The conversation around medical weight loss has expanded quickly—and not always accurately. Concerns about facial changes, muscle loss and long-term effects are common, but the reality isn’t always as alarming as social media makes it seem. To add perspective, we turned to Portage, MI lipid and obesity specialist Dr. Spencer Nadolsky, who works closely with patients navigating these treatments. Below, he breaks down the myths he still hears most often and explains what patients can realistically expect.
What’s the biggest misconception you hear from patients about GLP-1s and aesthetic changes?
“Definitely ‘Ozempic butt.’ These medications help people eat fewer calories, which leads to weight loss. They do not specifically make you lose muscle. However, if someone isn’t lifting weights and isn’t eating enough protein, some muscle loss is likely inevitable, including in the glutes. Many people naturally store more fat in their butt, so when they lose weight, they’ll lose fat from that area. That’s not specific to GLP-1s—it’s how weight loss works in general. I also hear concerns that these drugs will make the face look gaunt. There isn’t data to suggest GLP-1s make skin worse or cause facial changes more than any other calorie-restrictive diet.”
Are there any myths social media has made worse lately?
“The biggest one is muscle loss. GLP-1s are the most effective weight-loss therapy we have aside from bariatric surgery, and muscle loss is inevitable if someone isn’t lifting weights and isn’t eating enough protein. Body composition and strength training should absolutely be emphasized. But we shouldn’t fearmonger and make it seem like the medication itself causes more muscle loss than dieting without exercise. That’s simply not accurate.”
What changes do patients experience that they don’t typically expect?
“The biggest change is hope. Many patients realize, often for the first time, that they can lose weight and maintain it long-term. I also see improvements in mental health, including anxiety. People who have spent years feeling anxious around food often report feeling calmer and having more mental energy to focus on other areas of their lives. Another change patients frequently mention is a reduced pull toward other addictive behaviors. Alcohol is the most common example, but it’s not the only one.”
What’s one myth you wish patients would know about sooner?
“Probably the myth around gastroparesis, which people refer to as “stomach paralysis.” These medications do not cause permanent gastroparesis. They do slow gastric emptying, which is part of how they work. The nausea some patients experience is more related to the brain than to gastric emptying. Both the nausea and the slowing of gastric emptying tend to improve over time. When patients work with a knowledgeable doctor and dietitian to manage dosing and food choices, they can usually get through the side effects and stay on the medication long-term instead of stopping early and assuming it’s not for them.”
What’s your best advice for patients who want to prevent unwanted facial changes while losing weight?
“I recommend losing weight slowly—no more than about one percent of total body weight per week. For someone who weighs 200 pounds, that’s roughly two pounds per week. It’s also important to get sufficient protein, vitamins and minerals. Patients should regularly reassess how they look and feel, not just how much they weigh. At a certain point, some people decide they like how they look and feel and don’t want to lose more weight, which is completely reasonable.”
