GLP-1s, Female Athletes, and the Weight-Loss Conversation That’s Been Avoided
Shaun Provost is a women’s health and performance expert, endurance athlete, and founder of Live Unbreakable. With more than 16 years of coaching experience and 34 certifications, she helps women transform their health through strength training, hormone education, and lifestyle coaching.
There has always been a complicated relationship between women, sports, and body weight. If you are a female athlete, particularly an endurance athlete, there is a good chance you have heard some version of the same message before: lose a few pounds and you will run faster, get a little leaner and climbing will feel easier, reach “race weight” and performance will follow. Sometimes, that pressure is explicit, other times, no one ever has to say it out loud. We see the bodies that get celebrated (hello, Sydney Sweeney. We see you), notice which athletes are described as “fit,” and quietly start to wonder whether two or three pounds might actually be the difference between the pace we’re at now and the pace we think we should be capable of.
That is exactly why the rise of GLP-1 medications deserves a deeper conversation in athletic spaces. Medications such as semaglutide, along with dual agonists such as tirzepatide, have changed obesity treatment in a meaningful way, there’s no doubt about it. For many people living with obesity, type 2 diabetes, and related metabolic conditions, these medications can be incredibly useful. They can lead to substantial weight loss and important improvements in health, and their success has helped force a long-overdue acknowledgment that body weight is influenced by far more than discipline, willpower, or simply “trying harder.”
That is a good thing. What concerns me, however, is what happens when medications designed to treat metabolic disease enter a fitness culture that was already overly obsessed with being smaller.
Athletes are not immune to body-image pressure simply because we are strong, capable, or physically active. In some cases, I think we are even more vulnerable to it because the desire to be smaller can disguise itself as a desire to perform better. It sounds different when we say we are trying to improve our power-to-weight ratio, get to competition weight, feel lighter on the run, or carry less body mass on the bike. The language sounds athletic, disciplined, and strategic, but the underlying pressure can be very similar.
A 2025 study examining GLP-1 use and attitudes among 681 UK exercisers and recreational athletes found that, among those who were familiar with the medications, one in four had considered using a GLP-1 off-label to change their physical appearance. One in four! Women were significantly more likely than men to fall into the group that had used or considered using the medications, and that group also reported higher levels of body-image disturbance, anxiety, and depression. What this shows is that the interest in these medications has already moved beyond the treatment of metabolic disease and into the world of body image and performance. That matters.
Lighter is not automatically faster
Scientifically speaking, body mass absolutely influences performance in certain sports. Running requires moving your body over distance, cycling performance can be affected by the power-to-weight ratio, and body composition can play a role in some competitive environments. Pretending otherwise is just as unhelpful as the alternative. The problem is that the conversation all too often stops with the scale.
Performance is not determined by how little an athlete weighs. It is determined by what the athlete can produce at that weight. A lighter athlete who has also lost strength, muscle, power, glycogen availability, or the ability to recover is not necessarily a better athlete. She may simply be lighter.
This is where the GLP-1 conversation overlaps with a problem sports medicine has already been trying to address for years: low energy availability and Relative Energy Deficiency in Sport (RED-S). The International Olympic Committee describes low energy availability as a mismatch between the energy an athlete consumes and the energy required to support both training and normal physiological function. When that mismatch becomes significant or prolonged, the consequences can extend well beyond hunger or weight loss. RED-S can affect reproductive function, bone health, metabolism, immunity, cardiovascular health, psychological health, and performance.
Contrary to popular belief, an athlete does not have to have an eating disorder to end up with low energy availability. Sometimes restriction is intentional, but sometimes training volume simply increases and food intake does not keep up. Sometimes life gets busy. Sometimes athletes are praised for losing weight before anyone stops to ask whether they are actually fueling enough to support the work they are doing. GLP-1 medications add another layer because appetite suppression is part of how these medications work.
For someone whose excessive hunger or food noise has made weight management incredibly difficult, that appetite suppression can be therapeutic. For an athlete training eight, ten, or twelve hours per week, however, reduced appetite requires considerably more attention. The challenge is not simply whether the medication works. The challenge is whether the athlete can still consistently meet the nutritional demands of training when hunger is significantly reduced.
This is especially relevant in endurance sports, where athletes already struggle to eat enough. A long ride, long run, or multi-session training day can create enormous energy demands. Add work, family, stress, and everyday life to that schedule, and it becomes very easy for someone to believe she is eating “pretty well” while still falling short of what her body actually needs. (Don’t believe me on the stress piece? This is for you.) Now add a medication that causes earlier satiety and prolonged fullness, and the potential for accidental underfueling becomes even greater.
Carbohydrate availability still matters for training quality. Protein still matters for recovery and muscle maintenance. Total energy availability still matters for adaptation. Hydration, iron, calcium, and other micronutrients still matter. None of those requirements disappear because someone is less hungry. This is where the psychological side becomes especially important. A female athlete may experience a dramatic reduction in appetite and initially see it as an advantage. If she has spent years believing she would perform better five pounds lighter, being less hungry can feel like the easiest path she has ever had toward finally getting there. Meanwhile, she may be creating the exact conditions that make her training worse.
The 2023 International Olympic Committee (IOC) consensus on RED-S specifically recognizes the relationship between body-composition pressure, restrictive eating, psychological health, and low energy availability. We have known for years that athletes can underfuel themselves in pursuit of better performance. GLP-1 medications did not create that problem, but they may give some athletes a far more powerful tool with which to do it.
Bone health belongs in this conversation too
Bone health is another reason this discussion needs to go beyond the scale. Female endurance athletes are already a population in which clinicians pay close attention to low energy availability, menstrual dysfunction, stress fractures, and bone density. Relative Energy Deficiency in Sport (RED-S) is broader than the old Female Athlete Triad model, but bone health remains an important part of the picture.
