Episode 200 | Oct 8, 2026

Why GLP-1s Need Health Coaches

What happens after a GLP-1 medication quiets the “food noise” and weight begins to change? In the 200th episode of Health Coach Talk, Dr. Sandi explores why these peptides may be just one part of successful GLP-1 care, while lasting health also depends on what happens in a person’s everyday life. Drawing from emerging research, she examines the role health coaches can play alongside clinicians, nutrition professionals, exercise specialists, and other members of the care team to support behavior change, strength, emotional well-being, and long-term health.

“GLP-1 medications open the door, but the health coach is the one helping people actually walk through that door in a way that truly supports their health, their function, and creates lasting change.”

Dr. Sandi

GLP-1 medications can dramatically change the conditions in which behavior change takes place, but reduced appetite alone does not teach someone how to nourish their body, preserve muscle, build an enjoyable movement routine, or navigate the emotional and identity changes that may accompany significant weight loss. Dr. Sandi walks through recent studies examining GLP-1 treatment paired with behavioral and lifestyle support, highlighting promising findings around engagement, physical function, self-efficacy, emotional well-being, and weight-related outcomes. She also looks beyond pounds lost to questions of strength, function, confidence, connection, and quality of life, while acknowledging where GLP-1-specific health coaching research is still emerging. For Dr. Sandi, this reflects a message that has been central to Health Coach Talk across 200 episodes: meaningful change happens through human relationships, with someone who listens, believes in a person’s capacity to change, and helps translate recommendations into realistic steps.

For health coaches, GLP-1 care represents an important opportunity to contribute within a collaborative healthcare model while remaining firmly within scope. Coaches do not prescribe medications, determine nutrition targets, interpret medical findings, or develop exercise programs without the appropriate additional credentials. Their value lies in helping clients define success beyond the scale, turn clinical recommendations into personally meaningful actions, work through barriers to movement and other healthy behaviors, navigate changes in confidence and identity, and build habits that support their long-term vision for health. As GLP-1 use continues to shape conversations about weight and metabolic health, this episode offers a compelling look at the uniquely human role coaches can play in connecting a medical plan with the realities of daily life.

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Episode Transcript

Dr. Sandi: Welcome to “Health Coach Talk.” This is not just any ordinary episode. This is our 200th episode. We have been doing this podcast for 200 episodes. And that’s why today I have something very special in store for you.

So, think back to when we began the podcast. My goal at the time was to show that there were many, many ways that health coaches can be truly changing healthcare. But now, 200 episodes later, and that need for health coaches is even more urgent, and the world is taking notice. And specifically, in the United States, CMS, the Center for Medicare & Medicaid Services acknowledges the value of health coaching. And that is why they are proposing for calendar year 2027 that health and wellness coaching be reimbursed for Medicare. So, we will have more details on that as soon as full approval is reached. So, stay tuned for that.

But there are now over 500 studies that show the benefits of health coaching for any condition under the sun. There are a ton of them, and I have written extensively about these research studies and the value of coaching. In fact, there are over 100 randomized controlled trials, which is the gold standard in research showing the benefit of health coaching.

But today, I want to talk about an area that I think is just so important that we have health coaches who can be of great service to patients, and that has to do with GLP-1 medications and how this is not just the medication alone, but studies are showing the value of a true collaborative care approach when you are taking GLP-1 medications.

So, this prescription doesn’t automatically create a proper way of eating. It doesn’t teach people how to preserve their strength, how to build a movement routine, how to cope with changing…changes in body image, for example, or decide who they want to be as a result of these very significant weight changes, which often results in a true transformation in identity. It doesn’t create self-trust, and it doesn’t provide ongoing support and encouragement. That is what coaches do. So, that’s why I want to talk today about the critical role of the health coach in supporting people taking GLP-1 medications.

So, the saying that I love is that this medication opens a door, but coaching helps people walk through it. I’m going to say that again. The medication, GLP-1 medications open the door, but the health coach is the one helping people actually walk through that door in a way that truly supports their health, their function, and creates lasting change.

So, the important point is that these medications alter the context in which behavior change occurs. There’s many things that people are going to report to you if you’re a coach. For the first time, I’m not thinking about food every day. That internal environment is changing, but they’ve maybe never have learned a healthy way of eating. But now, there’s so much opportunity for that to take place, similarly a healthy movement throughout the day.

