Cicalfate – Fitness Master

Reviewed by Brian St. Pierre, MS, RD “Is this drug going to steal my job?” That’s the thought many health and fitness coaches had when GLP-1 medications first hit the mass market. Though semaglutide (Ozempic) became available in 2017, it initially felt like a theoretical threat. Prescription rates were still very low; it seemed like no one actually knew anyone who was taking it. Now, in 2026, over 1 in 10 US adults are taking a GLP-1 medication. Most of us know someone on it (or we’re on it ourselves). With wider use, opinions towards the medication have softened too. Most coaches no longer see it as a threat, and rather appreciate it as a valuable tool for certain clients, with coaching as an additive complement. Many still have concerns though, primarily about their clients’ long term health on the medication. (Among the worries: Loss of muscle mass! Using a “band-aid” solution! Bypassing foundational health habits! And more!) However, whether you count yourself as a GLP-1 supporter or a GLP-1 skeptic, there’s a framing that might change the way you think about your work in this field: “As a coach, you’re not in the GLP-1 world; you’re in the GLP-1 support world.” That quote comes from Kate Solovieva, Super Coach and PN’s Director of Community. She says that coaches need to recognize that their market isn’t “people on GLP-1s,” but rather “people on GLP-1s who want support.” Trying to coach everyone taking a GLP-1 just isn’t possible. And spending time thinking about all the people using GLP-1s “the wrong way” is, bluntly, wasted energy. Some of those people just don’t want, need, or aren’t ready for your help. Meanwhile, there is a subgroup of people on GLP-1s who are ready, willing, and able to receive your support. Honing in on this group is where you can actually make a difference (and where your business can thrive). In the following article, we’ll cover seven different GLP-1 client “types,” each with their own level of coaching readiness. Based on our experience coaching over 175,000 clients (of which an increasing number are on GLP-1s), we’ll offer strategies to deal with each. Let’s get into it. The 7 types of GLP-1 clients Before we begin, a reminder: People change, and readiness isn’t fixed. A person who starts off saying “I’m doing fine on my own” may eventually morph into “I’m flailing and really need someone else in my corner”—and vice versa. If the person in front of you fits into a certain type, that’s their type right now. So listen carefully to how your client speaks at every session, and respond dynamically. In general, Coach Kate says someone is usually ready for coaching when they demonstrate two things: Their issue feels important, urgent, or distressing: Taking better care of their health feels especially valuable right now. (“This really matters to me.”) They feel they have the capacity to devote some resources to the issue: Be it time, money, or both, they’re ready to accept some kind of cost. (“I have space to deal with this.”) Keep that in the back of your mind as you interact with client prospects, and as you read about the client types, which we’ve summarized in the below table. Client Type Readiness Level Coaching Move The Honeymooner Very Low Build rapport and encourage reflection, while also respecting their choice to not pursue coaching if they’re not ready yet. The Ambivalent Candidate Low-to-moderate The Ready-to-Quitter Moderate Bring awareness to opportunities and risks—specifically, that strategic nutrition and training can make medication more tolerable and safer long term. The Muscle-Loss Risk Moderate The Under-Fueler Moderate-to-High The Graduate High Discontinuing medication can make clients feel vulnerable, knowing the risk of regain is high. Temper expectations and work on maintaining habits—which is the best bet to sustain results. The Priced-Out High Now, on to our GLP-1 client types. Client Type #1: The Honeymooner This is the person who’s started a GLP-1 medication—and they love it. They’ve experienced minimal side effects, and have gotten great results on a relatively low dose. They haven’t changed much about their exercise habits or their diet (except the eating less part, which the medication has taken care of), but they’re seeing what they want to see on the scale, so they don’t feel motivated to change anything. Coaching move: It might be tempting to “lure” this kind of client in by warning them of the dangers of using a GLP-1 medication without adding in long-term health behaviors (like resistance training and strategic nutrition), but this type of approach can backfire. At best, you may sound like a downer. At worst, you may sound like an active antagonist. In Motivational Interviewing, a communication approach commonly used in coaching, this is called the “righting reflex.” It’s the urge that coaches, counselors, and therapists often have to help or “correct course” for their client. You