Why a Physiatrist Prescribes GLP-1 Medications: Weight Loss, Joint Pain Relief, and Improved Mobility

Weight affects how we move, how we feel, and how much pain our joints carry every day. As a physiatrist, my focus is restoring function, helping patients walk farther, move with less pain, and stay independent longer. Over time, it became clear that for many patients with chronic back, hip, knee, and ankle pain, excess weight was not just a risk factor, it was a primary driver of pain and mobility loss.

This is why physician-guided weight loss, including the use of GLP-1 receptor agonist medications, has become an important part of comprehensive musculoskeletal and rehabilitation care at Michigan Rehab Consultant (MRC).

1) Weight-Bearing Joints and Mechanical Load

The spine, hips, knees, ankles, and feet are weight-bearing structures. Every extra pound of body weight increases the mechanical stress these joints must absorb with standing, walking, and stair climbing.

Research shows that each additional pound of body weight places approximately four extra pounds of force across the knee joint during walking. Over time, this accelerates cartilage wear, joint inflammation, and pain, especially in patients with osteoarthritis or prior injury.

Key weight-bearing areas commonly affected by excess load:

• Lumbar spine (low back pain, facet arthropathy, disc degeneration)

• Hips (osteoarthritis, labral stress, gait changes)

• Knees (osteoarthritis, meniscal overload, instability)

• Ankles and feet (tendinopathy, plantar fasciitis, joint degeneration)

2) How Weight Loss Improves Joint Pain

Weight loss reduces joint pain through both mechanical and inflammatory pathways.

Mechanical Benefits:

• Reduced joint compression and shear forces

• Improved gait mechanics

• Lower energy expenditure with movement

• Improved tolerance for standing, walking, and exercise

Clinical studies show that even modest weight loss (5–10% of body weight) can significantly reduce knee pain and improve physical function in people with osteoarthritis.

Inflammatory Benefits

Adipose tissue is metabolically active and contributes to systemic inflammation. Weight loss reduces inflammatory cytokines that are associated with pain sensitization and cartilage breakdown, further improving symptoms beyond mechanical unloading alone.

3) GLP-1 Medications: Why They Matter in Physiatry

GLP-1 receptor agonists were originally developed for diabetes management, but evidence now supports their role in sustained weight loss and cardiometabolic risk reduction.

Indications Commonly Relevant to Physiatry Patients:

• Obesity or overweight with joint pain

• Osteoarthritis of the knee, hip, or spine

• Chronic low back pain worsened by body weight

• Mobility limitations affecting participation in therapy

• Prediabetes or type 2 diabetes

• Obstructive sleep apnea

• Elevated cardiovascular risk

For patients limited by pain, GLP-1 medications can reduce weight enough to make movement possible again, allowing them to better participate in physical therapy, home exercise programs, and daily activities.

4) Weight Loss and Mobility: Restoring Function

From a rehabilitation standpoint, weight loss is often the gateway intervention that allows other treatments to work.

Evidence shows that weight loss is associated with:

• Improved walking speed and endurance

• Reduced disability scores

• Improved balance and transfer ability

• Greater participation in exercise and rehabilitation

For many patients, pain relief from weight loss enables earlier and more effective engagement in therapy, leading to longer-term functional gains.

5) Nutrition Still Matters: Weight Loss Is Not “Medication Alone”

GLP-1 medications are tools—not substitutes—for nutrition education. Preserving muscle mass while losing fat is especially important in rehabilitation and aging populations.

Key Nutrition Principles We Emphasize:

• Adequate protein intake to preserve lean muscle

• Balanced meals to support energy and healing

• Micronutrient sufficiency (vitamin D, iron, B-vitamins as indicated)

• Avoiding under-nutrition, which can worsen weakness and fatigue

  
  

Nutritional education helps ensure that weight loss improves strength, endurance, and function, not just the number on the scale.

6) Physician-Guided Weight Loss: Why Oversight Matters

Weight loss impacts medications, blood pressure, blood sugar, and physical capacity. Physician guidance allows for:

• Proper patient selection for GLP-1 therapy

• Monitoring for side effects and tolerance

• Coordination with pain management and rehabilitation plans

• Integration with physical therapy and exercise progression

• Ongoing education and support

At MRC, weight loss is not a cosmetic goal—it is a functional intervention designed to reduce pain, improve movement, and enhance quality of life.

7) The Physiatry Perspective

As physiatrists, we look beyond isolated symptoms. When weight contributes to joint overload, pain, and reduced mobility, addressing it directly becomes part of restoring function.

For many patients, physician-guided weight loss has been the missing link—allowing injections, therapy, exercise, and daily movement to finally work as intended.