Is it safe to use GLP-1 (Glucagon-like peptide-1) receptor agonists, such as liraglutide (Victoza) or semaglutide (Ozempic), for weight cutting in wrestling?

GLP-1 Receptor Agonists Should Not Be Used for Wrestling Weight Cutting

GLP-1 receptor agonists like semaglutide and liraglutide are FDA-approved exclusively for chronic weight management in obesity (BMI ≥30) or overweight with comorbidities (BMI ≥27), not for rapid, temporary weight loss in healthy athletes. Using these medications for wrestling weight cutting represents an off-label, medically inappropriate, and potentially dangerous misuse of pharmacotherapy designed for long-term metabolic disease management 1, 2.

Why This Is Medically Inappropriate

Wrong Clinical Indication

• GLP-1 receptor agonists are indicated for adults with BMI ≥30 kg/m² or BMI ≥27 kg/m² with at least one weight-related comorbidity (hypertension, dyslipidemia, cardiovascular disease, type 2 diabetes), and must be used in conjunction with lifestyle modifications for chronic weight management 2, 3.
• These medications are designed for lifelong or long-term use in patients with obesity as a chronic disease, not for short-term weight manipulation in healthy athletes 2.
• Wrestlers attempting weight cutting are typically healthy individuals without obesity or metabolic disease, making them ineligible for treatment under any legitimate medical guideline 1, 2.

Mechanism Incompatible with Weight Cutting Goals

• GLP-1 receptor agonists work through appetite suppression, delayed gastric emptying, and metabolic changes that produce gradual weight loss over 16-72 weeks, with semaglutide achieving 14.9% weight loss at 68 weeks and tirzepatide achieving 20.9% at 72 weeks 2, 4.
• The titration schedule alone takes 16-20 weeks to reach therapeutic doses: semaglutide requires escalation from 0.25mg to 2.4mg weekly over 16 weeks, making rapid weight cutting impossible 2.
• Weight loss is primarily from fat mass reduction (not water weight), which is the opposite of traditional wrestling weight cutting that relies on temporary fluid manipulation 5.

Serious Safety Concerns for Athletes

Gastrointestinal Effects Incompatible with Athletic Performance:

• Nausea occurs in 18-40% of patients, vomiting in 8-16%, and diarrhea in 12-16%, with these effects most prominent during dose escalation and potentially lasting weeks 2, 4.
• Delayed gastric emptying persists even after extended fasting periods, creating aspiration risk during anesthesia and potentially impairing nutrient absorption critical for athletic performance 2.

Dangerous Perioperative Risks:

• Retained gastric contents documented even 4-14 days after discontinuation, with 24.2% of semaglutide users showing increased residual gastric content versus 5.1% of controls, creating aspiration risk that would be catastrophic during wrestling matches or any situation requiring physical exertion 2.

Muscle and Bone Loss:

• GLP-1 receptor agonists cause loss of lean body mass alongside fat loss, which is particularly problematic without concurrent resistance training 2, 3.
• This muscle loss would directly impair wrestling performance and strength, defeating the purpose of weight manipulation 3.

Nutritional Deficiencies:

• Calorie reduction from appetite suppression leads to risk of nutritional deficiencies including protein, vitamins, and minerals essential for athletic performance and recovery 3.

Weight Regain After Discontinuation

• Significant weight regain occurs after stopping GLP-1 receptor agonists, with 11.6% of lost weight regained after 52 weeks of cessation, making any weight loss temporary and requiring lifelong use for maintenance 2.
• This makes the medication useless for temporary weight cutting, as the weight would return immediately after discontinuation for weigh-in 2.

Absolute Contraindications That May Apply to Young Athletes

• Personal or family history of medullary thyroid cancer or multiple endocrine neoplasia syndrome type 2 represents an absolute contraindication 1, 2, 4.
• History of pancreatitis requires extreme caution, and these medications increase risk of pancreatitis and gallbladder disease 2, 6, 4.

Ethical and Regulatory Concerns

• Prescribing GLP-1 receptor agonists for weight cutting would constitute off-label use without medical justification, potentially violating medical ethics and sports regulations 1, 2.
• Cost of $1,300-$1,600 per month makes this economically irrational for temporary weight manipulation 2.
• Insurance would not cover this indication, requiring out-of-pocket payment for medically inappropriate use 2.

The Correct Approach to Wrestling Weight Management

• Wrestlers should work with sports nutritionists and athletic trainers to achieve appropriate weight through evidence-based nutrition, hydration strategies, and gradual body composition changes during off-season 3.
• Rapid weight cutting through dehydration and calorie restriction, while common in wrestling, carries its own risks and should be minimized through competing at appropriate weight classes 3.
• Any weight management for athletics should prioritize maintaining muscle mass, strength, and performance rather than pharmaceutical intervention designed for obesity treatment 3.