see them doing something “wrong,” and you want to help them “fix” it. However, following this instinct may actually strengthen a client’s defenses, and prevent change. If a person is flying high on their current approach, their readiness for coaching is extremely low. As Coach Kate says, “they’re just not my person yet.” Your best move with this type is to genuinely celebrate their current results, then plant the seed for support should they need it in the future. For example, you could say: “It must feel so good to see all these positive results! If you ever feel like you want to work on another layer, like resistance training or optimizing your nutrition, I’d love to work together.” Then, just stay available. (“My door is always open!”) Client Type #2: The Ambivalent Candidate This is the person who hasn’t started a GLP-1 medication—and might never, despite being a great candidate for one. Maybe their doctor has already suggested the medication to them and they’ve read everything they can on the topic. And yet, they’re frozen with fear at the starting line. They’re afraid of side effects, of being on medication for life, of not holding up their end of the bargain. (“I’ve been trying to start strength training for years. If I take this medication it matters even more… What if I still can’t do it?”) Toni Bauer, Super Coach and PN’s Director of Coaching and Education Operations also says that, in some cases, a client’s hesitation isn’t about side effects. “Some of our clients wonder, ‘Am I a good person or a bad person if I start taking a GLP-1 medication? Am I weak? Am I giving up?’” Coach Toni says these concerns aren’t unique to GLP-1 medications, but they seem to be especially common. She reasons, “If you have high cholesterol, are you weak for taking cholesterol medication? No. But often people don’t view obesity as a disease at a societal level, so the conversation is different here.” Regardless of the root cause of this person’s hesitation, the advice below can help them find clarity. Coaching move: First, let’s be clear: Deciding whether or not to take a medication isn’t a coaching decision, and falls out of your scope of practice. That choice is ultimately up to your client and a medical provider who can assess whether a GLP-1 is appropriate given their medical history. That said, clients may still come to you wanting to discuss their options. So the question becomes: How do you support someone through a decision you can’t make for them? Coach Toni advises: “You can share facts and data. For example, study results and what you’ve seen with other clients. But you can’t say, ‘For you, this is the right choice.’” Instead, the biggest coaching opportunity here is to help clients articulate what’s actually driving their hesitation. This hesitation about whether to do something different or stay the same is called ambivalence, and it’s a normal (albeit uncomfortable) stage of change. Problem is, without the right tools, a person can stay stuck in ambivalence for months or even years. And, much like being stuck at an airport in between two destinations, it sucks. But at PN, we have a cool exercise to deal with client ambivalence. It’s called the 4 Crazy Questions. Essentially, you explore: What’s GOOD about changing? What’s BAD about changing? What’s GOOD about NOT changing? What’s BAD about NOT changing? In this context, the questions can help a client explore the risk of starting a GLP-1 (which they’ve probably already voiced), but also the risk of not starting, which they may not have considered yet. Our 4 Crazy Questions worksheet can encourage clients to explore the pros and cons of both choices. With these considerations laid out explicitly, most people feel a lot more clear about their next steps—or at least what questions they need to ask their medical provider before they can move forward. Importantly, this exercise doesn’t have a “right” outcome. Some people work through it and fill the prescription. Others decide the medication isn’t for them, and that’s fine. (It’s also worth reminding clients that starting isn’t necessarily permanent: With their provider’s input, a trial run on the medication is a perfectly valid way in.) Either way, there are opportunities to support your client. As Coach Toni puts it: “Whether you go ‘natural’ or whether you go GLP-1, the foundational habits are essentially the same.” Client Type #3: The Ready-to-Quitter This is the person who started a GLP-1 with lots of optimism—and now feels like they have a plague that won’t end. In a cruel twist, this person might actually be seeing great fat loss results. And yet, they’re nauseated, exhausted, dreading their next dose, and wondering whether it’s worth continuing this medication. Adding to their sense of defeat, they may also be comparing themselves to a “Honeymooner” in their life, so they might also be wondering if there’s something wrong with them. (“It worked so well for my friend! I