Why Food and Training Still Matter for Clients with Obesity, Prediabetes and Type 2 Diabetes

Medications like semaglutide (Ozempic & Wegovy) have made a big splash in the world of weight loss. Appetite drops, the scales move and clients often feel they have found the missing piece. Yet weight loss is only one part of the bigger health picture. The human body still needs to be fuelled with enough protein to maintain lean tissue. It still needs the stress of strength work to keep muscles functional and bones strong. It still needs cardio sessions to improve the way the heart, lungs and blood vessels deliver oxygen. A drug may help reduce food intake, but it does not teach the body to move better, recover faster or perform daily tasks with more ease. The sweet spot is medication doing its job in the background, while food choices and training programmes actively build a healthier, more capable body. That balance is where personal trainers have the most impact.

This balance is also why so many coaches choose to upskill with nutrition coaching courses. Understanding how food works alongside medication allows a trainer to create plans that protect muscle, support energy levels and keep metabolism humming during weight loss. The principles apply across the board, but they are especially important for clients on GLP-1 receptor agonists, where the risk of losing lean tissue alongside fat is higher than many realise.

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Why Balance Still Matters on GLP-1s

GLP-1 receptor agonists work primarily by slowing gastric emptying and affecting satiety signals in the brain. Clients eat less, feel full faster and often lose a significant amount of weight. That is a win in many respects, yet it comes with considerations. A substantial portion of the weight lost can be lean tissue unless the diet contains enough protein and the muscles are stimulated through regular resistance training. Losing muscle not only reduces strength but also lowers resting energy expenditure, which can make maintaining weight loss harder when the medication is stopped or the dose is reduced.

Cardiorespiratory fitness is another piece of the puzzle. VO₂max, the gold standard measure of aerobic capacity, does not improve simply because someone loses weight. Structured aerobic training is needed to train the heart and lungs, improve oxygen delivery and enhance endurance. Bone density is also a concern during rapid weight loss. Resistance training and weight-bearing cardio both apply mechanical stress to bone tissue, helping preserve mineral density.

Metabolic health improves with exercise in ways that are independent of weight loss. Muscle contractions during exercise increase GLUT-4 transporter activity, which improves glucose uptake into cells. This effect happens regardless of body weight changes and is one of the reasons exercise remains a frontline recommendation for managing diabetes and prediabetes. Even with medication helping blood sugar control, training continues to have a unique and irreplaceable role.

Some Interesting New Research

A 025 randomised controlled trial published in BMC Medicine2 puts hard data behind the value of combining medication, nutrition and exercise. The study followed adults aged 18–60 with obesity and newly diagnosed prediabetes or type 2 diabetes. Participants were randomised into two groups. One group received standard pharmacological care, which could include GLP-1 receptor agonists as well as other hypoglycaemic agents. They also received basic lifestyle advice. The second group received the same medication options but added a structured lifestyle intervention that combined a high-protein, calorie-restricted diet with a supervised exercise plan.

The diet was designed to provide around 25% of energy from protein, 50% from carbohydrate and 25% from fat, with a daily energy deficit of roughly 500 kcal. Dietitians worked closely with participants through regular phone calls and clinic visits to monitor adherence and make adjustments. The exercise programme included 150–200 minutes per week of moderate-intensity aerobic activity at 60–70% of maximum heart rate, plus 20-minute resistance training sessions two to three times per week.

After 12 months, the results were striking. The intensive group lost an average of 19.29 kg compared with 1.52 kg in the standard care group. Rates of glycaemic remission were dramatically higher in the intensive group with around three-quarters of those with prediabetes returning to normal glycaemia and roughly the same proportion of those with type 2 diabetes achieved remission. Importantly, the intensive group preserved skeletal muscle mass despite the large reduction in body fat and visceral fat. Liver fat content dropped sharply, insulin resistance improved significantly and inflammatory markers fell. No serious adverse events were reported, and adherence to both the diet and exercise plan remained high throughout the year.

The study makes a clear point. Medication can help lower appetite and improve glycaemic control, but when it is combined with structured nutrition and exercise, the outcomes are far more impressive. Weight loss becomes targeted fat loss. Muscle mass is maintained. Metabolic health markers improve across the board.

Practical Coaching Strategies for Clients on GLP-1s

For us as trainers, the message is straightforward. Keep the nutrition plan protein-focused. Aim for 1.6–2.2 g of protein per kilogram of body weight per day, split evenly across three or four meals. Encourage a wide variety of protein sources, from lean meats and fish to eggs, dairy, tofu, tempeh and legumes. Support fibre intake through vegetables, fruits, whole grains and pulses, targeting 25–35 g per day. Manage overall energy intake to maintain a modest calorie deficit, adjusting as body weight changes.

