LIFTS Episode 116 - GLP-1s Are Changing Fitness: What Gym Operators Need to Know | PerformX Special (Part 2 of 3) | with Dr Hussain Al-Zubaidi

0:00And in terms of the evidence, it's important in terms of three phases. Before they start the medication, those that do best need to achieve that 5 % to 7 % body weight loss, not on the injection. The reason that you want to try and achieve that before intervention is because you vastly increase the likelihood of weight maintenance if they come off it or even if they stay on a maintenance dose. and when they're on treatment ensuring that that weight loss is both sustained but slow and ensuring that that weight loss is assessed not based on the kilos but on the body composition and ensuring also that they are getting those healthy habits that are going to build long-term sustainable health we're looking for health gained rather than weight lost because that's really what's going to show the improvement and there was a study published last month in the British Medical Journal, which looked at post intervention, what was the rapidity of the weight regain for people off injections.

0:58And the new ones that are coming out, yes, they see really significant weight loss, but they also see faster weight regain. So compared to behavioral programs, weight regain off these injections is from four to eight times faster, depending on the agent being used.

1:18Matthew Januszek:Hello, hello, hello. Hello indeed. Good afternoon. Are we still awake? We're going to have to bring the energy up. This is a thinner audience, but it's the best group. The ones that stay to the end are the ones that are most committed. So anyway, welcome to the final session of the day. We're here representing PerformX, so we appreciate being invited here. And also, we do a podcast each week, a fitness industry podcast each week called Lifts. And so for those of you that want to listen to this session again, or if you've got anyone else that's interested in it, then we'll be putting this out live in the next couple of weeks.

2:00Matthew Januszek:So I'm Matthew Januzek, and I'm here with my co-host, Mohamed Iqbal. How are you doing today, I'm doing good, Matthew. I'm really excited for this conversation because GLP-1 is where we live. I know you are originally from the UK, but I always say you are an honorary US citizen now. You've been there eight years? Eight years, yeah. I'm from Peterborough originally, and I've still got my accent. But now you're in Newport Beach. GLP-1 in the U.S. has just exploded over the last couple of years, which I think is a good thing overall because obesity in the U.S. is really getting out of control. And for the first time, and it's interesting because a lot of people who are not American, who travel to America or think about America, think about it being a paradox.

2:48paradox where you've got a very unhealthy overall population that is full of chronic disease, but then also a very fit wellness-focused culture. And the obesity rate in America for the last five decades has been increasing every single year until last year. So for the first time, the obesity rate in America actually went on a decline. And there's a lot of factors for that, better accessibility to food, the COVID pandemic increasing awareness on health. 28 % of Americans now participate in fitness gyms and studios, so there's awareness around that. National parks are at a high number. But also, nearly 10 % of Americans have now taken a GLP-1 drug.

3:35And in January of this year, in 2026, GLP-1s now came out in a pill format. But here's the thing. In the United States, like many things, things are just more accessible and more available and in some cases more affordable. So the private access to GLP-1s, and a lot of it is largely not covered by insurance. And in fact, insurance is covering not only less cases of people who are getting on a GLP-1, but also when you're on it for much more limited time. So originally they might have been covering it for a year at a dose that is pretty effective. Now it might be three months and they're not even covering a maintenance dose, but people are spending money and finding other ways to get GLP-1s.

4:22In the UK, however, just shifting gears here, you still have an obesity epidemic. About 28 % of the UK population is obese. only 15 % of the population in the UK participates in fitness or wellness. Yet, GLP-1 has taken a very different pathway towards accessibility in that a lot of it is largely driven by the criteria set by the NHS, but private access to GLP-1s are actually increasing. I remember us coming here a year ago, Matthew, and I think we mentioned GLP-1s, looked that at the audience, a lot of people said, I did not know what that was. And I even did a talk in Australia at the end of last year.