must be broken in some way.”) Coaching move: First, offer some neutral education to depersonalize their experience. Namely, they should know that side effects are extremely common: About half of users report nausea, a third report diarrhea, and a fifth report vomiting.1 So, what this person thinks is exceptional might actually just be a normal adjustment. (This doesn’t make the experience suck less, but it can give them some hope.) Also, getting GLP-1s right is a process of trial and error: the right medication, the right dose, and the right nutritional strategies to reduce symptoms. If their symptoms are severe, get them to loop in their doctor. Medication type and dosing is under the purview of a medical professional, so involving them is essential. After that, your best coaching move is to suggest an experiment. ▶ Ask about dose. To be clear, you’re asking about it, not adjusting it. Says Coach Toni: “Often, when people are experiencing extreme side effects, they’ve ratcheted up their dose too quickly. Sometimes the easiest way to keep somebody on a GLP-1 who’s experiencing high side effects is to lower their dosage.” Coach Toni makes clear that while dosage isn’t a coach’s domain, you can help draw a client’s attention to it. ▶ Start a food journal. It doesn’t need to be every day—just around the meals that precede the worst symptoms. You’re looking for three things: Fat content: GLP-1 medications slow down digestion. This is what contributes to its satiety effects, but also its side effects at the beginning. Fats also slow down digestion, so high-fat foods and meals (oils, nuts and seeds, and fried foods) can compound symptoms. Volume: Again, due to the slowing of digestion, a large meal can feel extremely uncomfortable to digest. A portion that felt normal a month ago may now be far too much at once. Random triggers: Spicy foods, tomatoes, chocolate, caffeine. All kinds of foods may trigger symptoms like nausea, acid reflux, or diarrhea in a client who used to tolerate them. These foods won’t always be obvious GLP-1 symptom triggers, so the best way to hunt them down is via a food log. ▶ Try smaller portions, eaten more often. Coach Toni says if you only try one thing, this one is the most reliable strategy. GLP-1 clients may be tempted to cut meals when symptoms are high, but this increases the likelihood of undereating and nutrient deficiencies. The goal, in her words: “Can we get small enough, frequent enough meals that we get nutrients in, but they never feel overwhelmed or super full?” To stay within your scope of practice, language matters. Don’t say: “You’re nauseous, so you should eat smaller meals.” Instead, say: “Folks who are nauseous sometimes do better with smaller, more frequent meals. Want to try it this week and see what you notice?” In the first example, you’ve offered a “prescription” (which coaches can’t legally do). In the second example, you’ve offered an experiment to consider. Red flags: When to loop in a medical practitioner Side effects (such as nausea, vomiting, constipation, and/or diarrhea) are extremely common among GLP-1 users, and typically last one to two weeks after initiating the medication. Some symptoms can last longer (particularly constipation), but most are mild to moderate, and usually improve within a few weeks. Symptoms can also return each time a dosage is increased, though they’re usually milder and more short-lived. These too tend to improve after the first week or so. However, you should strongly encourage a client to reach out promptly to their medical provider if they notice: Severe or persistent abdominal pain—especially upper-belly pain that radiates to the back, or comes with vomiting or fever Right-upper-abdomen pain, fever, or yellowing of the skin/eyes (jaundice) Vomiting that keeps them from holding fluids down for 24+ hours Dizziness, fainting, or confusion Rapid, uncontrolled weight loss or an inability to accomplish basic daily functions Reassure your client they’re not being dramatic by reporting these symptoms. Their medical team needs to hear this kind of information to help them get the best results, while preserving overall health. Also: Your client will get better care if they show up prepared. So, get them to jot down and bring: Symptoms they’ve noticed and roughly when they started How daily life is affected—eating, energy, mood, workouts What they’ve already tried, and what helped (if anything) Rough daily intake and protein, if they’ve been tracking Specific questions they want answered before they leave Client Type #4: The Muscle-Loss Risk This is the person whose results look great, but less visible changes are creating longer term risks. This person is likely to be quite sedentary, and when you ask what they do for exercise, they might tell you “I walk.” But they’re not the outlier type who consistently gets 20,000 steps a day. They just… walk a little. Women are more likely to fall into this