What Are Trainers For in the GLP-1 Era? with Dr Eric Helms

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Episode Summary

Dr Eric Helms returns to Mikkipedia for an unscripted conversation about GLP-1 medications and what they mean for anyone working in nutrition and fitness. Eric is a coach, athlete, author and educator, part of the 3DMJ coaching team, co-founder of the MASS research review, and co-director of the Sports Performance Research Institute New Zealand (SPRINZ) at AUT, where he is also a senior research fellow. Mikki opens with a personal trainer who was accused of stepping outside her lane for talking about GLP-1s, and the two of them work outwards from there.

The conversation covers whether coaches and nutritionists are within their scope supporting people on these medications, what obesity medicine can miss when a patient's weight loss stalls, and why reduced everyday movement belongs under the heading of metabolic adaptation rather than being treated as a separate problem. Eric separates appetite into distinct drivers — energy signalling, hedonic food seeking and food noise — and explains why that distinction matters clinically. The second half turns to protein, where Eric makes the case that it is a minor player for most people's health outcomes unless intake is genuinely low, and that "which macronutrient is most satiating" is the wrong question in the first place. He is candid throughout about the limits of what is currently known, including several things he says he cannot answer. The episode closes on his argument that trainers have an opportunity to stop being weight loss coaches and get back to promoting health, fitness and movement.

Key Topics

Scope of practice. Eric argues the behavioural, lifestyle, nutrition and exercise side of GLP-1 use is squarely within a personal trainer's remit — while cautioning that nobody yet has the twenty years of practitioner experience we have with medications like exogenous insulin.Where the usual trainer skill set doesn't transfer. Most trainers are practised at helping clients restrain appetite. Clients on GLP-1s often have the opposite problem: struggling to eat enough, and needing nutrient quality raised on a low intake.What a stall actually signals. When someone stops tracking calories and their weight loss plateaus, Eric's first read is not under-fuelling — it is that tracking had become tedious and unsustainable, and no second skill set has replaced it. He treats the stall as an opportunity to build other skills rather than a reason to resume tracking.Movement, NEAT and metabolic adaptation. Reductions in spontaneous physical activity and non-exercise activity thermogenesis come from the same mechanisms as the older, narrower idea of a falling metabolic rate. Eric's view is that most of the "side effects" attributed to these drugs are the side effects of successful weight loss.Appetite is not one thing. Eric separates energy signalling (feeling depleted), hedonic food seeking (actively wanting a particular food or experience) and food noise (constant, distracting preoccupation) — then notes satiety has several definitions of its own on top of that.Why near-universal drug response is interesting. In trials of a newer triple-agonist medication, every participant in the higher dose groups lost at least 5–10% of body weight. Eric speculates — and flags it clearly as speculation — that this implies the drug targets more than food noise alone.How much protein actually matters. Eric's position is that protein is a minor player for general population health outcomes unless someone is starting low. Moving from around 0.8–1.1 g/kg to 1.3–1.5 g/kg has a reasonably moderate effect; moving from 1.6 to 2.2 g/kg is minor outside physique sport, where it is "a game of inches".Meeting people where they are. Someone on an intermittent eating pattern may be reaching only 1.1 g/kg, and a poorly constructed plant-based diet 0.9 g/kg. Telling them to double it can r