5:05They have not even heard of GLP-1s. But today, it certainly is very much part of the active conversation. So I'm really excited to have Dr. Hossain here. So one, welcome to Performix and also welcome to Lyfts. Thank you for having me. Well, if you could maybe start by giving a 30-second overview on your background and your role. Yeah. Hi, my name's Hossain. I'm a GP. I'm also a personal trainer and a health coach. and I work with a number of organizations. I'm the Royal College of GPs, Lifestyle and Physical Activity Lead. In my Leamington Primary Care Network, I'm the Personalized Care Lead. And at FutureFit, I deliver training for fitness professionals on obesity management and GLP-1s.

5:45And the largest NHS educator, I lead their obesity and lifestyle medicine course.

5:51Matthew Januszek:Well, look, just you mentioned that we raised GLP-1 last year and the fact that when you went to Australia, there was not too many people knew about it. I just thought for a start, we'll just have a show of hands for a couple of questions just to see sort of where GLP Ones is in many of the businesses out there. So quick question. Raise your hand if you're either a trainer or own a facility where your members are actually using GLP Ones. Okay, so probably around about half, would you say? About 50 % of people there? Yeah. Now, raise your hands if you think that GLP-1s is a threat to your sort of traditional fitness business.

6:34Matthew Januszek:I've got no hands there, so no concerns. Raise your hand if you're running any sort of special program or specific program for GLP-1s. Okay, relatively small number. and raise your hands again if GLP-1 programming of any type is some kind of strategic priority. Okay. I think that's pretty interesting. So in the United States, 8 % of all new members in 2025 joined the gym because they were on a GLP-1. So I think, you know, as an operator, if you have someone coming through your doors in your front desk, one, and those are people who have actually stated that they're on GLP-1, I would assume that the number might even be higher than that, but just think about that for a minute.

7:25If your trainers or people in sales or even how the gym is structured and set up is not welcoming to someone who might never have stepped foot into the gym, it could really be intimidating. So I think the first question to you is, one, from a UK perspective, when people get on a GLP-1? Are you prescribing them a fitness, nutrition, and workout program? And how important is it for them to stay on that during the treatment and also after? Yeah, really good question. And it will differ depending on the provider because in the UK, the majority of prescriptions of the nearly two and a half million people in the UK that are on them access that privately.

8:04There's only a very small proportion that get it through the NHS that it's around 220 ,000 over the next three years and I'll go into why that is in a second but from the private providers you get a big range you get some where it's essentially focusing on the prescription and giving them some signposting in terms of leaflets information but no genuine support around dietician physical activity behavioral support and you do have others where they're going beyond that and they're looking to support them in a holistic way and in terms of the evidence like it's important in terms of three phases before they start the medication those that do best need to achieve about five to seven percent body weight loss not on the injection the reason that you want to try and achieve that before intervention is because you vastly increase the likelihood of weight maintenance if they come off it or even if they stay on a maintenance dose and when they're on treatment ensuring that that weight loss is both sustained but slow and ensuring that that weight loss is assessed not based on the kilos but on the body composition and ensuring also that they are getting those healthy habits that are going to build long-term sustainable health.

9:12The key thing that we often say in our service is we're looking for health gained rather than weight lost because that's really what's going to show the improvement and there was a study published last month in the British Medical Journal which looked at post-intervention what was the rapidity of the weight regain for people off injections. And the new ones that are coming out, yes, they see really significant weight loss, but they also see faster weight regain. So compared to behavioral programs, weight regain off these injections is from four to eight times faster, depending on the agent being used.

9:46And that's a really big issue. And it's that issue is why the NHS is being very cautious over its investment, because if we're going to roll it out, it's going to cost about three billion per year. If we see weight regain, then you will not get the outcomes that you need to make it a cost-effective intervention.

10:03Matthew Januszek:Yeah, I was reading before this interview that muscle loss with people that are taking GLP-1s, according to this step trial, was around about 25 to 40 percent of lean muscle mass. So with many people here in the fitness and wellness industry, Like, what's the opportunity to sort of almost, like, offset some of the challenges that people are getting from using the drugs? Yeah. Like, it's both a combination of sarcopenia and dinapenia. So, like, it's both the bulk and the function and quality of the muscle that really matters. And it matters for so many reasons. If we're focusing purely on terms of obesity, if we can improve the ratio, the body composition, at the end of intervention, you'll vastly increase the chances that they can have resistance to weight regain.