category, especially if they come from a generation or culture where strength training simply wasn’t a thing women did (or were welcomed to do). Additionally, this person might be running on a decades-long plain-toast-and-coffee breakfast habit, with lower protein intake already ingrained before medication further reduced appetite. The scale is dropping though, so they’re thrilled. It’s just that nobody’s measuring what kind of weight is dropping. Coaching move: Your job is to bring awareness to the invisible. Because once this person sees what’s at stake, they’ll be more likely to see the value in changing their habits, and in coaching. However, theoretical warnings about muscle loss are easy to dismiss. This is one of the reasons why Coach Kate says, “I don’t care if I coach you or not—please just get a DEXA as a baseline.” When a person has a quantifiable, objective measure of their muscle composition, it’s often more motivating than any amount of abstract concern. Ideally, every person who begins a GLP-1 medication should get a DEXA scan before they start, then again at six or twelve months to see how they’re progressing. If a client can’t or won’t do a DEXA, assess strength and function in other ways. Ask: “How do the stairs feel compared to a few months ago? What about carrying groceries?” Gather objective data too, recording baselines for squat, deadlift, and bench press (or other accessible exercises) to compare to over time. Declines in any of these areas can reveal potential muscle loss, and can motivate a client to take action. Without protective strategies, up to 40 percent of weight lost from GLP-1 medications can come from lean mass, with a majority of that being muscle.2 In order to prevent that from happening, there are two behaviors to prioritize: ▶ Protein at every meal. When appetite is suppressed, every bite has to earn its place. Aim for 25-40 grams of protein at every meal and 15-20 grams for snacks. (On days when appetite is severely suppressed, protein powders can be a more palatable way to reach that target.) ▶ Strength training, scaled to what they’d actually do. The term “weight lifting” might overwhelm a person who’s never set foot in a gym, so don’t start there. Start where PN always starts: Ask what they could do twice this week that they’re 9-out-of-10 confident they’d actually do. Sit-to-stands off the couch. A few moves with a resistance band. Bodyweight anything. Scale up from there, one week at a time. Client Type #5: The Under-Fueler This is the person for whom the medication has worked a little too well. Their appetite hasn’t just decreased—it’s gone. They’re not eating enough, and often don’t notice until you ask. “When did you last eat?” you say, and they say, “Ummm… Yesterday afternoon? I think?” Their protein and overall calorie intake is plummeting, and soon their energy levels will too. Plus, something more subtle might also be happening: Food stops being a pleasure and becomes a chore, or even a source of dread. For some, this might seem like an upside down world. They may have spent their whole life fighting to eat less. The idea of fighting to eat more feels completely absurd—and entirely off their radar. Coaching move: Before anything else: If there’s an active eating disorder in the picture, this medication likely shouldn’t have been prescribed. A vulnerability to disordered eating can both contribute to or be triggered by the above scenario. So, scope of practice first. Ask this person if they’ve ever struggled with disordered eating. If the answer is yes, refer out to a doctor or a dietitian. You can absolutely stay involved as a guide, but not as the only professional in the room. Have your referral network ready before you need it. But sometimes, you won’t know. Your client may have been screened and cleared. Or, they may not have disclosed. So your job is to figure out what you’re actually looking at—and that starts with what Coach Toni calls the “show me” approach. Rather than acting on a hunch, collect something concrete, such as a few days of food logging (in writing or via photos). From there, it branches two ways. ▶ If they’ll track, do some food math, and the numbers may do the work for you. When some clients see that their calorie intake is hovering around 800 to 1,000 Calories per day, it’s the only wake up call they need. They weren’t intentionally restricting; they genuinely just had no idea. For this client, establishing an eating routine is the best next action. Your client may be used to following appetite as a cue to eat, but now that medication has removed it, they need a different cue. That means eating on a schedule, likely every 3–4 hours, including protein at every one of those occasions. Portions can be small if appetite is very low, but they should be nutrient-dense. ▶ If they won’t track—and especially if they resist in a way that feels purposely avoidant—that resistance itself is information. Coach