Hydration can be an issue when appetite is suppressed, so setting daily fluid goals helps. Clients may also find that smaller, more frequent meals are easier to tolerate, especially in the first weeks on GLP-1s when gastrointestinal side effects are more common. Light, low-fat foods can be planned for dose days to avoid discomfort.

In the gym, full-body resistance training sessions two to three times per week should form the foundation. Each session can include a squat or leg press, a hip hinge movement like an RDL or cable pull-through, an upper-body push, and an upper-body pull. Add accessory work for the core, calves or glutes as needed. Begin with two to three sets of eight to twelve repetitions, progressing reps and then load over time while keeping one or two reps in reserve in the early weeks.

Aerobic work should total 150–200 minutes of moderate-intensity activity per week, such as brisk walking, cycling, swimming or elliptical training. Once a base has been built, short interval sessions can be added once a week to increase cardiovascular challenge without overwhelming recovery. For clients carrying significant excess weight or with joint issues, low-impact options are preferable until strength and mobility improve.

Progress should be tracked with more than just body weight. Waist measurements, step counts, strength benchmarks, resting heart rate and energy levels all help to build a picture of the client’s health and fitness improvements. Celebrating these wins reinforces that the goal is not just a lighter body but a stronger, fitter and healthier one.

Discover Why Food and Training Still Matter Whilst Still on Ozempic, Wegovy, & Mounjaro on the TRAINFITNESS Blog

12-Week Starter Plan for Clients on GLP-1 Therapy

Here is a practical framework for your clients to keep fat loss high, muscle loss low and health gains rolling.

Nutrition Targets

  • Calories: Start with ~500 kcal/day below maintenance; adjust based on 2–4 week trends.
  • Protein: 1.6–2.2 g/kg/day split over 3–4 meals (20–40 g per meal).
  • Carbs: Choose high-fibre, slow-digesting sources; time a portion around training if needed for energy.
  • Fat: Mostly unsaturated; include oily fish twice per week.
  • Fibre: 25–35 g/day from vegetables, fruit, wholegrains and pulses.
  • Hydration: 2–3 L/day; set a daily target and track it.
  • GI comfort:

Exercise Structure

Weeks 1–4 – Build the base

  • Resistance training: 2×/week, full-body, 45–60 min.
  • Main lifts: squat or leg press, hip hinge (RDL or cable pull-through), push (DB press or machine), pull (row or pulldown).
  • 2–3 sets of 8–12 reps; leave 2 reps in reserve (RIR).
  • Aerobic training: 120–150 min/week moderate intensity (RPE 5–6/10).
  • Steps: Start from current average; add 500–1,000 steps each week.

Weeks 5–8 – Progress the load

  • Resistance training: Move to 3×/week; add 1–2 reps per set before increasing load 2–5%.
  • Aerobic training: 150–200 min/week; introduce 1 interval session (6× 1 min hard / 2 min easy).
  • Steps: Aim for 8–10k/day if joints allow.

Weeks 9–12 – Consolidate and refine

  • Resistance training: Continue 3×/week; maintain progressive overload.
  • Aerobic training: Keep 150–200 min/week; increase interval challenge slightly (7–8× 1 min).
  • Steps: Hold at target or add gentle hikes/cycles for variety.
  • Week 12 deload: Drop total volume by 30% to aid recovery before the next block.

Tracking Progress

  • Weekly: Body weight, waist circumference, protein target met %, step count.
  • Fortnightly: Strength benchmarks (main lifts), RHR, energy levels.
  • Monthly: Photos, subjective fitness rating, any changes in medication dose or tolerance.

Trainer tip: Keep the focus on fat loss and what the body can do. Celebrate improvements in strength, endurance and recovery alongside changes in the scales.

Closing Thought

The combination of medication, a nutrient-dense eating plan and a structured exercise programme changes the trajectory for clients with obesity and early-stage metabolic disease. Trainers who can integrate all three elements into their coaching deliver more than weight loss. They deliver resilience, function and long-term health.

Reference

The Diploma That Blends Food & Training for Real Weight Change

Clients managing their weight need more than an appetite shift, they need coaches who can join the dots between food and training. That’s exactly what our Nutrition & Exercise Specialist and Master Diplomas™ are built for. In a 12-month randomised trial, pairing a high-protein, calorie-reduced eating plan with 150–200 minutes a week of moderate cardio plus 2–3 short resistance sessions delivered an average −19.3 kg weight loss, sent around 73–79% of people with prediabetes back to normal glycaemia and put about 75–87% with type 2 diabetes into remission, while preserving muscle and cutting visceral fat by ~54 cm² with a sharp drop in liver fat. On these Diplomas you’ll learn how to coach that blend in the real world with nutrition that keeps protein high, exercise that protects strength and fitness, and week-to-week systems clients can stick to. Progress will then show up in healthier bodies and better bloods.