Women’s Health: Dr. Jagriti Upadhyay on GLP-1 Medications, Metabolic Health, and Women's Wellness
“GLP-1 medications are not a shortcut—they are an assistant. Rather than viewing GLP-1 medications as a short-term solution, I encourage patients to see them as one tool within a comprehensive, long-term approach to metabolic health.” Meet today’s Woman Dreamer, Dr. Jagriti Upadhyay, an endocrinologist at Lahey with expertise in obesity medicine and medical weight management, diabetes, thyroid disorders, and reproductive endocrinology. In this interview, Dr. Upadhyay breaks down some of the biggest misconceptions surrounding GLP-1 medications, what women should know about weight regain after stopping treatment, and how hormones, stress, sleep, and lifestyle can impact weight and insulin resistance. Importantly, she also shares her expertise on weight loss and management beyond GLP-1s and reflects on her own approach to wellness and why she believes in “consistency over perfection.” A must-read for all women, we are excited to share Dr. Upadhyay’s insights as part of our Women’s Health series at Women Who Win!
1. From your perspective as a physician, what are you seeing women struggle with most today when it comes to weight, hormones, and overall health?
One of the most common concerns I hear from women is, “I’m doing everything right, but nothing seems to work.” Many women struggle with fatigue, brain fog, poor sleep, stress, and the competing demands of careers, family, and caregiving responsibilities. Weight is often at the center of these concerns. Despite trying multiple diets, exercising consistently, and carefully monitoring what they eat, many women find that the scale barely moves or that lost weight quickly returns.
For women in perimenopause and menopause, hormonal changes add another layer of complexity. Declining estrogen levels can affect sleep, body composition, energy, mood, and insulin sensitivity, making it harder to maintain a healthy weight. As a result, many women feel frustrated and sometimes blame themselves for changes that are actually driven by biology.
What I try to emphasize is that weight and metabolic health are influenced by a complex interaction of hormones, sleep, stress, genetics, nutrition, physical activity, and life circumstances. My role is to help women understand those factors, identify underlying contributors, and develop realistic, sustainable strategies that improve both health and quality of life.
2. What are some of the biggest misconceptions about GLP-1 medications that patients should clarify with their doctor?
One of the biggest misconceptions is that GLP-1 medications are a “magic pill” or a short-term fix. While medications such as semaglutide and tirzepatide have transformed obesity treatment and are among the most effective therapies available, they are not a substitute for healthy habits. They work best when combined with good nutrition, regular physical activity, adequate sleep, and stress management.
Another myth is that these medications are only about weight loss. In reality, their benefits often extend beyond the scale. Depending on the individual, GLP-1 therapies may improve blood sugar control, cardiovascular risk factors such as blood pressure and cholesterol, fatty liver disease, and even conditions like obstructive sleep apnea.
Patients are often surprised to learn that responses vary significantly. Some people lose modest amounts of weight, while others lose more than 20–30% of their body weight. Genetics, lifestyle, medical conditions, and adherence all influence outcomes, which is why comparisons on social media can be misleading.
I also remind patients that weight regain after stopping treatment is not a personal failure. Obesity is a chronic disease, and the biology that drives hunger and weight gain often returns when medication is discontinued. GLP-1 medications are not a shortcut—they are an assistant. They help create an opportunity for patients to build healthier habits that support long-term metabolic health.
3. How do hormones, stress, sleep, and lifestyle interact with weight and insulin resistance?
Many women are surprised to learn that weight and metabolic health are influenced by much more than calories and exercise. Hormones, sleep, stress, physical activity, and nutrition are deeply interconnected.
Sleep is one of the most overlooked factors. Inadequate sleep lowers leptin, the hormone that signals fullness, and increases ghrelin, the hormone that stimulates hunger. It can also worsen insulin sensitivity and blood sugar control. Studies show that women in their 40s and 50s with greater variability in sleep duration and a tendency toward stress-related eating often have higher BMI independent of age and physical activity.
Chronic stress is another major driver of metabolic dysfunction. Stress activates the hypothalamic-pituitary-adrenal axis, increases cortisol, promotes abdominal fat accumulation, worsens insulin resistance, and increases cravings for calorie-dense foods. Research has shown that work and life stress are associated with excess weight independent of exercise habits.
Hormonal transitions also matter. During perimenopause and menopause, declining estrogen levels contribute to abdominal weight gain, changes in appetite regulation, and increased insulin resistance. PCOS, which affects a significant proportion of women during their reproductive years, is strongly associated with insulin resistance and obesity. Encouragingly, even a modest weight loss of about 5% can produce meaningful improvements in metabolic health and PCOS symptoms. Thyroid disorders, particularly hypothyroidism, are also more common in women and can contribute to fatigue, slower metabolism, and modest weight gain.
