GLP-1s versus exercise: public health trade-offs

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Show notes

Today, we focus on three news pieces from last week that reminded us of other stories we covered during 2025. The first two concern weight loss and management in elite sport, beginning with a look at the GLP-1 agonist issue (28:27). This was triggered by reports in the UK advising people that they must continue to exercise, specifically weight train, in order to combat the loss of lean mass that has been observed on the drug, which some have equated with aging a decade. Elite sport, meanwhile, will have to consider whether to ban such drugs as potentially performance-enhancing or harmful.

On the subject of harm, we stay on weight issues to discuss RED-s (40:10), in the light of a remarkable and candid announcement by elite cyclist Veronica Ewers that she's taking time away from the sport to address issues that she explains go back over a decade. Her story highlights all the traps - control and thoughtfulness about discipline, obsession over measurement and gadgets, disordered eating, intense training, positive validation in competitive environments, the remarkable ability of the body to tolerate this punishment, but ultimately, the sacrifice of health in a misplaced pursuit of performance. We talk about the lessons we can all learn, thinking back to Pauline Ferrand-Prevot's victory in the TDFF, which was a success story for weight periodization.

We also cover precocious talent, after a three-year old Indian prodigy earned a chess ranking (1:00:40). That reminded us of Malcolm Gladwell's "compression of adolescence" concept, and we talk about the inefficiencies sport accepts in its pursuit of the next champion, highlighted numerous times this year, with the realization that the system is broken and won't be fixed unless there is a collective will be fix it.

Also in this show, a more light-hearted look at the Football and Rugby World Cup draws (2:54) has us bemoaning the dilution of quality and the dearth of competitive matches early in those tournaments. And we chat about a super-fast Valencia marathon (10:43), that threw up fast winning times and nine national records, leading to a chat about globalization of the sport, the dominance of African runners, the slowest marathon nations (with some reasons), and the density of men's and women's top performers.

Plus Gareth remembers that Curacao is both a drink and World Cup finalist, and Ross defends Ghana's football honour!

Other links

• Review article advising resistance training in people taking GLP-1 agonists
• Paper that examines weight loss after 1 year of exercise or GLP-1 drugs
• More in-depth look at appetite and exercise behaviours in that study
• Study finding risk for RED-s in 30% of triathletes, including the tools that can be used to identify risk factors
• Cycling teams paying young riders big salaries

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