10:51If you think of the muscles, not as important for movement, which they are, but instead as metabolically active organs, these store glucose as glycogen. So they're great sinks. Think of them as car parks. And you want big car parks, but you also want car parks that you know where to find the spaces, with attendants that direct you the way. And that's when we talk about muscle quality. So what is their insulin sensitivity, etc.? So when someone eats a meal, if they don't have a big car park and they don't have any attendance showing the way, when that car's come in, they'll fill up the small car parks.

11:22They won't really use them efficiently. And then they have to go to the overflow car park, which is the fat. And that fat can be subcutaneous, but also visceral fat, which is then going to lead to further metabolic issues. So what we want to try and do through the intervention is we want to make bigger car parks. We want to make better car parks with signs and green and red lights that therefore all the energy can move through. and that really does improve the resistance to weight regain. And there was a trial that looked at liraglutide, which was one of the older GLP-1s, alongside supervised exercise, and looked at the weight regain afterwards.

11:55So 12 months after stopping treatment and the exercise, you had six kilos regain on just the injection and only two and a half kilos regain on the injection plus physical activity. So it is, at the moment, the biggest lever when it comes to the weight regain angle. So it's interesting in terms of, one, we'd love to get your perspective on accessibility. So the NHS has this strict criteria. Some of it is because of cost restrictions. What do you think the plan is? So obviously, GLP-1, weight in general, chronic conditions, obesity, we can go on and on, but leads so much to chronic conditions, which could then lead to heart disease, which is the number one killer of all cause mortality.

12:40So when you start there, you're like, well, to reduce all-cause mortality, which is a big impact to the NHS, a big cost of the NHS overall. Well, you would think that if I make an investment down the chain in a GLP-1, maybe even furthermore down the chain into preventative care, that it would reduce the overall cost of the system. But is there something that is either not clicking or not happening? I mean, I'd just love to get your perspective because you work at the NHS. Absolutely. And I work at a national level making these kind of decisions in my role at the college. And the simple fact is, when you look at the evidence and all the agents that are currently licensed in the UK, none of them meet the threshold that if you just simply give them, you will get your money back.

13:23The reason I say that is, let's say we look at disepatide. The cost that you would need to spend in order to see an improvement in one quality adjusted life year is just under£20 ,000 in a very specific population. That's a BMI of 35 and over, and they need to have one or more weight-related comorbidity. You need to invest that amount of money in order to improve the markers, which means you get the outcome of improved quality of life, reduced impact on health. And the issue is that that's all great, and that's assuming that they don't regain weight. But sadly, they do. They do. The vast majority, for example, coming up to Zepatide, will regain all of the weight they lost within a year and a half.

14:00and even if they stay on the injections, although there is no published data from the pharmaceutical companies, we know from clinical consensus that even if they stay at the dose, they're going to start regaining weight. And so we need to ensure that we have mechanisms in place that means that the investment we put in, which is estimated at under 3 billion per year in the UK to deliver it in the NHS, that we get that back. Because sadly, we have a limited purse. We can't just look for short-term solutions. So we need to see how can we apply these injections in such a way that we get continued benefits, not just over two years where they work brilliantly.

14:37If you tell me over one two-year period, they're brilliant. You can lose up to 21 % body weight loss to Zepatide. But then if I look three years down the line, assuming that they stopped it after a year and a year and a half, they're back to where they started. Is there something, as an example, with the NHS that has been deployed where you've seen that return successfully? Yeah, no, like there are lots of instances where we see the benefit in terms of cost effectiveness. When NICE decide whether an intervention is cost effective enough, the threshold that they use is 20 ,000 or cheaper per quality adjusted life year that is gained.