It’s tempting to assume, and I’m sure there are those in the medical community assuming this, that once the appetite is reduced, they’re losing weight, that everything else is just going to take care of itself. But that’s not true. Research and clinical experience suggests that it’s a complex picture, that people can be losing weight, but they’re consuming way too little protein. They’re becoming dehydrated. They’re losing strength. They might be relying on a very narrow range of food. The food habits that they have had for many years haven’t gone away. They’re still eating this way, but now, they’re using the medication, so they’re losing the pounds. But are they really getting healthier? And there’s a tremendous opportunity for this to happen because, again, the medication is opening the door to that.

There are also people on these medications experiencing GI symptoms. Again, it changes in identity. They may feel unsettled. All of a sudden, everybody’s commenting on their weight loss. Maybe they’ve identified as somebody who needs to diet, needs to lose weight, have experienced that self-image in a way that now people are looking at them differently.

And that brings up a whole lot of feelings, which is worth exploring. And I do want to point out that this exploratory process is not psychotherapy. We’re not talking about somebody who has a mental health diagnosis. But there are, there’s lots of fears about weight regain. There might be shame about needing medication. They may feel that people are judging them for using medication.

And then there are issues that are practical issues, the cost, the availability. And these are issues that often their medical practitioner doesn’t have the time or they might be reluctant to discuss it with their doctor. And this is where the coach comes in and provide just invaluable support and education.

But it’s not just information. We can get information through AI these days. But it involves how do you help people with their motivation, their confidence, their identity, exploration, support that they might need in the coaching process. It’s where that individual is telling the coach where they want to go, which direction they want to take the conversation.

So, we have studies showing…as you know, I love looking at the research. So, there are a number of studies that are beginning to come out, and this is still developing. So, we don’t have state of the art research just yet that has tested the value of specifically health coaching alongside GLP-1 treatment. But we do have a lot of current evidence from…there’s enough real-world programs out there where they looked at the bundled support.

What does bundled support mean? It means that, in addition to the medication and the care provided by a clinician, there were access to digital tools, perhaps nutrition, guidance, exercise, support, and coaching, and they bundle it together. Those are the studies, these characteristics I’m going to talk about.

So, these designs show an integrative model is really promising, but they are falling short of being definitive as far as it’s absolutely the health coaching component that was the secret sauce. But we can draw our own conclusions knowing the benefit of coaching. There’s a number of studies I want to share with you.

The first one, which is named Quality Over Quantity. This is a 2026 study. Lisa Stanton and her colleagues, they evaluated 245 adults. They had recently begun a GLP-1. One group participated in a 12-week virtual lifestyle companion program. That’s what they’re calling it. While the other, the comparison group, the control group, just usual care. The program itself was comprehensive, and that means it included virtual coaching, GLP-1 specific peer groups, meal and behavior tracking, AI-based nutrition support, a tailored resistance and functional movement plan, and they had communication, asynchronous communication, so it wasn’t live, with an exercise coach who was certified in personal training. So, that distinction matters because it was not just a clean test of health coaching alone, and the exercise support was delivered by a personal trainer. So, this is an integrative lifestyle program.

And what did they find? Participants in the program lost 6% of their starting body weight over 12 weeks, and that was compared with 3.3%, much lower, in the usual care group. They also, this is the experimental group, had a greater reduction in body fat percentage, greater increase in muscle mass percentage. They also reported improvements in weight loss self-efficacy. This is important. Almost all the studies of health coaching show improvements in self-efficacy, this idea that, yes, I can take charge of my health, improvements in well-being, physical functioning, depression, symptoms, and anxiety. This is significant. So many of the studies on health coaching show this. Mental health gets better.

So, the title, I love this phrase, quality over quantity, and that’s exactly the right frame. The goal can’t be limited to how many pounds someone loses, but that’s what I hear all the time. Oh, she lost so much weight. She lost 50 pounds. That’s not where it’s at, but it’s really hard to get people to think differently. These weight loss old standards, old myths are still with us very much today. So, we need to ask what kind of weight is being lost, whether strength and function are being protected, and whether that person is actually becoming healthier in the fullest sense of the word.

So, this was a great study. And it was, again, 2026, and it was in the Journal of Diabetes, Obesity, Metabolism.

