95: Dr. Spencer Nadolsky: The Dark Side of Ozempic No One Talks About
The Dark Side of Ozempic No One Talks About
You're not losing fat because you're doing it wrong. Dr. Spencer Nadolsky breaks down GLP-1 medications, metabolic adaptation, muscle loss on Ozempic, and why willpower isn't your problem.
You're not losing fat because you're doing it wrong. And no, not because you're lazy or lack willpower, but because the advice you've been fed is outdated, oversimplified, and straight-up wrong.
Calorie deficits, cortisol fear-mongering, and the overtraining obsession? We're done with that noise.
This week, Tara sat down with Dr. Spencer Nadolsky, board-certified obesity specialist, former NCAA wrestler, and medical director at Sequence, to break down what's actually going on when fat loss stalls. They dig into GLP-1 medications (think Ozempic, Wegovy, Mounjaro), metabolic adaptation, willpower myths, and how to lose fat without losing your mind or your muscle.
Whether you're stuck in a plateau, navigating perimenopause, or just sick of guessing, this episode gives you the science, the strategy, and the mindset shifts that actually work.
The Real Reason Your Body's Holding Onto Weight
Let's start with the uncomfortable truth: your body doesn't want you to lose weight. Like, at all.
When you diet and drop pounds, your body perceives this as a threat. It doesn't care that you're trying to fit into your favorite jeans or feel better in your skin, it thinks you're starving. So it fights back by slowing your metabolism, ramping up hunger hormones, and making you tired so you move less.
This is metabolic adaptation, and it's why weight loss gets harder the longer you diet. Your body is literally working against you, trying to get back to its previous weight. It's not a character flaw. It's biology.
Dr. Nadolsky explains that this is where most traditional diet approaches fall apart. You cut calories, lose weight initially, then hit a wall. So you cut calories even more, move even more, and stress yourself out even more, only to see the scale refuse to budge. Sound familiar?
The problem isn't that you're not trying hard enough. The problem is that your body has adapted, and you need a different approach.
What GLP-1 Meds Are Actually Doing to Your Cravings and Brain
Okay, let's talk about the elephant in the room: GLP-1 medications like Ozempic, Wegovy, and Mounjaro.
These drugs have exploded in popularity, and for good reason, they work. But how they work is what most people don't understand.
GLP-1s mimic a hormone your gut naturally produces after eating. They slow gastric emptying (so you feel full longer), reduce appetite, and, here's the kicker, they work on your brain to reduce food noise. You know that constant mental chatter about food? The cravings, the obsessive thoughts about your next meal? GLP-1s quiet that down.
For people who've struggled with their weight for years, this can be life-changing. Suddenly, food isn't the center of your universe. You can eat a normal portion and feel satisfied. You're not white-knuckling your way through every meal.
But here's the part no one talks about: these medications aren't magic. They're a tool. And like any tool, they work best when used correctly, with proper nutrition, strength training, and lifestyle support. Without that? You risk losing muscle along with fat, which brings us to the next point.
Muscle Loss on Weight Loss Meds: Here's the Truth
One of the biggest concerns with rapid weight loss, whether from extreme dieting or GLP-1 medications, is muscle loss.
When you lose weight quickly, your body doesn't just burn fat. It also breaks down muscle tissue for energy, especially if you're not doing anything to preserve it. And losing muscle is bad news: it tanks your metabolism, makes you weaker, and leaves you looking "skinny fat" instead of lean and strong.
Dr. Nadolsky is clear: muscle loss on these medications is not inevitable, but it requires intentional effort. You need to:
Lift heavy things consistently. Resistance training is non-negotiable. Your body needs a reason to hold onto muscle, and lifting provides that signal. Three to four times per week, focusing on progressive overload.
Eat enough protein. Aim for at least 0.7-1 gram per pound of body weight. Protein supports muscle repair and growth, and it's even more critical when you're in a calorie deficit.
Don't crash diet. Even with medication, losing weight too quickly increases muscle loss. A sustainable rate is 0.5-1% of body weight per week.
Monitor your progress beyond the scale. Track body composition, strength levels, and how you feel. The scale might be going down, but if you're losing strength and muscle, you're headed in the wrong direction.
Bottom line: GLP-1s can be an effective tool for fat loss, but you still need to train smart and eat enough protein to protect your muscle mass.
Why the Same Med Works for Your Friend But Not You
Here's something that doesn't get talked about enough: not everyone responds to these medications the same way.
