Lost a ton of weight on Semaglutide and am having some issues now.

Medical Q&A [Moderated]
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Two years ago I was put on Semaglutide (Wegovy specifically) for weight loss. At the time I weighed 260 pounds at 5’9; I believe I even made a thread about it here. Anyway I’m now down to 160 pounds (and on Tirzepatide in the form of Zepbound), which according to my endocrinologist is the best result he’s ever seen. This has been a fantastic boon for my mental health. I got a lower body lift to remove some loose skin and have never felt better about how I look.

Unfortunately a couple issues have come up:

The entire time I have lost weight I did not exercise. I used to be a pretty solid lifter with a competitive total, and taking so much time off has left me with a ton of anxiety about going back. I’m stuck in the “I’ll start tomorrow” loop, as well as a perfectionist mindset telling me when I finally do start I have to do it exactly right. This has been an incredibly difficult hurdle, more so than I ever expected.

I’m worried about what my strength level is going to be at this new body weight. I have this irrational fear that I’m going to run into the old crew I lifted with and they’ll see me unable to lift the bar, or that losing all this weight is going to make lifting feel totally different than it used to. This has been a surprisingly solid wall gating me from simply going to the gym. I know it’s irrational but I feel an actual mental block in my mind preventing me from going back.

Another issue is I barely eat now. I usually have one meal a day and it’s often not nutritious at all. Because of my changed relationship with food I don’t really think about it ever, and when I do eat it’s usually to get it over with, as if it’s an inconvenience. The medication has aided me greatly but it wasn’t without its negative side effects. My endocrinologist wants me to lose a little more weight to create a “buffer” zone where we can start lowering the medication to see what dose is correct for me now. I think this is a good idea but it’s a long term experiment, and I know I need to make changes now.

Finally, my energy levels are absolutely awful. I have always been a low energy type, but now I feel exhausted all the time. I had a sleep study post weight loss that showed no issues, and my psychiatrist put me on Adderall for excessive daytime sleepiness. Unfortunately, it didn’t seem to work and actually has the opposite effect at times. I’m sure getting my body moving and eating more food would help, but like I said I’ve always been low energy even when I was at my fittest.

Some other quick possibly pertinent details:

  • I got off TRT entirely and my levels have returned to normal.
  • Blood work has shown no abnormalities.
  • Overall I feel “healthier” even with the exhaustion.
  • I’m turning 39 this year and am a very late bloomer in life. I’m just now getting my education and career under control. I’m working on a BS and eventually an MS with the goal of teaching at the community college I currently work for as an IT apprentice.

I have been following BBM for half a decade now I believe and have an incredible amount of respect for your wisdom, so I figured I’d throw this thread out on the forum to see what I could glean from your insight.

I truly appreciate your time and dedication.

Thank you.

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GL,

Thanks for the post and welcome back to the forum. Good to “see” you again. Also, nice work on the weight loss. Plus the education glow up? Talk about life changing…

Not to take too many shortcuts here, but it seems like the main obstacles here are energy, hesitance of doing something that’s “not optimal”, and some fear of embarrassment.

For the energy, I think it’s unlikely to be something I can solve via a forum post…but I do think that under-eating could be contributory. I tend to have the folks I work with who are on these agents plan and schedule both their pre- and post-workout meals. I typically have them aim for ~300-500 Cals in the meal/snack before the workout, and 400-500 Cals in the post workout meal. From a workout perspective, I think that’s likely to help energy levels, though it may not touch the other feelings of exhaustion. There’s more to a fatigue work up that is beyond the scope of what we can do on the forum, though we do consultations

Regarding the non-optimal workouts and concerns of embarrassment, I do wonder who amenable you’d be to going to a different commercial gym to get your legs back from under you. With the feelings of exhaustion, low energy intake, extensive detraining, and your training history, I’d have some significant concerns of an overuse injury upon your return. While making a lot of good decisions around loading, exercise and load selection, etc. would help reduce this risk, I would favor a 2-3 month “return to training” program that starts with predominantly machines, dumbbells, and, and exercises you don’t have a history with. Towards the end of that program, I’d start reintroducing more familiar exercises per your preferences. If you were up for something like that, I think our time crunch program
would give you a bunch of options and not be too intrusive time-wise.