The second study is hybrid. And this study, again, 2026, followed 708 adults. This was a physician-led obesity program in Singapore, and they were combining GLP-1 medications with app-based lifestyle coaching. The participants had access to personalized diet and physical activity coaching, self-monitoring tools, and communication with the care team. And at 12 months, the average weight loss was 12.7%, and at 18 months, it was higher. It was 14.7%. And blood pressure, body fat percentage, waist-to-hip ratio, and importantly, hemoglobin A1c also improved.

Now, here’s an interesting finding. That is engagement. The greater use of the app was associated with roughly 2% to 2.2% additional weight loss. So, what does this mean? It means more frequent health coach consultations were associated with smaller but measurable additional reduction in weight and body mass index. We can conclude that support is really important.

So, a caveat, this was observational research. So, we can’t really conclude that it was the coaching that caused the better outcome. But we know, clinically, I know from being in practice for 40 years or so, that people who are more engaged may differ in other important ways. But still, it supports a practical principle that medication works within this collaborative care experience. Can’t just give them a script for the drugs and think, no, that’s all we need to be doing. Unfortunately, that’s happening in way too many clinics. But the ongoing engagement with behavioral support, that’s what matters.

So, the next study is…we’re calling Proactive Contact. It was an industry-associated evaluation. There were 154 adults. They were in a digital program supported by the semaglutide compared with proactive…they were comparing proactive with reactive coaching. So, what that means is, in the proactive model, the coaches initiated personalized contact. They reached out to them. They were prompting them for progress. They were supporting goal setting, accountability. In the reactive group, they were relying on the clients to reach out when they wanted help and complete the standard check-in.

So, if you’re a coach and you’re listening, the value of being proactive…because some people are shy. They feel like, oh, I don’t want to bother people. But this proactive approach worked, that significantly greater engagement. Participants who sent more messages to their coaches and used the app on more days were the ones where the coaches were reaching out initially. The average weight loss was 10.1% in the proactive group and 8.9% in the reactive group.

Now, that difference was not significantly significant. So, it should not be presented as strong data that the proactive coaching caused the greater weight loss. But it’s something to consider, this clear finding that proactive coaching improved participation and connections. And we can draw our own conclusions, but this is the main thing that’s…takeaway that the proactive, reaching out, improved participation. Connection is so important these days when we’re feeling so isolated.

So, a client who is struggling often may not initiate contact at the moment that support is most needed. And they may welcome that proactive behavior on the part of the coach. So, this is reducing the burden of asking for help. So many people may be suffering in silence, and they’re afraid, they’re feeling ashamed. For whatever reason, they’re not asking for help.

Okay. The next study, this is about behavioral support and emotional health. So, we all know that weight loss is not only a physical process. So, this was a 2026 single-arm pragmatic study. What does that mean? There were 180 adults receiving either semaglutide or tirzepatide. They were receiving it through telemedicine, and they also participated in a virtual behavioral program tailored to people using these long-acting medications. And over 24 weeks, the participants showed significant improvements in depression, perceived stress, well-being, internalized weight bias, and weight-related quality of life. So, this goes way beyond just pounds lost.

But there was no comparison group. So, we have to be cautious. It’s not separating the effects of the medication, the weight change, the behavioral intervention, or perhaps other factors as well. But here’s what we can say. It does draw attention to outcomes that are too often left out of these GLP-1 conversations. People need to be receiving support for how they’re feeling emotionally, how they’re seeing themselves, how they’re treated by others. This is not only the number on a scale. When you are losing weight, significant amount of weight, your identity, your values may be shifting, your relationships are changing, and this is where coaching becomes very critical.

So, the next step, this is the fifth study I’m going to share. And we’re going to call this Small Steps Can Change Expectations. This was a large randomized controlled trial, gold standard of research, and it was in JAMA Network Open, that’s an esteemed journal, in 2026. And this included more than 5,000 adults who were on GLP-1s. They received a single digital exposure to eight small behavior change prompts related to their food choices, physical activity, sleep, and stress. Some received kind of a short…what they’re calling a storytelling video. Others received a didactic, an instructional video. And then the control group didn’t receive anything. So, what happened?

