Weight loss starts with a question
“Would you tell me more about why you want to lose weight?”
This is one of my favorite questions to ask patients and clients. The answer usually starts on the surface: to be healthy, to look better, to wear nicer clothes. I’ve learned to keep listening and stay curious. Eventually, something more meaningful comes through: “I want to get down on the floor and play with my grandkids. I want to hike with my spouse again. I want to take care of my garden. I want to do my job without being distracted by pain and fatigue.”
For most patients, the “Why” behind weight loss is about how they want to feel and function so they can enjoy life with more ease. As clinical exercise physiologists (CEPs), we get to have that conversation and then build the plan that takes them there. What a gift!
A global call for what we do
This year, 12 exercise and sport science organizations, including the Clinical Exercise Physiology Association (CEPA), released the International Joint Statement on Exercise and Physical Activity in the Era of Obesity Pharmacotherapy. It calls for integrated, multidisciplinary care so GLP-1 and related medications are used safely, equitably, and effectively.
The statement welcomes these medications as a major advance, with mean weight loss of about 15% for semaglutide and up to 21% for tirzepatide. But they are labeled as adjuncts to diet and physical activity, not stand-alone treatments, and they are still often prescribed without support for putting those changes into place. Many patients turn to internet searches or AI for answers and end up overwhelmed and stressed rather than feeling and functioning better.
The statement offers a solution. It names us! It calls for physical activity to be individually assessed, prescribed, and progressed by a clinical exercise physiologist who accounts for each patient’s comorbidities, medications, and risk. It describes this as clinical care, not a lifestyle add-on. That is our scope, written down by our peers on four continents.
Muscle: Not a new problem, a new spotlight
The statement cites evidence that 20–40% of the weight lost on GLP-1-based therapies may come from lean tissue, including skeletal muscle. This was shocking news to the general public, but it is not news to a CEP. We have seen how muscle slips away with aging, weight loss, and chronic illness. Restoring not just muscle mass but function is a major part of what we as clinicians have been doing for decades. What is new is that these medications have pulled the conversation front and center.
Muscle is more than a number on a body composition scan. It is the body’s main site of insulin-mediated glucose disposal, an endocrine organ that helps regulate metabolism and inflammation, and the foundation of independence and healthy aging. Progressive resistance training is among our most effective tools to protect it. Alongside GLP-1 therapy, it can limit lean-mass loss and improve physical function compared with medication alone.
Use it to keep it: Specificity is our superpower
As CEPs, we know the physiology of reversibility: the body adapts specifically to what we do regularly. Weight loss alone sends the body no instructions. It needs us to tell the body what we want it to be able to do.
Knowing how to tailor exercise to each patient’s Why, and to their comorbidities, is our superpower. If exercise is only a way to burn calories, the plan looks the same for everyone, and a medication that already reduces intake makes it feel optional. When the plan is built on the patient’s Why, everything changes:
- Getting up and down from the floor with grandkids becomes chair sits that progress to squats, lunges, and balance challenges.
- Walking the airport becomes progressive walking capacity in a symptom- and pain-free range, gradually adding loaded carries for the suitcase as the body adapts.
- Hiking with family becomes five-minute walks on flat ground after dinner, then step-ups, gradual uphill intervals, and endurance built week by week.
- Carrying groceries up the stairs becomes grip, trunk, and leg strength, with step-ups and gradually loaded stair climbing.
What they want to do guides the plan, not just the calories burned. We also know which body systems are affected by chronic illness, and we build them into the plan. That is how we protect not just muscle but the whole person, with purpose. Science-guided clinical exercise delivers value now and long after the scale stops moving or the medication stops.
Why it takes a CEP
The patient in front of us is rarely living with obesity alone. People prescribed these medications often bring cardiovascular disease, type 2 diabetes, musculoskeletal conditions, mental health concerns, and complex medication lists. Add rapid weight loss, reduced appetite, GI side effects, and shifting blood pressure or glucose responses, and generic advice to “move more” is not enough. We have the specialty to do this.
The statement also asks us to frame movement around function, health, and wellbeing rather than weight alone, which is exactly what a Why-centered conversation does. This matters for the long run: about half of people stop their GLP-1 within a year, and much of the weight returns. The strength, skills, and habits we help build are the resources patients use to keep moving toward their Why.
Joy at every step, not just the goal weight
The part of this work I love most is what happens between the first visit and the moment they enjoy their weight loss Why. A medication can change the number on the scale. It cannot teach someone that their body is capable, or give them back the belief that they can regain strength, mobility, and stamina for the things that matter most.
We get to do that, gradually, respectfully, and safely. The first time a patient stands from a chair without using their hands. The first flight of stairs without stopping. The first walk that ends with “I could have gone farther.” Each one rebuilds self-efficacy: belief in themselves, their bodies, and their ability to enjoy life, not just at their goal weight but at each step along the way.
The joint statement gives our profession a clear mandate, and CEPs are trained to answer it. I feel fortunate to be a health care professional who gets to focus on what patients want to do, and then guide them there.
What a gift!
Janet Lagerman Huehls, MS, ACSM-CEP, NBC-HWC, is a clinical exercise physiologist and national board-certified health coach with nearly four decades of experience restoring exercise self-efficacy for people living with chronic pain and chronic medical conditions. Since 2004, she has served on the multidisciplinary team at a Central Massachusetts teaching hospital, where she created and leads the exercise program for surgical and pharmacological weight loss patients. She is a member of the American Diabetes Association Obesity Advisory Group and a research consultant. As founder of Exercising Well, LLC, she offers online clinical exercise coaching nationwide. Janet is a speaker, educator, and author of the forthcoming book Well First, which brings her whole-person approach from the clinic into everyday life.