15:13And there's loads of interventions. Now, what is a shame is that a lot of the preventative elements, that's if we just want to get a physical activity program to support people with their strength and their aerobic benefit. The cost of that is actually peanuts. The cost is peanuts. The issue is that when it comes to delivering that, there is a real mismatch in terms of the willingness and the ability to scale it at a national level. But we know that would help. It's the challenges in trying to do that. So we're trying to shift to that preventative model. But there's so many hurdles that means that trying to, let's say, encourage and support people with long-term conditions to get access to the physical activity offering that they need, there's just so many missing bits in the system, which is a shame.

15:53And it's because the healthcare system has been built and designed around an acute problem solution. You know, back in the late 40s when the NHS was created, we didn't really have a problem with long-term conditions. And so the 10-minute consultation, the referrals to the hospitals, every way that it's been built is not designed for the problems we have today. And it's going to take a long time to restructure it. A system like the NHS, seventh biggest company in the world, that's going to take time to adjust to the present landscape.

16:22Matthew Januszek:today's episode of the lifts podcast is sponsored by egym egym delivers smart strength solutions that help gyms and health clubs attract engage and retain members while improving health outcomes at scale from intelligent equipment to ai-powered training programming and corporate wellness via well pass egym is leading the way in smart fitness visit egym.com to learn more

16:47Matthew Januszek:one of the things that i've been reading there's there's a lot of new research coming out around GLP-1s and a lot of time we're focusing on people with obesity but it seems that it's a bit of a miracle drug because it reduces all kinds of issues and illnesses and almost like helps people live a lot longer and better quality of life. What are you seeing probably that may not be necessarily recognized by the NHS at the moment but do you it seems like we're still at the very beginning of people using GLP-1s. And it looks like that probably over the next decade, many more people, not just people obese, are going to be using it because it makes such a huge difference on all kinds of diseases that we're still understanding a little bit more about.

17:34Matthew Januszek:What do you know about that? And would you generally agree with that as a direction? So I would never use the term that GLP-1 is a miracle drug, in my opinion. I think GLP-1 is a brilliant tool for those living with obesity because we know that obesity has strong genetic components as well as social determinants which influence it and yes there is growing evidence in particular around conditions where there is a kind of a reward element so things like adhd gambling alcohol addiction we're seeing that actually the fact that glp1 not only acts on insulin sensitivity glucagon etc it acts on the reward centers in the brain we're seeing improvements in those elements Now, we need better and longer trials to really ascertain whether this is something that is safe and appropriate for someone without obesity.

18:21But time will tell, and evidence definitely is pouring in. Now, there are other agents that are beyond GLP-1s, like they're looking at some of the other neurogastric hormones as well as the other peptides. And that's going to be interesting, and we'll see how they evolve. But what we need to be careful of is, for example, if someone came in with osteoarthritis of their knee, and I gave them a knee brace, it improves things. in the short term. In the long term, it makes things worse because what happens is it deconditions the muscles that was trying to support the joint and it relies more on the brace.

18:54That what can happen in GLP-1s if they're inappropriately prescribed because GLP-1s can make things easier, but then everything that's around that actually needs to support what's happening, they decondition. We've seen that in the same when it comes to opiates and giving long-term painkillers. Yes, it provides great relief over eight weeks. Beyond that, you run into whole issues that both our countries are struggling with. Antidepressants as well, great in the short term if they're applied correctly and they're used in a holistic manner, but if they become a reliant tool, then actually outcomes are worse.

19:24So we do need to be careful how we utilize pharmacology, and we need to use it at the minimum effective dose and not instead of. It has to not ever be framed as the solution, but it needs to be framed as a really useful tool for some people that are really struggling. What we need to realize, especially in obesity, it's not really an individual issue. It's a community issue because there are so many social determinants, whether it be disabilities, deprivation, that really play a much bigger role when it comes to obesity than just individual choices. We need to create an environment that produces health rather than illness.

20:01The pill form came out early this year. Is that available in the UK yet? Not yet. Not yet, okay. So in the U.S., you can now take a daily pill of a GLP-1, and the adoption of that has been incredible and through the roof. And as you see that happen, I would love to get your perspective from a gym-operated perspective. So what I've seen is a lot of gyms that we work with, both digital and physical, have adopted things like talking about strength training and education around that, but also the importance of VO2 max and understanding how to improve that, eating more protein, making that a central focus of your meal planning and meal prep.