The intervention increased the participants’ expectations that they would adopt the behaviors, and some effects remained two weeks later. So, the storytelling format was especially effective across most of the behaviors. Now, I want to be clear, this was not health coaching, and it didn’t establish long-term behavior change. What it did show is that these small, actionable steps could increase readiness and help in people taking these medications.

So, in other words, these prompts, they were breaking it down into small steps you can take to change eating, to change movement patterns, for example. So, these were prompts. But what was the process of health coaching? Well, you are breaking it down into small, manageable, achievable steps. So, a coach can take that idea much further. Instead of just giving people this list, they can ask what small steps feel meaningful to them, what’s realistic, given their lifestyle, and connect it to that individual’s values, where do they want to set what makes sense to them, what doesn’t make sense. So, the value of the coach. So, again, this study doesn’t directly look at coaching, but it is showing that there is value in getting these prompts. Now, think of what would happen if we actually added a coach to the process.

So, what can a coach do? And if you are a coach listening to this and you are thinking, really, this is an area that I can focus on, absolutely, go for it because we need coaching for people on these medications and so that they will receive successful outcomes. So, here are five that I’ve identified, the five essential roles for the health coach coaching people on GLP-1 medications.

Okay. Number one, you’re going to help people define success beyond the scale. A coach might ask if this medication works as you hope, what will become possible in your life? And they might say, well, I want to be able to play on the floor with my grandkids. I’ll be able to walk through the airport without pain. I’ll feel comfortable in my own body for the first time in my life. I won’t feel uncomfortable when I’m in an airplane seat or a theater seat. I’ll have less health risks. I want to get healthy. Health matters to me. I’ll have more energy. So, you listen to their words as a coach.

So, going beyond the scale, completely getting off the obsession with the pounds lost because that’s what they’re used to doing. If they’ve been dieting their whole lives, that diet culture, weighing themselves three times a day, focusing on pounds lost. But this is a whole other way of looking at overall health or taking this medication for overall health. And the weight loss, that’s just one effect.

So, number two, we’ve touched on this, is to translate recommendations into small actionable steps. So, whereas their clinician, their doctor, they’re just…maybe say, oh, yeah, make sure you eat enough protein, do exercise, stay hydrated, get enough fiber, eat regularly. Yeah. That’s all good. But what does that actually mean? The coach is the one who helps people work out what it means. On Tuesday morning when you’re late for work and you’ve got to get the kids off to school and maybe you have no appetite and yet you’ve heard, you know, I should eat breakfast. Again, how do you put that into action? And that’s where the coach can, through these conversations and asking the right questions, help people have a plan.

So, the coach doesn’t prescribe a diet. They don’t give you a plan. They don’t determine a protein target unless they are qualified to do so if they also have training as a nutrition professional. But they play such an important role because they’re going to take the clinician’s guidelines, and I would recommend, if somebody’s on GLP-1 that they also have a consult with a nutritionist. But it doesn’t stop there because that’s where so many people get this wrong.

So, if they go to another consultant, their doctor’s going to recommend it, that’s going to be a nutritionist, but that’s not…they’re going to get a plan. But how do you put it into action? How do you successfully weave it into your life, given your circumstances as well as the social determinants of health? And what are the challenges you’re experiencing in your environment, your family and your social circles? So, that’s all the things the coach is going to explore. What are your preferences? What are your barriers? What’s your routine? What is going to work? And then you start with baby steps.

For example, you have specific questions, like what foods feel tolerable to you right now? What did your clinician recommend? What did your doctor tell you? What did the nutritionist tell you in this plan? And what part feels easiest to begin? What’s doable for you? And then working out, like where could a protein-rich food fit into your day? What are some ideas? What kind of movement would help you feel stronger rather than facing it as punishment for engaging in that type of movement?

So, the power is the collaboration. It’s not the coach drawing up the plan. And that’s why coaching is so powerful because it is that individual, that client who’s creating it.

So, number three, the critical role of a health coach for GLP-1 medication coaching, protecting strength, function, and the quality of weight loss. So, weight loss commonly includes losing lean tissue. You’re losing muscle. And current reviews emphasize that we need adequate nutrition, protein, and they’ll say resistance exercise, strength training. And that’s part of the supportive care during GLP-1 treatment. But a lot of people are not getting it. They’re just focused on the weight loss. But a 2006 randomized controlled trial showed that structured exercise combined with the GLP-1…that improved. So, the exercise plus the GLP-1 improved stair climbing performance, cardio-respiratory fitness, for example, compared with the medication alone. So, what we’re saying here, it’s not the medication alone.

