The “miraculous transformation” myth: ordinary physiology instead of magic
You know that familiar story on social media? An influencer shows a teenage photo - a slightly puffy face, round cheeks and a waist that is not yet clearly defined - next to a current picture with visible abs. The caption reads: “I did this with my unique exercises. Buy my fitness challenge!”
But look at these stories through the lens of physiology, and some of that “success” may have more to do with natural changes and physical development than with miracle workouts.
During adolescence, the body grows rapidly. Its proportions and the distribution of fat and muscle change. Our bodies are literally “finding” their adult shape. Weight fluctuations and fluid retention also affect how we look. But two photographs cannot tell us what actually changed: puffiness, body fat, muscle, or simply the lighting and pose.
It is wonderful when people start moving and eating more mindfully. But presenting natural changes in the body as proof that a “signature method” works is, at the very least, misleading.
The main problem with self-appointed experts is that what worked for one person may not suit another. We each have our own pace of life, stress levels, eating habits and state of health.
When people without relevant training start handing out one-size-fits-all advice, they can push others towards severe food restrictions and excessive exercise. This increases the risk of nutrient deficiencies, menstrual disturbances and injuries, especially while the body is still growing.
Growth and anatomical development involve far more than getting bigger. The body’s structures undergo complex changes. Organs and tissues mature at different rates, and hormones play an important part in that process.
Magic in a syringe: how Ozempic and Mounjaro work, and what you should know
Medicines based on semaglutide and tirzepatide are riding a new wave of popularity around the world: Ozempic, Wegovy, Mounjaro and others.
In simple terms, semaglutide acts on receptors for the hormone GLP-1, while tirzepatide acts on receptors for two hormones, GLP-1 and GIP. These medicines help regulate appetite and can also slow stomach emptying. People feel full sooner and eat less. The European Medicines Agency explains how they work in its information on Wegovy and Mounjaro.
Under a doctor’s supervision, they are an important medical tool. The indications depend on the medicine: Ozempic is approved in the EU for treating type 2 diabetes, while Wegovy and Mounjaro are also used for weight management under specific medical criteria. But when people start injecting these medicines on their own for “a quick 5 kg off before summer”, there is another side to the story.
Rapid weight loss without keeping an eye on nutrition and how you feel can come with weakness and an inadequate intake of nutrients. The face can also lose its natural fullness as fat tissue decreases. The media have dubbed this look “Ozempic face”, although similar changes can happen after weight loss without medication. Photographs of celebrities cannot tell us whether they took medicines or what changed their appearance.
Another problem is weight regain after treatment stops. In the STEP 1 trial extension, participants regained, on average, about two-thirds of the weight they had lost within a year of stopping semaglutide and structured lifestyle support. Obesity is a chronic condition, so this is not necessarily a result of “weak willpower” or a return to old habits. Nutrition, sleep and physical activity matter, but some people need long-term treatment planned with their doctor.
An important anatomical detail: you lose more than fat
Clinical studies show that weight loss with these medicines can reduce lean mass as well as fat mass. But lean mass is not just muscle: it also includes water, organs and other tissues. The percentage of lean mass lost cannot automatically be described as the percentage of muscle lost. For example, in the SURMOUNT-1 study, about 75% of the weight lost was fat and about 25% was lean mass.
Muscles do more than give us definition. They provide:
- Structural support. Muscles support posture and stabilise the body, while the pelvic floor muscles help support the pelvic organs.
- Joint protection. Muscles help control movement and distribute the load on the spine and joints.
- A metabolic engine. Muscles use glucose and play an important role in metabolism.
If you lose strength and stamina along with the kilos, the number on the scales may make you happy, but your body might not. Significant muscle loss can make everyday movement and recovery after exercise harder.
A rehabilitation specialist’s note: when these medicines are prescribed for medical reasons, a comprehensive approach is also needed: manageable strength exercises to preserve muscle, enough protein and other nutrients, sleep, and monitoring how you feel. Rehabilitation exercises can be added when needed. Professional guidance on supporting GLP-1 therapy also stresses the importance of nutrition and strength training.