20:39What are some things that as an operator that they could do? Because to your point, when someone is on a GLP-1, whether you know it or not, how instrumental of a role does that frontline worker, as I call it, is the fitness operator? Because they might only see you at very specific points, maybe during the assessment, at specific points during the treatment, but they could be going into their gym three, four times a week. So to me, that is the front line, right? Which I know is interesting from a medical perspective because I'm sure your colleagues would say, hey, we're the front line. How can operators be best prepared for someone who's coming in with the GLP-1?

21:19What kind of program should they be thinking about such that they don't gain that weight once they come off the treatment? Yeah, really good question. So first and foremost, it needs to be a place where they feel comfortable, confident, and not judged. And we need to avoid wanting to just give advice. Because a lot of time, these people get advice from everyone. From their family that tell them, oh, you should just do this and do that. From the doctor who says you just need to move more and eat less. And so try to avoid just wanting to blurt out lots of helpful, often, but advice. Instead, listen to them.

21:53Ask them, what are the challenges you're facing? because people with obesity aren't just some homogenous group. Some of them actually super fit, super strong, already go to the gym lots, have great muscle already. Some may really struggle with confidence, haven't been physically active or physically literate for a long time. So firstly, just listen to them and find out what do they actually need rather than just giving them some generic advice. When it comes to the nutrition side, we want to get a grounding in food quality rather than just calorie tracking because we want to improve the actual makeup of the diet to ensure that one, they're able to fuel the workouts, two, that they're not looking as the best result is the quickest weight loss.

22:32Because actually the quicker the weight loss is, the worse you see in terms of the body composition that they're losing. So you're gonna lose more muscle mass the quicker it is. And what we wanna do is get them to see the right outcomes. So often they'll look at the scales as the outcome for what they're doing. And often when they start becoming physically active, actually you don't lose that much weight. You may even gain a bit because you're gaining a bit of muscle, you're improving body composition so do you have access to high quality body composition assessment but one of the things that we've got in our nhs facility is we've got a seeker device which is high quality high grade and people can track they see what they're doing and so they don't stress that okay i haven't lost any weight but actually i lost three kilos of fat and i've gained a lot of muscle these are the kind of things get them to assess the right stuff and then in terms of the programs that you're delivering name them correctly do not name this the obesity group or the GLP-1, let's help me.

23:23Like, give it a positive frame and instead focus on, you know, using the terms that they're looking for. You know, improved health, feeling stronger, feeling more confident. Even things like toning can be better than just talking about purely weight loss. And then really consider the impacts that these medications have. You're on a calorie restriction because of the appetite suppression. So be mindful that they're going to maybe struggle with energy. So how can you make them feel like they're still getting a useful and meaningful workout by just reducing the intensity a bit, maybe reducing the length, focusing on things that matter.

23:55And how can you build the advice you give around the specific needs? So identifying that, look, let's support you maintain that muscle mass. Let's support you improving your baseline fitness. Let's support you being more confident in your body and how it moves. So focus on functional things, things that are going to mean that next week, next month feels that bit easier. So it's simple things that often matters to people. How easy is it to get up the stairs? How easy is it to pick up the kids or the grandkids? How easy is it to walk to work? You know, these are the things that often changes quality of life.

24:26So yeah, so consider the side effects, consider the importance of muscle preservation, and consider getting them to track the right things, not the kilos on the scales. I literally don't even care. Like when I'm doing the assessment and reviews of patients, I don't care how many kilos they've lost. I care more about what's actually happening. metabolically and composition-wise.

24:46Matthew Januszek:You mentioned that there's different groups of people that are coming into the gym, some people that are already going to gyms and that are fit, but a big percentage of the people that are on them have probably never worked out, which is partly the reason why they're taking this in the first place. You're involved in an education organization. Where do you think the education level is in terms of being able to treat this specific... It is a specific, I guess, demographic where there's specific requirements, both on the, I guess, communication and coaching level, and then also on how to deliver programs for people that probably have very, very limited ability to do some of the exercise.