Finally, physical activity improves health far beyond calorie burning. Skeletal muscle is one of the body’s most important sites for glucose uptake. Regular movement, strength training, and even a 10–15 minute walk after meals can improve blood sugar control and insulin sensitivity. The key message is that weight gain is rarely a simple matter of willpower. Sustainable improvements in sleep, stress management, nutrition, physical activity, and hormonal health often have a much greater impact than extreme diets or exercise programs.
4. What happens if I stop taking a GLP-1 medication?
Patients should understand that GLP-1 medications used for obesity treatment are often considered chronic therapies, similar to treatments for high blood pressure or cholesterol. The maintenance dose may differ from the weight-loss dose, but most experts recommend using the lowest effective dose that maintains health benefits.
Research consistently shows that many people regain weight after discontinuing semaglutide or tirzepatide. Meta-analyses suggest weight regain can approach 10 kilograms (approximately 20 pounds) over time. Importantly, it is not just the weight that returns—blood sugar, blood pressure, cholesterol levels, and waist circumference may also worsen.
If discontinuation is necessary or patient prefers, I generally recommend a structured taper over several months (approximately 20 weeks) with close monitoring rather than abruptly stopping therapy. If weight regain exceeds about 5% of body weight, dose adjustment, continuation, or re-initiation of treatment may need to be considered.
Long-term success depends on more than medication. The patients who maintain weight loss most effectively tend to prioritize adequate protein intake, resistance training two to three times per week, regular physical activity, high-fiber minimally processed foods, and ongoing self-monitoring of weight, nutrition, and activity. Cognitive behavioral therapy and stress-management strategies can also be extremely helpful.
There is significant individual variability. Some of my patients have maintained or even continued to lose weight more than a year after stopping a GLP-1 medication, while others regain weight relatively quickly. Those who do best typically continue the healthy habits they developed during treatment. Rather than viewing GLP-1 medications as a short-term solution, I encourage patients to see them as one tool within a comprehensive, long-term approach to metabolic health.
5. For women who may not medically qualify for GLP-1 medications but are still struggling with energy, weight fluctuations, or metabolic health concerns, where should they start?
The first step is making sure there is not an underlying medical condition contributing to weight gain or difficulty losing weight. Appropriate evaluation may include screening for thyroid disease, prediabetes or diabetes, PCOS, liver disease, and other metabolic disorders.
It is also important to remember that success is not defined only by dramatic weight loss. Even a modest 3–5% reduction in body weight can lead to meaningful improvements in blood pressure, cholesterol, blood sugar, and overall metabolic health.
For most people, the foundation remains lifestyle intervention. The American Diabetes Association and the American Heart Association support intensive behavioral programs that combine nutrition counseling, physical activity, self-monitoring, goal setting, and problem-solving strategies. Long-term studies such as the Look AHEAD trial have demonstrated meaningful and sustained health benefits from these approaches.
I encourage patients to focus on sustainable habits rather than quick fixes. A Mediterranean-style eating pattern rich in vegetables, lean protein, fiber, and minimally processed foods is effective for many individuals. Creating a modest calorie deficit of approximately 500–600 calories per day can support gradual, sustainable weight loss.
Physical activity is equally important. Aim for at least 150 minutes of moderate aerobic exercise weekly in addition to resistance training two to three times per week. Sleep quality, stress management, and treatment of sleep disorders should also be part of the conversation.
For some patients, other evidence-based medications—including metformin, phentermine-topiramate, or naltrexone-bupropion—may be appropriate. Ultimately, I encourage women to focus on improving health, energy, and quality of life rather than chasing a specific number on the scale.
6. What does wellness look like in your own day-to-day life?
I try to follow the same advice I give my patients. For me, wellness starts with the fundamentals: staying hydrated, getting enough sleep, and making time for movement every day. A 30-minute walk is one of my favorite ways to stay active, clear my mind, and manage stress.
I also focus on home-cooked meals and try to limit ultra-processed foods. Meal prepping on weekends helps me make healthier choices during busy workweeks. I weigh myself regularly not out of perfectionism, but as a way to stay aware of trends and make small adjustments when needed.
Most importantly, I believe in consistency over perfection. Wellness is not about following a strict plan every day. It is about building sustainable habits that fit into real life. Small choices made consistently over time often have the greatest impact on long-term health and well-being.