezin J, Gouverneur A, Pénichon M, et al. GLP-1 receptor agonists and the risk of thyroid cancer. Diabetes Care 2023;46(2):384–390. Search PubMed
Ch. 6365 Days After the Last Dose5
  1. Stopping semaglutide (STEP 4) Rubino D, Abrahamsson N, Davies M, et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA 2021;325(14):1414–1425. Search PubMed
  2. Stopping tirzepatide (SURMOUNT-4) Aronne LJ, Sattar N, Horn DB, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA 2024;331(1):38–48. Search PubMed
  3. Pace of regain and return of cardiometabolic markers West S, et al. BMJ 2026. PMID 41500720. See Chapter 1.
  4. STEP 1 extension Wilding JPH, et al. Diabetes Obes Metab 2022;24(8):1553–1564. doi:10.1111/dom.14725. See Chapter 1.
  5. Half-life of semaglutide US Food and Drug Administration. Wegovy (semaglutide) prescribing information, revised March 2026.
Ch. 7Stop, Step Down, or Stay On?5
  1. Staying on the medicine Rubino D, et al. JAMA 2021;325(14):1414–1425; Aronne LJ, et al. JAMA 2024;331(1):38–48. See Chapter 6.
  2. WHO guideline World Health Organization. Guideline on the use of GLP-1 medicines in treating obesity in adults, December 1, 2025.
  3. Switching to a pill (ATTAIN-MAINTAIN) Aronne LJ, Horn DB, le Roux CW, et al. Orforglipron for maintenance of body weight reduction: the double-blind, randomized phase 3b ATTAIN-MAINTAIN trial. Nat Med 2026. doi:10.1038/s41591-026-04386-7 (published May 12, 2026).
  4. Tapering Gudbergsen H, et al. (Embla). Conference report on tapering semaglutide in patients of a digital weight-loss clinic (real-world cohort; 54 people tapered to zero), European Congress on Obesity, Venice, 2024; abstract in the ECO 2024 abstract supplement, Obesity Facts (Karger). Not peer-reviewed; no comparison group.
  5. Generic semaglutide Health Canada approvals of generic semaglutide (Dr Reddy's, Apotex), April–May 2026; launches in India, March 2026.
Ch. 8The 12-Week Handover4
  1. The National Weight Control Registry Wing RR, Phelan S. Long-term weight loss maintenance. Am J Clin Nutr 2005;82(1 Suppl):222S–225S. doi:10.1093/ajcn/82.1.222S. PMID 16002825.
  2. Exercise after stopping Jensen SBK, et al. eClinicalMedicine 2024. See Chapter 4.
  3. Daily weighing and self-regulation (STOP Regain) Wing RR, Tate DF, Gorin AA, Raynor HA, Fava JL. A self-regulation program for maintenance of weight loss. N Engl J Med 2006;355(15):1563–1571. Search PubMed
  4. Self-weighing Zheng Y, Klem ML, Sereika SM, Danford CA, Ewing LJ, Burke LE. Self-weighing in weight management: a systematic literature review. Obesity (Silver Spring) 2015;23(2):256–265. PMID 25521523.
Ch. 9Real, Compounded, Counterfeit4
  1. Counterfeit semaglutide World Health Organization. Medical Product Alert N°2/2024: Falsified OZEMPIC (semaglutide), June 19, 2024; and WHO issues warning on falsified medicines used for diabetes treatment and weight loss, June 20, 2024.
  2. Dosing errors with compounded semaglutide US Food and Drug Administration. Alert on dosing errors associated with compounded injectable semaglutide products, July 26, 2024.
  3. Generic semaglutide See Chapter 7.
  4. Access and equity World Health Organization guideline, December 1, 2025. See Chapter 7.
Ch. 10Who Shouldn't Be on It4
  1. Contraindications, pregnancy, retinopathy, type 1 diabetes, heart rate US Food and Drug Administration. Wegovy (semaglutide) prescribing information, revised March 2026.
  2. Retinopathy in people with type 2 diabetes (SUSTAIN-6) Marso SP, Bain SC, Consoli A, et al. Semaglutide and cardiovascular outcomes in patients with type 2 diabetes. N Engl J Med 2016;375(19):1834–1844. Search PubMed
  3. Who the WHO guideline covers World Health Organization guideline, December 1, 2025. See Chapter 7.
  4. Eating disorders No clinical studies were found; the chapter draws on published case reports described by clinicians and does not assign a label.
Ch. 11New Body, Same Old Brain4
  1. Semaglutide and alcohol Hendershot CS, Bremmer MP, Paladino MB, et al. Once-weekly semaglutide in adults with alcohol use disorder: a randomized clinical trial. JAMA Psychiatry 2025;82(4):395–405. doi:10.1001/jamapsychiatry.2024.4789.
  2. Medicine plus behavior change Wadden TA, Berkowitz RI, Womble LG, et al. Randomized trial of lifestyle modification and pharmacotherapy for obesity. N Engl J Med 2005;353(20):2111–2120. PMID 16291981.
  3. Behavioral support doesn't slow regain West S, et al. BMJ 2026. PMID 41500720. See Chapter 1.
  4. Weight stigma Rubino F, Puhl RM, Cummings DE, et al. Joint international consensus statement for ending stigma of obesity. Nat Med 2020;26(4):485–497. PMID 32127716.
Ch. 12Keep the Muscle, Keep the Results1
  1. The six key claims See the sources for Chapters 1, 2, 4, 6 and 7.
BackWorksheets at the back of the book6
  1. Three numbers and the chair stand See Chapters 1 and 2 (Jones et al. 1999).
  2. Protein by hand See Chapter 3 (Mozaffarian et al. 2025).
  3. 12-week strength program See Chapter 4 (Bull et al. 2020; Sardeli et al. 2018).
  4. Three-level side-effect chart See Chapter 5 (Wegovy and Zepbound prescribing information; EMA PRAC 2024 and 2025).
  5. Handover plan and red line See Chapter 8 (Wing et al. 2006; Wing and Phelan 2005).
  6. Twelve check questions See Chapter 10 (Wegovy prescribing information; WHO 2025).

Updates and corrections

Evidence last reviewed October 20, 2026

Each evidence label shows how solid the evidence was on the day it was last reviewed. Corrections are posted here with the date they were made, and included in the next printing.

No corrections have been posted for this edition. Spotted an error, or a study that should change a label? Email [email protected]

Most likely to change

  • New medicines being approved, especially pills and medicines acting on several hormones (Chapters 1, 7)
  • Legal generics in different countries, prices and insurance (Chapters 7, 9)
  • Labels and warnings, including those on mood, eyes and the thyroid (Chapters 5, 10)
  • Data on the years after stopping, and on the best way to stop (Chapters 6, 7, 8)
  • Trials combining exercise with semaglutide or tirzepatide (Chapter 4)
  • Guidance from WHO and professional societies on long-term use, nutrition and access (Chapters 3, 7, 9)

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