Toni suggests that if you suspect that disordered eating is in the picture and a client is really resistant about tracking, it might be time for a crucial conversation—an often uncomfortable, but honest and essential conversation between a client and a coach. She suggests leading with non-judgement and safety. For example: “I want you to know this is a safe space to talk. My goal as a coach is always to prioritize your overall health. However, there have been a couple of things you’ve shared recently that have me wondering whether we’re protecting your body’s basic needs.” Then name the specific things you noticed, sticking to facts. (“You’ve mentioned you’ve been losing hair and struggling more during workouts. Those can both be signs of undereating. Would you be open to revisiting food journaling for a short stretch so we can see more clearly what’s happening, or telling your doctor about your symptoms?”) If this conversation is enough to help a client see the value in tracking, follow the advice after “If they’ll track” above. If what surfaces is a genuinely troubled relationship with food, refer out, while offering to stay involved for support as needed. Client Type #6: The Graduate This is the person who got the results they wanted with the medication, and is now choosing to wean off. They’re not quitting because of crappy results or intolerable side effects, they’ve simply decided they don’t want to be on a GLP-1 forever. The coaching opportunity here is, in part, about tempering expectations. Most people imagine coming off as the finish line. Instead though, it’s more like starting a different endurance course: The medication has been managing their appetite, and now they have to. Coaching move: Ideally, you start working with this client while the medication is still doing some of the heavy lifting with appetite regulation. If you can have six months to build the right habits as well as prepare mentally for the tapering off period, your client will be in a much better position. Make sure the previously mentioned habits—like resistance training and optimizing protein—are already firmly established. If your client is managing those habits consistently (not perfectly, but consistently), even on their busiest, most stressful, most side-effect-disrupted days, then they’re more likely to be able to maintain them when they’re off their medication and food distractions re-enter the picture. After that, work on how you’ll continue to define success. This client has been accustomed to measuring it on the scale, but the scale will move—some regain is normal. So, ask them early: What does success look like if the scale ticks up eight pounds but your habits hold? Be honest about the odds, too. People who changed nothing while on the medication almost universally regain most of the weight—usually within the first year and a half or so3—because the appetite that went down comes right back up. However, people who integrate and sustain healthier nutrition and exercise behaviors while they’re on medication are four times better at maintaining a ten percent or higher weight loss when they come off the medication.4 Client Type #7: The Priced-Out This is the person who was also getting great results on the medication—except instead of choosing to go off it on their own time, they’re forced to quit due to external circumstances. Maybe their insurance stopped covering it, or they lost the job that came with the benefits, or the one drug they tolerated turned out to cost four times as much as the one they couldn’t tolerate. About 50 percent of GLP-1 users stop the medication within the first year of using it.5 Some stop due to side effects, and others stop because they’ve gotten the results they want and they want to see if they can maintain them drug-free. But many are simply priced out. The latter is an especially frustrating scenario because, for this person, a “solution” exists. It’s just that, for them, the solution is out of reach. Understandably, this person may be angry or even ashamed that they can’t afford this medication. Those feelings may or may not show up in your coaching, but it’s good to prepare for them anyway. Coaching move: First, reassure this person that this is a system failure, not a personal one. Whether someone can access affordable medication comes down to their insurance plan, the region they live in, and their socioeconomic status—also known as the social determinants of health. Those forces shape health outcomes far more than willpower does, and none of them are a measure of how hard someone has tried or how “worthy” they are. Acknowledging that reality isn’t about throwing up your hands and saying, “Well, I’m screwed!” Rather, it’s about accepting some miserable truths about the world, and then shifting from self-blame to problem-solving. Once they’ve had a chance to process some (very valid) anger and disappointment, it’s time to focus on what they can