Just my 0.02.

-Jordan

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Thank you for the reply Dr. Feigenbaum.

And thank you for the kind words! I included that bit because I do feel the pretty drastic change to my lifestyle and priorities has been one of the key factors preventing my return to the gym. I have a lot more going on these days in other words.

I was considering an official consultation to discuss the energy issue a bit more in depth. I’ve spoken with my psychiatrist, neurologist, a sleep specialist, and my GP about it and it has yet to be “solved”. It’s not new with the weight loss and has been a persistent issue as far back as I can remember.

Your “return to training” program is exactly the kind of solution I was looking for, and definitely something I had not considered. Going to a commercial gym for a couple months and working with machines would definitely reduce a lot of the pressure I’m feeling over a return to my old powerlifting gym. I’ll add the Time Crunch program to my collection of BBM templates (all of which have been incredible, especially with the app).

Please let me know if I seem like a good fit for a consultation and I’ll schedule one right away.

Thanks again,

Gabriel

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Sounds like a plan, Gabriel.

I think you are likely to benefit the most from a consultation after a 2-3 week trial of the changes I suggested above, as that would give us some feedback on how restarting exercise went for you alongside some other lifestyle changes. It does sound like you’ve been worked up extensively for fatigue, but we’d have to review your medical history to know if anything was missed. I think that could be addressed, at least in part, with a consultation at that time.

-Jordan

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Thanks again Dr. Feigenbaum. I’m excited to get back to it after so long. I hope to update this thread with positive progress in a few weeks.

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Okay here’s my update, and I wish it was better news (though there is some good news). My old coach contacted me and suggested I meet with him for a few lessons, and it turns out having a set meeting time finally got me in. Unfortunately I don’t think he was prepared for how out of shape I really am, as even with VERY little work I still massively overdid it. I ended up pulling over and puking on the way home, had lung pain afterward, and then an hour of chills later in the day. I’m finally starting to feel better five hours after the fact.

I believe this is due to my calorie intake still being incredibly small. I simply do not think about food until something or someone reminds me, “Hey you didn’t eat!” The Zepbound has also made me significantly more picky, which limits my choices of healthy food. My endocrinologist changed my dose to every 10 days instead of 7 a few weeks back, and I have a note to call him tomorrow with this update.

The small bit of good news is I still plan on going back on Thursday and will try to find a better entry point. I was really humbled, but there’s no use feeling bad about it and continuing to make the same mistakes.

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Ah, sorry to hear this. I can imagine this was both frustrating and unpleasant.

If I may, what type of workout did your coach have you do? At the risk of jumping the gun, I have some concerns there given your experience.

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He’s pretty great so he understood to only assign some machine and dumbbell work. I even felt like we were taking it incredibly easy but it still completely overwhelmed my system.

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Yea, I’m more concerned with the total training load vs the implements used, but I’m hopeful you’ll be back in the gym today or tomorrow!

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Ah, in that case we probably did go too heavy. I plan on switching it up next time I go in. I’ll still follow his program because it’s mostly what you recommended here (machine/dumbbell) but I’m going to max out at something like an RPE 7, maybe even less.

Quick question, I can tell the tendons in my elbows took a beating based on the doms, but I can still get work in without exacerbating the problem if I pick light enough weight, correct?

Also, thank you for taking the time to reply to my posts. I feel like this is a unique case study for tirzepatide, drastic weight loss, and gym anxiety and I really appreciate your thoughtful input.

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I don’t think your tendons in your elbows are likely to be worse off if you exercise again, no. I would definitely train again. If you have this same experience after seeing your previous coach again, I would strongly encourage you to do a different program.

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Thank you again. Next time I’ll have more autonomy so I’ll make sure to listen to my body and try to key in new RPE levels.

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I finally made it back in and the session was a success. I kept the weight low and ended up with no adverse affects. I also discovered that a small crowd doesn’t bother me as much as it used to, likely due to a combination of medication and therapy.

I believe I’m on the right track now, but I’m still considering a consultation in the future just to go over my health with people who’s opinion I greatly value.

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Great to hear! Keep it up. We’ll be here when you need us.