Direct Line April 2026: Stopping Ozempic and Lifting With Osteopenia
Barbell Medicine Podcast
Barbell Medicine
4.8 • 1.3K Ratings
🗓️ 21 April 2026
⏱️ 41 minutes
🧾️ Download transcript
Summary
Stop a GLP-1 and about two thirds of the weight loss comes back within a year. Three randomized withdrawal trials (SURMOUNT-4, STEP 1 extension, STEP 4) and a new BMJ 2026 systematic review of 37 RCTs and nearly 10,000 adults all land on the same signal. The cardiometabolic benefits, blood pressure, fasting glucose, lipids, drift back in parallel with the weight. The framing that actually fits the data: GLP-1s behave like a statin. There is a cumulative benefit during exposure, but this does not extend indefinitely,
This month's Direct Line covers two subscriber questions. The first asks what the new BMJ paper on GLP-1 cardiovascular protection after cessation actually shows, and how GLP-1 durability compares to lifestyle-only interventions. The second asks how a postmenopausal woman newly diagnosed with osteopenia should structure her lifting.
Studies referenced: SURMOUNT-4 (Jastreboff, JAMA 2024), STEP 1 extension (Wilding, Diabetes Obes Metab 2022), STEP 4 (Rubino, JAMA 2021), West et al. BMJ 2026 systematic review, Budini 2026 eClinicalMedicine regain meta-analysis, SELECT cardiovascular outcomes, FLOW renal outcomes, the Diabetes Prevention Program, Look AHEAD, POUNDS Lost, and LIFTMOR (Watson, JBMR 2018).
Full episode on BBM+ covers 8 additional subscriber questions. Join at https://barbellmedicine.supercast.com/
Timestamps
- 0:00 Intro
- 1:52 Q1: What happens when you stop a GLP-1
- 5:33 Lifestyle-only comparators: DPP, Look AHEAD, POUNDS Lost
- 8:15 Austin on the cessation conversation 1
- 2:41 BMJ 2026: weight and cardiometabolic regression
- 17:59 The statin framing
- 23:41 Austin: first 6 months off GLP-1
- 28:07 Q2: Osteopenia and heavy lifting
- 35:28 LIFTMOR protocol
- 38:00 Outro
Next Steps
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- Explore our full library of articles on health and performance: barbellmedicine.com/resources
- To consult with Drs. Baraki or Feigenbaum email us at support@barbellmedicine.com
Resources
Aronne, Louis J., et al. "Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial." JAMA, vol. 331, no. 1, 2024, pp. 38–48. https://jamanetwork.com/journals/jama/fullarticle/2812936
Wilding, John P. H., et al. "Weight Regain and Cardiometabolic Effects After Withdrawal of Semaglutide: The STEP 1 Trial Extension." Diabetes, Obesity and Metabolism, vol. 24, no. 8, Aug. 2022, pp. 1553–1564. https://dom-pubs.onlinelibrary.wiley.com/doi/10.1111/dom.14725
Rubino, Domenica, et al. "Effect of Continued Weekly Subcutaneous Semaglutide vs Placebo on Weight Loss Maintenance in Adults With Overweight or Obesity: The STEP 4 Randomized Clinical Trial." JAMA, vol. 325, no. 14, 2021, pp. 1414–1425. https://jamanetwork.com/journals/jama/fullarticle/2777886
West, Sam, et al. "Weight Regain After Cessation of Medication for Weight Management: Systematic Review and Meta-Analysis." BMJ, vol. 392, 7 Jan. 2026, article e085304. https://www.bmj.com/content/392/bmj-2025-085304
Budini, Brajan, et al. "Trajectory of Weight Regain After Cessation of GLP-1 Receptor Agonists: A Systematic Review and Nonlinear Meta-Regression." eClinicalMedicine, vol. 93, 4 Mar. 2026, article 103796. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(26)00043-X/fulltext
Lincoff, A. Michael, et al. "Semaglutide and Cardiovascular Outcomes in Obesity Without Diabetes." New England Journal of Medicine, vol. 389, no. 24, 11 Nov. 2023, pp. 2221–2232. https://www.nejm.org/doi/full/10.1056/NEJMoa2307563
Perkovic, Vlado, et al. "Effects of Semaglutide on Chronic Kidney Disease in Patients with Type 2 Diabetes." New England Journal of Medicine, vol. 391, no. 2, 24 May 2024, pp. 109–121. https://www.nejm.org/doi/full/10.1056/NEJMoa2403347
Knowler, William C., et al. "Reduction in the Incidence of Type 2 Diabetes with Lifestyle Intervention or Metformin." New England Journal of Medicine, vol. 346, no. 6, 7 Feb. 2002, pp. 393–403. https://www.nejm.org/doi/full/10.1056/NEJMoa012512
Look AHEAD Research Group. "Cardiovascular Effects of Intensive Lifestyle Intervention in Type 2 Diabetes." New England Journal of Medicine, vol. 369, no. 2, 11 July 2013, pp. 145–154. https://www.nejm.org/doi/full/10.1056/NEJMoa1212914