So, health coaches, they’re not personal trainers, and I’m not suggesting for this point that they develop an exercise routine for clients, unless they hold that additional credential. And we have a lot of people who are personal trainers, trained to be coaches. But they can help with the most important thing, and that is to help people act on the exercise program that’s been approved by an appropriate professional.

So, how do you get going when you don’t feel like it, when you think that you have no energy, when you’re tired, when you’re fatigued? How do you rework the plan, for example? And they explore things like confidence, like scheduling, like enjoyment, fear of injury, and shame. There’s often deeply held beliefs that people will describe that are holding them back.

Many years ago, I worked with a woman, and she was told to start an exercise program, and we explored what would be best. When she was younger, what did she love to do? What movement gave her great joy? And she said swimming. Okay. I helped her find a place that…a neighborhood where she can go swimming. But she wouldn’t do it because she didn’t think she looked good in a bathing suit. She had gained weight, and she thought everybody’s going to be staring, and she was embarrassed to walk in the pool area.

So, we did a lot of work, and this is not psychotherapy. Again, this is small steps where she was starting to visualize herself having a lot of joy, and the joy of movement, and feeling better, having more energy. And then we talked about the unlikely possibility of anybody who would be laughing at her, for example. But it wasn’t my exploring of the deep-seated basis of her fears. It wasn’t my telling her what to do, but it was her discovering that, and working through it, and then taking small baby steps to actually get in the water and enjoy it.

For an older adult, what may be critical to independence is not becoming sarcopenic, preserving muscle. And so, we have a lot of seniors on GLP-1. A lot of my friends are on GLP-1s, and some of them may be paying lip service to resistance training, but they’re still focusing on the pounds lost and don’t really focus, don’t really get it. It’s such a hard concept, if you’ve been dieting your whole life, to understand the muscle that’s being lost.

So, the fourth one is, and we’ve been talking about this, supporting emotional balance, emotional wellness, and identity transitions. So, body change affects identity in many different ways. So, people may welcome that change, but they can still grieve for the person they were if their identity had evolved around being overweight. Or perhaps their identity was on loving food and going out to restaurants and being the foodie. And now, all of a sudden, they don’t have appetite. What’s that about? Or a familiar family role. Or perhaps now they’re attractive again. They’re attractive to their partner or on the dating scene, and that is new for them. And so, working through those feelings.

And again, the coach is not doing psychotherapy, but they are helping them to describe where they want to be and help them try on this new identity of having energy, of having vitality, of being fit and healthy.

So, they may fear other things. They may fear that they’re being judged for taking medication, doing cop-out, doing it the easy way as opposed to lifestyle change, or a lot of fear. I’ve heard this a lot. Fear that they’ll gain the weight back, which is a significant concern. So, a coach takes this non-judgmental attitude, and explores the experience of weight loss and body image changes. What are you learning about yourself as your body changes? And what parts of your identity…what do you want to change as you let go of the weight that you’ve been carrying for some time?

And of course, there are concerns that may come up regarding eating disorders, body dysmorphia, significant depression, and those would be areas that a coach, unless you are a therapist, you would refer to a mental health professional.

The fifth is preparing for maintenance or ongoing, keeping this medication for some time. Because obesity has been described as a chronic condition, and many people may need long-term pharmacotherapy. So, a coach should never imply that better habits are going to make medication unnecessary. That’s a decision between the client and their doctor. But certainly talk about decisions. What are their thoughts about continuing? What are their feelings regarding stopping the medication? Or sometimes it’s a dose change, which of course would be something handled by their doctor.

But we know that weight regain after discontinuation is very common. Many people are regaining the weight. There was one, this was the STEP 1 extension. Participants regained two-thirds of the weight they had lost during the year after the medication stopped and lifestyle intervention would stop.

There was a separate post-treatment analysis found that supervised exercise during treatment improved the maintenance of healthy weight and body composition after this GLP-1 was discontinued. So, that’s promising. But that’s not to imply that the exercise alone prevents all regain. And it doesn’t mean that clients should abruptly stop medication. It suggests that behaviors, physical capacity built during treatment may provide some support over time.

