Direct Line April 2026: Stopping Ozempic and Lifting With Osteopenia

Direct Line April 2026: Stopping Ozempic and Lifting With Osteopenia

Stop a GLP-1 and about two thirds of the weight loss comes back within a year. Three randomized withdrawal trials (SURMOUNT-4, STEP 1 extension, STEP 4) and a new BMJ 2026 systematic review of 37 RCTs and nearly 10,000 adults all land on the same signal. The cardiometabolic benefits, blood pressure, fasting glucose, lipids, drift back in parallel with the weight. The framing that actually fits the data: GLP-1s behave like a statin. There is a cumulative benefit during exposure, but this does not extend indefinitely,

This month's Direct Line covers two subscriber questions. The first asks what the new BMJ paper on GLP-1 cardiovascular protection after cessation actually shows, and how GLP-1 durability compares to lifestyle-only interventions. The second asks how a postmenopausal woman newly diagnosed with osteopenia should structure her lifting.

Studies referenced: SURMOUNT-4 (Jastreboff, JAMA 2024), STEP 1 extension (Wilding, Diabetes Obes Metab 2022), STEP 4 (Rubino, JAMA 2021), West et al. BMJ 2026 systematic review, Budini 2026 eClinicalMedicine regain meta-analysis, SELECT cardiovascular outcomes, FLOW renal outcomes, the Diabetes Prevention Program, Look AHEAD, POUNDS Lost, and LIFTMOR (Watson, JBMR 2018).

Full episode on BBM+ covers 8 additional subscriber questions. Join at https://barbellmedicine.supercast.com/

Timestamps

  • 0:00 Intro
  • 1:52 Q1: What happens when you stop a GLP-1
  • 5:33 Lifestyle-only comparators: DPP, Look AHEAD, POUNDS Lost
  • 8:15 Austin on the cessation conversation 1
  • 2:41 BMJ 2026: weight and cardiometabolic regression
  • 17:59 The statin framing
  • 23:41 Austin: first 6 months off GLP-1
  • 28:07 Q2: Osteopenia and heavy lifting
  • 35:28 LIFTMOR protocol
  • 38:00 Outro


Next Steps

  • For evidence-based resistance training programs: barbellmedicine.com/training-programs
  • For individualized training consultation: barbellmedicine.com/coaching
  • Explore our full library of articles on health and performance: barbellmedicine.com/resources
  • To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com

Resources

Aronne, Louis J., et al. "Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial." JAMA, vol. 331, no. 1, 2024, pp. 38–48. https://jamanetwork.com/journals/jama/fullarticle/2812936

Wilding, John P. H., et al. "Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide: The STEP 1 Trial Extension." Diabetes, Obesity and Metabolism, vol. 24, no. 8, Aug. 2022, pp. 1553–1564. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725

Rubino, Domenica, et al. "Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial." JAMA, vol. 325, no. 14, 2021, pp. 1414–1425. https://jamanetwork.com/journals/jama/fullarticle/2777886

West, Sam, et al. "Weight Regain After Cessation of Medication for Weight Management: Systematic Review and Meta-Analysis." BMJ, vol. 392, 7 Jan. 2026, article e085304. https://www.bmj.com/content/392/bmj-2025-085304

Budini, Brajan, et al. "Trajectory of Weight Regain After Cessation of GLP-1 Receptor Agonists: A Systematic Review and Nonlinear Meta-Regression." eClinicalMedicine, vol. 93, 4 Mar. 2026, article 103796. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00043-X/fulltext

Lincoff, A. Michael, et al. "Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes." New England Journal of Medicine, vol. 389, no. 24, 11 Nov. 2023, pp. 2221–2232. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563

Perkovic, Vlado, et al. "Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes." New England Journal of Medicine, vol. 391, no. 2, 24 May 2024, pp. 109–121. https://www.nejm.org/doi/full/10.1056/NEJMoa2403347

Knowler, William C., et al. "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin." New England Journal of Medicine, vol. 346, no. 6, 7 Feb. 2002, pp. 393–403. https://www.nejm.org/doi/full/10.1056/NEJMoa012512

Look AHEAD Research Group. "Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes." New England Journal of Medicine, vol. 369, no. 2, 11 July 2013, pp. 145–154. https://www.nejm.org/doi/full/10.1056/NEJMoa1212914