A 2024 randomized controlled trial involving adults at increased fracture risk found that semaglutide treatment was associated with increased bone resorption and lower bone mineral density at the lumbar spine and total hip after 52 weeks compared with placebo. That does not prove that semaglutide causes osteoporosis. The participants receiving semaglutide also lost substantially more weight, and significant weight loss itself can affect bone because mechanical loading decreases as body mass decreases.
The current evidence around glucagon-like peptide-1 (GLP-1) medications and bone remains mixed, which is exactly why fearmongering is not helpful. But for a female athlete who may already be managing high training loads, low energy availability, menstrual changes, or a history of stress fractures, bone health should be part of the conversation before intentionally driving body weight lower.
This is especially true because the risk can be easy to miss. Weight loss is visible. A lower number on the scale gets celebrated. Bone loss is silent until it is not.
Female athletes have been taught to be smaller for a long time
Women have spent generations being encouraged to make themselves smaller, and unfortunately, fitness did not completely eliminate that pressure. In some cases, it simply changed the language. We were not dieting anymore, we were cutting. We were not restricting, we were dialing in our nutrition. We were not trying to become thin, we were trying to become lean. We weren’t avoiding muscle, we were trying to “tone.” In endurance sports, the message became even easier to rationalize because we could frame it entirely around performance.
The language matters because it can make the same behavior feel virtuous. A woman restricting food because she dislikes her body raises concern. A female athlete restricting food because she wants to qualify for Boston can look like dedication. Physiologically, however, the body does not care what story we attach to the energy deficit. This is why the psychological conversation around GLP-1s and athletes needs to happen alongside the physiological one.
The 2025 study on recreational athletes is particularly interesting because the people who had used or considered using GLP-1 medications reported greater body image disturbances than those who had not. Women were also more likely to be represented in that higher-risk group. That does not mean GLP-1 medications cause poor body image. It suggests that people drawn toward off-label use may already be carrying complicated beliefs about their bodies.
For coaches and clinicians, that should matter. For athletes, it should matter too. Before asking whether a medication can help someone lose weight, it may be worth asking why an already active body needs to become smaller in the first place. Sometimes there is a legitimate medical answer. Sometimes there is a legitimate sport-specific reason. Sometimes, if we are being honest, the answer is simply that being a female athlete has not protected us from spending most of our lives believing there is always another five pounds we could lose.
Appetite and nutritional need are not the same thing
One of the most important things I think athletes need to understand is that reduced appetite does not mean reduced physiological need. GLP-1 (glucagon-like peptide-1) medications can dramatically change hunger, but they do not change the amount of carbohydrate required to fuel a long training session. They do not remove the need for amino acids to repair muscle, calcium to support bone, iron to carry oxygen, or enough total energy to allow the body to adapt to training.
For that reason, an athlete taking one of these medications may actually have to become more intentional about fueling. That could mean eating before hunger becomes strong, using smaller meals more frequently, prioritizing carbohydrate around key sessions, making protein intake more deliberate, or working with a sports dietitian who understands both the medication and the demands of training.
This is also why I become uncomfortable when extreme appetite suppression is celebrated as proof that a medication is working especially well. Statements like “I barely eat anymore” may sound exciting in a weight-loss conversation, but they should raise very different questions in an athlete. Are you actually recovering? Are you maintaining strength? Are you sleeping well? Are you fueling long sessions? Are your cycles changing? Are you becoming more capable, or just lighter?
Those questions matter more than appetite alone.
GLP-1s can be useful, but the overarching focus needs to be on health and performance
I do not want the takeaway from this conversation to be that athletes should fear GLP-1 medications. There are athletes living with obesity, insulin resistance, and type 2 diabetes. There are athletes for whom GLP-1 treatment may meaningfully improve health, mobility, confidence, and quality of life. Being athletic does not make someone immune from metabolic disease, and using medication does not make someone less of an athlete. The problem is not the medication. The problem is using an effective medical tool inside a culture that has spent decades rewarding women for becoming smaller at almost any cost.
We have seen this pattern before through restrictive diets, fasted training, fat burners, ignored menstrual cycles, untreated stress injuries, and the glorification of “discipline” when what we really meant was chronic underfueling. GLP-1 medications are simply much more effective than most of the tools that came before them, which means the conversation around how and why they are used has to become much more responsible.
Female athletes do not need another reason to be afraid of taking up space. We need strong bodies that can absorb training, recover between sessions, maintain healthy bones, support hormonal function, and produce enough force to actually perform. If a GLP-1 helps someone improve her health while maintaining those things, it can absolutely be a useful tool. But the goal cannot simply be to weigh less, especially in athletes.
Lighter does not automatically mean faster, leaner does not automatically mean fitter, and smaller has never been the same thing as stronger.
Read more from Shaun Provost
Shaun Provost, Women’s Health & Performance Expert
Shaun Provost is the founder of Live Unbreakable and a women’s health and performance coach with more than 16 years of experience in fitness, nutrition, and hormone health. She is passionate about helping women build strength, improve confidence, and create sustainable habits that support long-term wellness. As an endurance athlete and educator, Shaun combines science-backed coaching with a relatable, empowering approach that makes health feel achievable in real life. Through her writing, she aims to educate, inspire, and help women feel truly unbreakable.
References:
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Martin D, Hawkins RM, Gee TI, Turnock L, Lazuras L. Use of glucagon-like peptide 1 (GLP-1) agonists among exercisers and recreational athletes and associated mental health symptoms. Performance Enhancement & Health. 2025;13(4):100353. doi:10.1016/j.peh.2025.100353.
Look M, Dunn JP, Kushner RF, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes, Obesity and Metabolism. 2025;27:2720-2729. doi:10.1111/dom.16275.
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