The fat-burning illusion: why walking is often an easier starting point than running
When someone with excess weight decides to lose it, the first thought is often: “I’ll put on my trainers and go for a run.” As a rehabilitation specialist, I say: first, let’s check whether your body is ready.
Running puts a greater impact load on the musculoskeletal system than walking. But that does not mean every step causes a micro-injury or that running necessarily destroys joints. In a study of Osteoarthritis Initiative participants, running was not associated with an increased risk of symptomatic knee osteoarthritis. Gradual progression, previous injuries, pain and fitness level all matter, alongside body weight.
When it comes to energy sources, the balance between fat and carbohydrates changes as exercise intensity increases:
- During walking, the effort is usually more moderate, and a higher proportion of energy may come from fat. Walking is often easier to keep up comfortably for longer, especially when you are starting out.
- During intense running, the body generally relies more on carbohydrates. But it also uses fat, and the balance depends on intensity, duration, nutrition and fitness.
The takeaway: running usually burns more calories per minute, while walking often fits more easily into everyday life. The proportion of fat used during a single workout does not, on its own, determine how much body fat you will lose. Overall energy balance and regular movement matter for weight management, as explained in the NIDDK guidance.
A rehabilitation specialist’s advice: running is excellent cardiovascular exercise, and not everyone needs to wait until they reach a “normal” weight to start. But if you have not exercised for a long time or have joint pain, walking at a comfortably brisk pace or using an exercise bike may be an easier starting point. We build up gradually and choose the activity individually when pain is present.
The consequences of excess weight: this is about more than appearance
I fully support emotional wellbeing and self-acceptance. At the same time, caring for your health means paying attention to pain, breathlessness and other symptoms. Excess weight, particularly obesity, can increase the risk of several problems:
- Pelvic floor dysfunction. Increased pressure inside the abdomen can put more strain on the pelvic floor muscles. Obesity is associated with a higher risk of urinary incontinence and pelvic organ prolapse, although these are not inevitable and weight is not the only cause. This link is examined in studies of urinary incontinence and prolapse.
- Extra strain on the joints. Additional weight increases the load on the knees and hips and can make movement harder. But changes in posture and pain are not the same for everyone.
- Hormonal and reproductive problems. Fat tissue takes part in hormonal regulation, and excess fat can affect reproductive health.
- Strain on the heart and blood vessels. The risk of high blood pressure and cardiovascular disease increases.
- Metabolic problems. Insulin sensitivity may decrease, and the risk of type 2 diabetes may rise.
These risks are described in the NIDDK information on overweight and obesity. They are a reason to pay attention to health, rather than to diagnose someone by their appearance.
It especially pains me when children face obesity. A child does not yet have a clear understanding of nutrition and movement, so providing support and creating healthy habits is an adult responsibility. But childhood obesity cannot be explained solely by parents’ behaviour: genetics, sleep, health and the environment also play a part. Alongside bullying at school and emotional difficulties, children may experience joint pain and other health problems. They need help and support, rather than shame or punishment. You can read more in the NIDDK guidance for parents.
Bringing it together
Excess weight can affect different systems in the body, beyond our appearance. Our organs and joints do not work in isolation: a change in load in one area can affect how others function.
Thomas Myers, author of Anatomy Trains, highlights the limitations of viewing muscles as separate structures. Muscles, the nervous system and connective tissues work together. To me, this is another reminder to see the body as a whole and not reduce caring for it to a number on the scales.
Weight loss and health are not about fitness challenges from unqualified influencers, exhausting diets or putting all your hopes in “magic injections”. They are about understanding what your own body needs. Medically indicated treatment, nutrition and movement can complement one another.
Would you like to take a thorough approach to excess weight, with your joints and wellbeing in mind? Not sure where to start? I invite you to an initial assessment of your posture and the function of your pelvic floor and diaphragm. We will assess your movement mechanics and choose a personal exercise plan based on your condition and your doctor’s recommendations. Message me to arrange a consultation.