control. At PN, we call this the Spheres of Control exercise. The image below shows you how it works. Access, price, and coverage are not on the list of controllables, and fighting those realities may only compound frustration. Meanwhile, they can control other influential factors, like their protein intake, their training, their sleep, their food environment, and maybe their next insurance appeal. Use the image above to begin a conversation with your client about what is within their control, and lean in hard on those factors. What can coaches honestly promise when it comes to getting and maintaining GLP-1 results? The truth is, you can’t predict how a client will respond to medication. And, some regain after stopping it is expected. However, diet and lifestyle habits hugely affect what kind of weight is lost, plus the rate and amount of that regain. Says Coach Toni: “I can’t promise anyone they’ll lose a specific amount of weight or that they’ll never regain it—and I’d be suspicious of any coach who did. What I can tell you is that the habits we build while the medication is doing its work are the ones that’ll still stand when it isn’t.” Of course, “coming off” isn’t the endpoint for everyone. Many providers now treat obesity as a chronic condition and these medications as long-term therapy—the same way we’d treat cardiac disease. Again, whether someone stays on, tapers, or stops is a conversation for them and their provider. But for those who do come off, Coach Toni says the people who hold their results share one thing: “They maintain consistency with their behaviors as if they were still on the medication. Like nothing changes.” She shares an analogy for why that works: “Think about the Oregon Trail. The ruts in the trail were made by wagon wheels hitting the same ground over and over and over. You can still see those ruts today—they’re still there. Habits are the same way: If you lay down those neural pathways and reinforce them enough times while your client is on the medication, then they’ll have a better chance of continuing on the same path even when they go off the medication.” So that’s the actual promise. It’s not: “You’ll keep it off.” It’s: “While the medication is doing its work, we’ll cut ruts deep enough that those pathways will still be there after the medication is gone.” Practically, that means regular resistance training, rock solid nutrition, appetite awareness, and attending to the parts of health that never show up on a scale—sleep, energy, mood, relationships, and identity, which is where Coach Toni lands: “Ideally, your client will have embraced the identity of a ‘new person.’ As in, ‘I am the person who wakes up at 6 a.m. and walks two miles. I am the person who eats protein at every meal. I am the person who does resistance training because it builds the tissue I need to age well.’ That’s the client who maintains.” References Click here to view the information sources referenced in this article. Wharton, Sean, Salvatore Calanna, Melanie Davies, Dror Dicker, Bryan Goldman, Ildiko Lingvay, Ofri Mosenzon, et al. 2022. “Gastrointestinal Tolerability of Once-Weekly Semaglutide 2.4 Mg in Adults with Overweight or Obesity, and the Relationship between Gastrointestinal Adverse Events and Weight Loss.” Diabetes, Obesity & Metabolism 24 (1): 94–105. Mechanick, Jeffrey I., W. Scott Butsch, Sandra M. Christensen, Osama Hamdy, Zhaoping Li, Carla M. Prado, and Steven B. Heymsfield. 2025. “Strategies for Minimizing Muscle Loss during Use of Incretin-Mimetic Drugs for Treatment of Obesity.” Obesity Reviews: An Official Journal of the International Association for the Study of Obesity 26 (1): e13841. West, Sam, Jadine Scragg, Paul Aveyard, Jason L. Oke, Lia Willis, Stella J. P. Haffner, Heather Knight, et al. 2026. “Weight Regain after Cessation of Medication for Weight Management: Systematic Review and Meta-Analysis.” BMJ (Clinical Research Ed.) 392 (January): e085304. Jensen, Simon Birk Kjær, Martin Bæk Blond, Rasmus Michael Sandsdal, Lisa Møller Olsen, Christian Rimer Juhl, Julie Rehné Lundgren, Charlotte Janus, et al. 2024. “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 69 (102475): 102475. Rodriguez, Patricia J., Vincent Zhang, Samuel Gratzl, Duy Do, Brianna Goodwin Cartwright, Charlotte Baker, Ty J. Gluckman, Nicholas Stucky, and Ezekiel J. Emanuel. 2025. “Discontinuation and Reinitiation of Dual-Labeled GLP-1 Receptor Agonists among US Adults with Overweight or Obesity.” JAMA Network Open 8 (1): e2457349. If you’re a coach, or you want to be… You can help people build sustainable nutrition and lifestyle habits that will significantly improve their physical and mental health—while you make a great living doing what you love. We’ll show you how. If you’d like to learn more, consider the PN Level 1 Nutrition Coaching Certification. (You can enroll now at a big discount.) Source link

August 15, 2026

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