Sacks, Frank M., et al. "Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates." New England Journal of Medicine, vol. 360, no. 9, 26 Feb. 2009, pp. 859–873. https://www.nejm.org/doi/full/10.1056/NEJMoa0804748

Watson, Shelley L., et al. "High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial." Journal of Bone and Mineral Research, vol. 33, no. 2, 2018, pp. 211–220. https://onlinelibrary.wiley.com/doi/10.1002/jbmr.3284



Our Sponsors:
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out FIGS and use my code FIGSRX for a great deal: https://wearfigs.com
* Check out Factor and use my code factormeals.com/bbm50off for a great deal: https://www.factor75.com
* Check out Quince and use my code BBM for a great deal: https://www.quince.com
* Check out Ten Thousand and use my code PODCAST15 for a great deal: https://www.tenthousand.cc


Advertising Inquiries: https://redcircle.com/brands

Denne episoden er hentet fra en åpen RSS-feed og er ikke publisert av Podme. Den kan derfor inneholde annonser.

Episoder(448)

Is It Safe to Train When the Air Is Full of Wildfire Smoke?

Is It Safe to Train When the Air Is Full of Wildfire Smoke?

Parts of the country now get a few weeks of wildfire smoke every year, and the obvious question is whether there is a point where the air is bad enough that the workout costs you more than it gives yo...

24 Sep 37min

Do You Need a Calorie Surplus to Build Muscle? | Dr. Eric Helms

Do You Need a Calorie Surplus to Build Muscle? | Dr. Eric Helms

Most lifters have been told they need to eat in a Calorie surplus to build muscle. That rule has always come with a list of exceptions: unless you're new, unless you're carrying extra body fat, unless...

17 Sep 2h 1min

Is Obesity A Muscle Problem?

Is Obesity A Muscle Problem?

Muscle is where most of the glucose goes, and muscle insulin resistance is the first thing that breaks on the road to type 2 diabetes. Both of those are true, and neither one means that building more ...

4 Sep 1h 17min

Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4

Who Needs Testosterone, and Who's Not Getting It I Signal Episode 4

Most men who start testosterone never needed it, and some who genuinely do never get treated. In the final episode of the Signal series, Dr. Jordan Feigenbaum and Dr. Austin Baraki work through who ac...

27 Aug 1h 26min

Your Fat Has a Storage Limit

Your Fat Has a Storage Limit

In 2004 a surgeon removed about ten kilograms of fat from fifteen women and measured everything that mattered. Nothing improved. Four years later, it still hadn't.That result should have ended an argu...

20 Aug 49min

Lifting and longevity: is 1 hour a week really the limit? Plus GLP1s and mood, training with ME/CFS, and Protein vs. Calories

Lifting and longevity: is 1 hour a week really the limit? Plus GLP1s and mood, training with ME/CFS, and Protein vs. Calories

A popular paper claimed the longevity benefit of lifting disappears once you train more than an hour a week. It's a real paper, but the claim is a misread. This is the free cut of this month's Direct ...

12 Aug 46min

The FDA Voted for 6 Peptides. Its Own Scientists Said No

The FDA Voted for 6 Peptides. Its Own Scientists Said No

An FDA advisory committee just voted to open a legal compounding supply line for six of seven peptides, including BPC-157 and TB-500, over the objection of the FDA's own scientists, who recommended ag...

7 Aug 1h 6min

The Man Who Couldn’t Stop Gaining Weight | A Medical Mystery

The Man Who Couldn’t Stop Gaining Weight | A Medical Mystery

A previously healthy 21-year-old shows up with seven months of headaches and 30-plus pounds of weight gain he can’t explain. He’s eating the same and training more, and the scale climbs anyway. We han...

31 Jul 1h 10min

Populært innen Helse

fastlegen
rss-gukild-johaug
psykodrama
hvordan-har-du-det-mann
leger-om-livet
relasjonspodden-med-dora-thorhallsdottir-kjersti-idem
rss-skravla-gar
foreldreradet
morten-ramm-lar-kakla-ga-til-du-sovner
rss-lopedrommen
treningsprat
g-punktet
klimaks
kjed-deg-i-sovn-verdens-kjedeligste-podcast
hjernesterk
bak-fasaden-en-reise-i-livet-med-sykepleier-ine
rss-loping-for-nybegynnere
hverdagspsyken
helsetipspodden
apent-forhold