Which Comes First: Exercise or Weight Loss Medication?

It's a bit of a chicken-and-the-egg question.

If you're considering a weight loss medication—whether it's a GLP-1 or another medication prescribed by your physician—should you start the medication first so that losing a little weight makes movement feel easier?

Or should you establish an exercise routine first so you can build and maintain muscle before beginning to lose weight?

I'm not sure there's one right answer.

What I can offer is my own experience.

My Body Changed After Cancer

For most of my adult life, weight management was fairly straightforward.

As a personal trainer, I've followed a consistent nutrition plan for well over a decade. I've tracked my macros, prioritized protein, and adjusted my calorie intake based on what I was asking my body to do.

Training for a half marathon? I ate more.

Lifting heavier? I adjusted my nutrition.

Trying to lose a few pounds? I increased my activity, decreased my energy intake, and my body responded.

It was a fairly predictable equation.

Then cancer happened.

After chemotherapy, surgery, radiation, surgical menopause, and beginning an estrogen blocker, my body simply stopped responding the way it always had.

Despite maintaining the same habits that had worked for years, my weight wasn't changing.

That was a completely new experience for me.

Why I Decided to Try Medication

After talking with my medical team, I started a weight loss medication called topiramate.

Topiramate isn't a GLP-1 medication. It's most commonly prescribed for migraines and seizure disorders, but it can also be used to support weight loss in some people.

Like every medication, it comes with potential side effects. One of the more amusing ones is that sometimes words completely disappear from my brain mid-sentence. (If you've watched any of my videos, you've probably seen me pause while my brain searches for a word that suddenly vanished.)

Fortunately, the medication has also had the effect we were hoping for.

My appetite has decreased.

But that change has taught me something I wasn't expecting.

Appetite Isn't the Same as Nutrition

One of the biggest effects I've noticed is that my body doesn't send the same hunger signals it used to.

Sometimes I simply don't feel hungry.

Other times I'll begin eating and feel full much sooner than I normally would.

That means my opportunities to eat enough throughout the day are smaller than they used to be.

Instead of asking, "What sounds good?"

I now have to ask, "What nutrition does my body need while it's willing to eat?"

That's a very different question.

Why I'm Grateful I Built My Habits First

This is where I feel incredibly fortunate.

Long before medication entered the picture, I had already built routines around nutrition.

I knew how much protein I generally needed.

I understood how to balance carbohydrates, fats, and protein.

I already planned meals around fueling my body instead of simply satisfying hunger.

Because those habits were already in place, the medication didn't replace healthy eating.

It changed how I applied those habits.

Now, when my appetite is lower, I naturally prioritize protein first because I know I have fewer opportunities to meet my nutritional needs throughout the day.

For me, that means aiming for roughly 120–140 grams of protein daily.

That's higher than the recommendation I received from my dietitian—and that's okay.

Recommendations are exactly that: recommendations.

They're designed for the average person.

I'm not average in terms of activity.

Your Protein Needs Should Match Your Life

My work is movement.

Each week I coach multiple strength classes where I'm demonstrating exercises, walking the gym floor, getting up and down from the floor, and staying active for hours at a time.

I also strength train several days each week, teach yoga, and walk regularly.

Because my activity level is high, my protein needs are higher than someone who spends most of their day sitting at a desk.

That doesn't mean carbohydrates or fats aren't important.

Far from it.

Carbohydrates provide quick energy for workouts and support brain function.

Healthy fats provide longer-lasting energy and support many essential processes throughout the body.

I'm still eating all three macronutrients.

I'm simply making sure protein comes first when my appetite is limited.

So... Should You Start Medication Before Exercise?

I still don't know that there's one correct answer.

But I do know this:

The habits you build before starting medication will still matter after you start medication.

Movement matters.

Strength training matters.

Protein matters.

Learning how to nourish your body matters.

Medication can absolutely be a helpful tool.

For some of us—including cancer survivors whose bodies have changed dramatically—it can be the support we genuinely need.

But I don't believe it replaces the foundations of health.

If anything, it makes those foundations even more important.

As my appetite has decreased, I'm more intentional than ever about making every meal count.

Because my goal isn't simply to lose weight.

My goal is to stay strong enough to keep doing the things I love for years to come.

And for me, that's the outcome that matters most.