So, you can prepare people for maintenance. The time to do that is not when the medication stops, but it’s during the coaching process while they are on the GLP-1. It starts right from the beginning. What are their long-term goals? What do they want their health for? What is valuable to them as they continue the medication, for example? So, coaching, this is a process of learning more about your client, adjusting, again, building self-efficacy so that they are the ones in charge, not their doctor, not you, the coach, not the nutrition professional, not something they hear on social media or read in a blog. This is building self-efficacy that they can take charge of their health, that they are the expert in their own life, and encouraging them to remain connected to their clinical team.

So, the coaching role is powerful because it is so clear. Health coaches, just to reiterate, anyone unfamiliar with health coaching in that they don’t diagnose, they don’t prescribe, they don’t change medication dosages, they don’t interpret symptoms or medical findings or interpret labs, and this is the area for the clinician. But what does the coach do? The most important role. They listen. And increasingly, people are not being heard, and it is so important to be heard.

So, I just want to say a bit more about shame and the easy way out. So, people taking these medications are sometimes told it’s cheating, they’re taking the easy way out. There might be people who are really prejudiced against GLP-1s. But obesity is this complex chronic condition, and it’s shaped by so many different factors, by biology, by environment, by sleep, stress, toxic load, social conditions, psychology of eating, family history, of meaning of food.

So, yes, effective treatment may include medication, but that’s not all. But as a coach, one of the first things for you to consider, if you’re a coach listening to this, is your own moral judgment. Are you, even in subtle ways, implying that if you are losing weight with medication, you’re taking the easy way out, that it should be only lifestyle-based, changing your eating, exercise? And so, really question your own beliefs, and coming to each encounter with your client centered, checking your biases at the door. And that is the best way to coach.

And at the same time, there might be the opposite where you think everybody should be on these wonder drugs, and ignoring behavior, and ignoring the benefits of lifestyle support.

I just want to say where the evidence is strong and where it’s still emerging. So, we have strong evidence that these medications can produce substantial weight loss, and we haven’t talked about it. That’s the important metabolic benefits. The cardiometabolic conditions are rampant, and metabolic benefits are really important regarding GLP-1s. And we have strong, really strong, broader evidence that behavioral interventions and health coaching supports lifestyle change across many chronic conditions. And we have growing GLP-1-specific evidence that integrative programs, the ones I’ve discussed on this episode, where you’re combining medication with behavioral, nutrition, exercise, and coaching support can improve engagement, weight-related outcomes, other biomarkers changing, physical function, and psychological well-being, self-efficacy.

So, yes, we don’t yet have a large body of randomized control trials that are isolating health coaching as the single additional component alongside GLP-1 that’s going to do it. The field needs more studies that define coach training. But what we have, the evidence so far, is really promising. So, we want to provide support as health coaches. And a lot of these interventions that I’ve talked about, you can go to physicians who are prescribing these medications, and help them to see that this would really benefit their patients. At the end of the day, it is all about the human relationship.

And as we celebrate 200 episodes of “Health Coach Talk,” I’m going to keep repeating and returning to the same proposition, that change happens not in isolation, but in relationships. Yes, information matters. We can get information from AI. Medical treatment matters, but just telling somebody to take this medication and lose weight, that’s not it. Technology can be enormously helpful, of course, with AI particularly, our new technological advancements in medical care. But people really flourish when someone listens to them, believes in their capacity to change, and helps them take that next step that they are ready to take.

So, GLP-1s may quiet the hunger, the food noise, but a coach can really help that individual hear something much clearer, and that is their personal values in addition to their body signals. But the vision, what’s the vision for the life that they want to create, that what matters most to them? So, the future of GLP-1 care is team-based. Providers are going to do the medical evaluation, the medical management. Dieticians, nutritionists may offer support in terms of food plans. There might be exercise and personal trainers, rehab professionals providing special guidance as needed, mental health clinicians. But the health coach is key because the health coach connects the plan to the person’s daily life, and supports the process of change.

So, I’ll return to what I said at the beginning. Medications, like GLP-1s, they open the door to change, but the coach helps that person decide how they want to walk through that door one step at a time. So, I want to thank you for being part of our community at FMCA and for this podcast, for being a listener, our 200th episode of “Health Coach Talk.” Here’s to the next 200 conversations about the power of health coaching.