Rapid weight loss has always been celebrated, but in the era of GLP-1 medications like Ozempic, Wegovy and Mounjaro, spine surgeons are seeing something surprising.
Dr. Ed Dohring, an orthopedic spine surgeon at the Spine Institute of Arizona, says the medications are helping people shed pounds quickly, but not without consequences. The weight is coming off, yes, but so is muscle — including the deep core muscles that unassumingly hold the spine together.
“When you have rapid weight loss — although 70% of that weight loss is fat, about 30% is actually muscle — you lose muscle tissue,” he explains.
Patients who never struggled with back pain are suddenly showing up in his office with aching, unstable spines. The issue isn’t the GLP-1s. This happens when appetite drops so dramatically that people unintentionally stop eating enough protein, vitamins and nutrients to maintain muscle.
“They’re losing abdominal core muscle strength,” Dr. Dohring says. “They’ve changed how they eat — not just how much they eat, but what they eat.”
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Why the spine reacts this way
Weight loss is almost always good for the back. Less mass means less pressure on the vertebrae, discs and joints. And there’s another benefit: fat cells release inflammatory cytokines, including leptin, which irritate joints and the spine.
“Fat cells release a protein that causes inflammation in the joints and in the spine,” Dr. Dohring says. “Before these benefits kick in, the body goes through a biomechanical adjustment period. Losing deep stabilizing muscles can temporarily throw off posture, balance and alignment. The spine suddenly has less support than it’s used to.”
A surge of new patients
Spine specialists across the country are seeing an influx of GLP-1 users with new back pain. Not because the drugs are harmful — but because the body is changing faster than people are prepared for.
“It’s surprising that we didn’t see this before,” Dr. Dohring says.
The fix, he says, is simple: structured exercise, proper nutrition and guidance.
His team often pairs patients with physical therapists or chiropractors who teach a handful of targeted exercises. Even a few sessions can help people rebuild the core strength they’ve lost. For those with access to a gym, a personal trainer can help them safely incorporate resistance training to regain muscle.
GLP-1s and surgery: A new protocol
The rise of GLP-1 medications is also changing how surgeons prepare patients for spine procedures. Obesity has long been one of the strongest predictors of surgical complications, and GLP-1s are helping patients reach safer BMI ranges.
However, the news isn’t all sunshine and butterflies. GLP-1s slow stomach emptying. If a patient goes under anesthesia with food still lingering in the stomach, they can regurgitate — or worse, aspirate — when the breathing tube is removed.
“It’s great if people can lose weight,” he says. “It’s hard to lose weight. Some of it is genetic — without question. The GLP-1s help a lot. But because they delay stomach emptying, they make your brain feel like you’re fuller.
“But if your stomach has leftover food in it, when you’re waking up from anesthesia and they take out the breathing tube, people can throw up or regurgitate. These little bits of leftover, semi-digested food can get into the lungs.”
Preventing GLP-1-related back pain
The good news: most of this back pain is temporary and preventable. Surgeons recommend:
• Structured core strengthening — even a few guided sessions can make a big difference.
• Adequate protein intake — appetite drops, but protein needs don’t.
• Basic nutritional support — vitamins and balanced meals help the body adapt.
• Gradual exercise progression — soreness is normal; instability is not.
A cultural shift
The popularity of GLP-1s reflects a broader change in how society views obesity and metabolic health. Weight loss is no longer framed as a matter of willpower alone. It’s increasingly understood as a chronic condition with biological drivers. As pharmacies, telehealth platforms and employers expand access, these medications have moved from niche to mainstream.