Your friend might lose 30 pounds in three months on semaglutide and feel amazing. You might try the same medication at the same dose and barely lose 5 pounds, or experience side effects that make it unbearable.
Why? Because everyone's biology is different. Factors like your genetics, gut microbiome, insulin sensitivity, stress levels, sleep quality, and even your history of dieting all influence how you respond to these meds.
Some people are "super responders" who see dramatic results. Others are "non-responders" who need a different medication or approach entirely. And that's okay. It doesn't mean you're doing something wrong, it just means your body is different.
This is why working with a knowledgeable doctor (ideally an obesity specialist) is so important. They can adjust dosages, switch medications, or combine therapies to find what works for your body, not just what's trending on social media.
Can You Lose Fat and Build Muscle at the Same Time?
Short answer: yes, but it's complicated.
Body recomposition, losing fat while building muscle, is possible, especially for beginners, people returning to training after time off, or those who are significantly overweight. But for most people, it's a slow process that requires patience and precision.
Dr. Nadolsky explains that to build muscle, you generally need a calorie surplus and adequate protein. To lose fat, you need a calorie deficit. These goals are somewhat at odds, which is why trying to do both simultaneously is tricky.
That said, you can make it work with the right approach:
Eat at maintenance calories or a very slight deficit (100-200 calories below maintenance)
Prioritize protein (at least 0.8-1g per pound of body weight)
Lift heavy with progressive overload
Be patient, this process takes months, not weeks
Focus on performance metrics (strength gains, endurance improvements) rather than just the scale
For most people, alternating between focused fat loss phases and muscle-building phases is more effective than trying to do both at once. But if you're new to training or have a lot of weight to lose, you can absolutely make progress on both fronts.
Willpower Isn't Your Problem, This Is
Let's kill this myth once and for all: weight loss is not about willpower.
You're not failing because you lack discipline. You're failing because you're fighting against powerful biological drives that evolved over millions of years to keep you alive.
Your body has systems in place to regulate hunger, fullness, cravings, and energy expenditure. When these systems are out of whack, whether from poor sleep, chronic stress, hormonal imbalances, or metabolic adaptation, no amount of willpower is going to overcome them.
This is why the "just eat less and move more" advice is so frustrating. It's technically true, but it completely ignores the biological and psychological factors that make eating less and moving more so damn hard.
The solution isn't to try harder. It's to work with your biology, not against it. That might mean:
Fixing your sleep so your hunger hormones normalize
Managing stress so cortisol doesn't drive cravings
Eating enough protein and fiber to stay full
Finding a training routine you actually enjoy
Addressing underlying health issues (thyroid, insulin resistance, etc.)
For some people, using medication to level the playing field
When you stop blaming yourself for a lack of willpower and start addressing the actual problems, everything changes.
Still Judging Weight Loss Meds? You Might Be Missing the Point
There's still a lot of stigma around weight loss medications. People assume that taking a drug like Ozempic means you're "taking the easy way out" or that you just need to "try harder."
But here's the reality: obesity is a chronic disease with biological, genetic, environmental, and psychological components. For many people, diet and exercise alone aren't enough, not because they're lazy, but because their biology is working against them.
Would you judge someone with diabetes for taking insulin? Someone with depression for taking an antidepressant? Then why judge someone with obesity for using medication to manage their condition?
GLP-1 medications aren't a shortcut. They're a tool that helps people overcome biological barriers to weight loss. And when combined with proper nutrition, strength training, and lifestyle changes, they can be incredibly effective.
The goal isn't to be on medication forever, it's to use it as a bridge to help you lose weight, build healthier habits, and improve your metabolic health so you can eventually maintain your results with or without medication.
Key Takeaways
Here's what you need to remember from this episode:
Metabolic adaptation is real, your body fights against weight loss
GLP-1 medications work by reducing appetite and food noise in the brain
Muscle loss on weight loss meds is preventable with strength training and adequate protein
Everyone responds differently to medication, what works for your friend might not work for you
Body recomposition is possible but requires patience and precision
Willpower isn't the problem, biological factors are
Weight loss medications are a legitimate tool, not a moral failing
Ready to Stop Guessing and Start Making Progress?
If you're tired of spinning your wheels and ready to finally figure out what works for your body, check out Broads 1:1 coaching. Whether you need BroadsCOACH or BroadsCHAMPION, we'll help you ditch the bullshit and start feeling good in your body.
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