Why I Treat Your Metabolic Health—Not Your Scale: A 5-Minute Read on GLP-1s in 2026
If you’ve been hearing nonstop about GLP-1 medications—Ozempic, Wegovy, Mounjaro, Zepbound (and yes, more coming)—you’re not alone. But here’s what often gets lost in the noise:
GLP-1 therapy is not about chasing a smaller number. It’s about treating metabolic disease—and building a body that’s stronger, healthier, and more resilient.
In my two decades as an endocrinologist, I’ve watched trends come and go. What’s different now is how many high-performing adults—especially across Silicon Valley and the Bay Area—are seeking answers for insulin resistance, prediabetes, type 2 diabetes, visceral fat, menopause weight gain, fatigue, and “why nothing is working.
At Unified Endocrine, my approach rests on three pillars: Evidence. Safety. Body Composition.
Here are the five most important questions I address with patients considering semaglutide or tirzepatide—and the answers you deserve.
1) “Will GLP-1s cause muscle loss?”
Weight loss can include some muscle loss—any method can. The difference is how you do it.
My goal is to help you target visceral fat (the inflammatory fat around organs) while we actively protect and build lean muscle mass. That means we don’t just track pounds—we track body composition:
Lean mass / muscle
Visceral fat
Body fat percentage
I often tell patients:
“While the medication helps manage hunger, our lifestyle plan protects your strength.”
That’s where results become sustainable—and longevity-focused.
2) “Can I lose weight with lifestyle alone?”
Lifestyle is always the foundation. Always.
But many patients I see in Palo Alto, Menlo Park, San Francisco, Walnut Creek, Oakland, and Sacramento are doing “everything right”—they’re walking, lifting, eating well—yet their insulin resistance and metabolic markers won’t budge.
Why? Because biology is personal. Genetics, ethnicity (including higher metabolic risk in many South Asian and Middle Eastern individuals), environment, medications, sleep disruption, chronic stress, and menopause—these can create a metabolic “lock.”
For the right patient, GLP-1 therapy isn’t a shortcut. It’s the tool that finally allows the lifestyle work to work.
3) “Will I regain weight if I stop?”
This is one of the most searched—and most important—questions.
Some weight regain is common if GLP-1 therapy is stopped. The key question is: regain how much, and what happens to your metabolic health?
In my practice, we don’t guess. We individualize. If you started GLP-1 therapy for obesity, prediabetes, type 2 diabetes, fatty liver, sleep apnea, or metabolic risk, we treat it like what it is: a chronic metabolic condition, not a short course.
If your numbers improve—A1c stabilizes, visceral fat drops, lean mass rises—we can discuss a slow, monitored dose reduction in select patients. The goal is always the same: build a metabolic reserve so your body can maintain progress.
4) “Is long-term GLP-1 use safe?”
GLP-1 medications have been used in diabetes care since 2005–2007. We now have extensive data—especially for type 2 diabetes—and strong evidence of broader benefits, including cardiovascular risk reduction in higher-risk individuals.
But here’s the truth: Safety is not just about the medication. Safety is about medical oversight.
That’s why I caution patients about “one-click” prescribing or trend-driven models. True safety includes:
Appropriate screening and labs
Thoughtful dose titration (based on your tolerance and gut health)
Ongoing monitoring and education
A plan to preserve muscle and nutrition, not suppress eating entirely
You deserve expertise—not just access.
5) “What matters more: the scale or body composition?”
Body composition. Every time.
The scale can be misleading. Two people can weigh the same and have completely different health trajectories. You can look “fine” and still have high visceral fat and low muscle—what many people call “skinny fat.”
Muscle is not cosmetic. Muscle is metabolic. It improves insulin sensitivity, supports bone health, reduces inflammation, and strengthens long-term resilience.
So if you take one thing from this 5-minute read, let it be this:
Stop chasing weight loss. Start chasing strength, energy, and metabolic health.
My commitment to you
Endocrinology is nuanced. Hormones are complex. Metabolism is not a willpower issue.
That’s why at Unified Endocrine & Diabetes Care, I provide 60–75 minute consultations built on time, trust, and transformation—whether you’re seeking a one-time expert second opinion or ongoing specialty care.
If you’re in Lafayette, Walnut Creek, San Francisco, Palo Alto, Menlo Park, Silicon Valley, or anywhere in California via telemedicine, and you want a clear, science-based plan for GLP-1 therapy, insulin resistance, diabetes prevention, menopause metabolism, thyroid health, or body composition, we’re here.
Ready for clarity—even if it’s just one visit?
Your health isn’t a trend. It’s your most important long-term investment.
By Dr. Chhaya Makhija, MD, DipABLM
Board-Certified Endocrinologist | Lifestyle Medicine Physician | Founder, Unified Endocrine & Diabetes Care
Lafayette • Fresno • California Telemedicine (including Silicon Valley, Palo Alto, Menlo Park, San Francisco, Walnut Creek, Oakland, Sacramento)
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