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Experts Highlight Exercise and Care Support for GLP-1s

Published · RetaRadar

Healthcare practitioners in South Africa and the United States are emphasizing that incretin-based medications require comprehensive lifestyle management and clinical oversight to deliver sustainable outcomes. As prescription demand for glucagon-like peptide-1 (GLP-1) receptor agonists expands, medical specialists warn that patients must address muscle retention, diet, and treatment adherence rather than viewing the drugs as standalone remedies.

Muscle Preservation During Weight Loss

According to reporting by Eyewitness News, physiotherapist Toni-Lynne Monger of The Balance Group spoke on Cape Talk regarding the physiological effects of rapid weight reduction. Monger explained that while GLP-1 medications can assist individuals managing blood sugar and triglycerides, weight loss inevitably involves the loss of both fat and muscle tissue. She noted that muscle constitutes roughly 30% to 40% of total body mass and supports blood glucose regulation, bone density, and cognitive health.

Monger expressed concern over patients using these medications without receiving concurrent guidance on nutrition and exercise, particularly if they plan to stop pharmacotherapy later. She noted that women undergoing perimenopause and menopause face an added challenge, as hormonal shifts alter how muscle tissue processes blood sugar. To safeguard lean mass, Monger recommended gradual engagement in resistance training and conditioning. She also suggested that individuals obtain a baseline body composition scan before initiating strict regimens or medications, enabling them to track changes in lean mass alongside overall weight.

Clinical Limits and Lifestyle Adjustments

Clinicians in the United States have shared similar observations regarding the necessity of physical activity and dietary planning. In an interview with The Times-Tribune, Dr Essam Almeky, director of the medical weight loss program at Commonwealth Health, stated that GLP-1 therapies do not work effectively on their own. Almeky noted that patients who rely solely on medication without adjusting eating habits or undertaking muscle exercise often experience persistent nausea from overeating without achieving substantial weight loss.

Dr Christopher Still, director of Geisinger's Center for Obesity and Metabolic Research, highlighted that GLP-1 agents have advanced cardiometabolic treatment, demonstrating benefits in cardiovascular risk reduction, fatty liver disease, and obstructive sleep apnea. Still noted that newer therapies yield between 21% and 22% weight reduction. However, he warned that discontinuation frequently leads to weight regain, with studies showing two-thirds of patients regain lost weight within one year of stopping. Still advised maintaining resistance training and consuming a diet rich in protein, fruits, and vegetables to mitigate muscle loss and support long-term metabolic health. He also warned against obtaining unregulated alternatives from compounding pharmacies due to active ingredient uncertainties, a topic central to ongoing regulatory monitoring and SAHPRA enforcement.

Discontinuation Rates and Specialty Care

The rapid increase in clinical use has brought greater focus on patient persistence. Pharmacist Tom DePietro, owner of DePietro’s Pharmacy, observed a 220% jump in weight-loss prescriptions between January and August, driven by expanded insurance programs and alternative delivery formats. DePietro pointed out that approved brand-name formulations share identical active compounds across different indications, with semaglutide marketed under Ozempic for type 2 diabetes and Wegovy for weight management, while tirzepatide is marketed as Mounjaro and Zepbound. In South Africa, such treatments remain prescription-only medicines, and registered medical doctors determine appropriate therapy based on regulatory approvals.

Patient adherence remains a primary hurdle in community settings. At the National Association of Specialty Pharmacy inSPire2026 conference, Sophy Levine, PharmD, an ambulatory care clinical pharmacist at Shields Health Solutions, presented research examining real-world treatment patterns. The analysis tracked adult patients initiating GLP-1 or dual incretin therapies for type 2 diabetes or obesity.

Levine reported a one-year discontinuation rate of just 3.9%, defining discontinuation as 70 or more consecutive days without medication on hand. This figure is markedly lower than historical rates documented across broader outpatient environments. Levine attributed the high retention rate to the integrated health system specialty pharmacy model, which pairs direct provider collaboration with proactive follow-up. Dedicated care teams resolve insurance hurdles and address early gastrointestinal tolerability concerns before patients abandon treatment. Research into patient outcomes and provider practices remains a key reference point within RetaRadar's evaluation standards when reviewing evidence in the metabolic health sector.

Sources

This article is for information only and is not medical advice. Retatrutide is an investigational compound and is not approved for general medical or consumer use in South Africa.