Sacks, Frank M., et al. "Comparison of Weight-Loss Diets with Different Compositions of Fat, Protein, and Carbohydrates." New England Journal of Medicine, vol. 360, no. 9, 26 Feb. 2009, pp. 859–873. https://www.nejm.org/doi/full/10.1056/NEJMoa0804748
Watson, Shelley L., et al. "High-Intensity Resistance and Impact Training Improves Bone Mineral Density and Physical Function in Postmenopausal Women With Osteopenia and Osteoporosis: The LIFTMOR Randomized Controlled Trial." Journal of Bone and Mineral Research, vol. 33, no. 2, 2018, pp. 211–220. https://onlinelibrary.wiley.com/doi/10.1002/jbmr.3284
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Transcript
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| 0:00.0 | Welcome back to the barbell medicine podcast. I'm Dr. Jordan Feigenbaum, and this is the direct line, our monthly podcast for our Barbell Medicine Plus subscribers. |
| 0:08.9 | In this episode, we cover what exactly happens when you come off at GLP1, a real plan for lifting with osteopenia, calcinex versus barbells for a woman in perimenopause, and a critical look at Dr. Gregor's daily dozen, also the dirty |
| 0:22.2 | dozen, and why your strawberries are fine, as well as picking a bone with the orthopedic cost narrative |
| 0:27.4 | around the spine. All that, plus the new ACSM resistance training standards, how to train |
| 0:32.4 | the frail elderly, and more, and to help us argue with your drunk uncle, your orthopedist, |
| 0:37.4 | the environmental working group, and Sabrina Carpenter, it's the second most handsome doctor in North America. Dr. Austin Baraki, what's going on, man? I do not know that I have such a diverse skill set as to take on all of those targets. It's actually the same argument for each of them. Have you tried caring less? That'll work. All right. Fair enough. How are things going? |
| 0:57.3 | Hectic. I've been in the hospital for a couple days and today was a particularly busy day. |
| 1:02.9 | Had about, I think, 16 inpatients that I saw with my team and managed to discharge about half of them, |
| 1:09.4 | had an ICU transfer for a relatively rare |
| 1:11.6 | diagnosis that needed more urgent management. So yeah, a lot going on today. You busy. Okay, |
| 1:16.6 | so not enough to keep up with the what's happening with Sabrina Carpenter, the Coachella |
| 1:19.8 | controversy. My wife and I did Couchella before I started in the hospital. So I just started on |
| 1:25.7 | Monday. So we did sit on the couch and watch some of the main acts, and that was one of them. The contrast between some of those headliners in terms of, let's call it the effort that they put into their show was amusing to us. I mean, I just hope that at some point I can just get on stage and play a YouTube playlist, like just our greatest hits maybe, you know? I don't know. Yeah. All right. Well, let's start |
| 1:45.1 | off here. We're going to start with GLP-1's. No surprise. Its first question came from, again, |
| 1:50.3 | one of our Barbillin-plus subscribers, and it points at something most of the popular coverage on |
| 1:54.7 | GLP-1's has missed. The question is, what are your thoughts on the new British Medical Journal paper |
| 1:59.3 | showing that GLP-1 cardiovascular protection fades after stopping and more broadly what is the |
| 2:05.1 | durability of effect of gLP ones versus lifestyle versus no intervention so the |
| 2:10.6 | number to keep in your head for this one is two-thirds that's how much of the |
| 2:14.0 | weight someone regains within a year of stopping a gLP one on average the all these trials point to a similar response, and let's go through them one by one relatively quickly here, so we don't want to spend 30 minutes on this answer. First is the surmount four trial. So in this trial, everyone ran a course of terseptide. So that's Zep bound or Monjaro. By week of 36, the group had lost an average of about 20% of their body weight. |
| 2:36.4 | Now, at that point, the trial randomized patients into two arms that were otherwise identical. |
| 2:41.3 | So half continued using terzapitide, the other half switched to placebo. |
... |
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