A Workout For Your Mental Health

Stressed out? Grumpy? Tired all the time?

For months, therapists have reported a significant increase in clients who are anxious, worried or depressed over current events—the Covid-19 pandemic, economic woes, civil unrest. And while they can teach coping skills, such as emotion regulation, to help deal with the stress, they say it’s also important for people to proactively take steps to be mentally healthy, just as they would if they wanted to be physically fit. “If you wait until a major stressor hits to try and bolster your mental health, it’s like trying to inflate your life raft while you are already drowning at sea,” says Wendy Troxel, a clinical psychologist and senior behavioural and social scientist at Rand Corp.

Many people turn to talk therapy, exercise, meditation and a healthy diet to do this. Shirlee Hoffman, a 75-year-old retired marketing consultant in Chicago, limits her news consumption to about five minutes a day. Erin Wiley, 50, a licensed psychotherapist in Toledo, Ohio, uses an app to track the things for which she is grateful. Rhonda Steele, 62, a special-education teacher in Sellersburg, Ind., prays and reads devotions. Dwight Oxley, 84, a retired physician in Wichita, Kan., reads and plays the piano. Rachel Glyn, 66, a retired aesthetician in Philadelphia, tries to do as many things as possible for others. Michael Schauch, 40, an investment portfolio manager in Squamish, British Columbia, rock climbs—he says the view gives him perspective. Stedman Stevens, 62, the CEO of an aviation technology company in Wilmington, N.C., takes 15 minutes each afternoon to sit alone without distractions. “I listen to what my mind shows me,” he says. “This restores my mental strength.”

What steps should you include in your mental-fitness regimen? Here is advice from the experts.

Make sleep non-negotiable

Most adults need 7-8 hours of quality sleep. “Following a consistent sleep-wake schedule sends a powerful signal to the brain that the world is safe and secure, which can help reduce anxiety and foster resilience,” says Rand’s Dr Troxel, author of “Sharing the Covers: Every Couple’s Guide to Better Sleep.” She suggests setting a consistent wake-up time, counting backward to determine when to go to bed, and creating a relaxing wind-down routine, starting an hour before bedtime. Take a bath, read a book, turn down the lights and the thermostat. (18-20 degrees is ideal.) Disconnect from technology to minimize your exposure to distressing news and light.

Set a routine

Get up at the same time each day. Get dressed! Create a morning ritual—many people write in a journal or set an intention for the day, although just drinking coffee in the same chair works. (I drink a large glass of water first thing, then a cup of coffee, and play with my dog.) Eat meals and exercise at set times. This helps create a sense of predictability in a world that feels out of control.

Calm your mind

You can’t cope with stress well if your brain is on high alert at all times, says Carolyn Daitch, a psychologist in Farmington Hills, Mich., and co-author of “The Road to Calm Workbook.” She recommends beginning the day with 15-20 minutes of yoga, meditation or prayer, then scheduling four “mini interventions” during the day—a two-minute breathing exercise or other quick tension-releasing technique. (One of her favourites: Make a tight fist with one hand, imagine it holding all the tension in your body for 10 seconds, release it.) She says to think of these practices as a “stress inoculation.”

Watch your language

The words we use to talk to ourselves colour our outlook. So try to replace “hot” language with “cooler” language, suggests Patricia Deldin, a professor of psychology and psychiatry at the University of Michigan, Ann Arbor. (“This is a challenge but I can handle it,” not “I’m overwhelmed.”) And stop “shoulding” yourself. (“I would like to…” not “I should.”) “A simple language change can influence our feelings and, subsequently, our actions,” says Dr Deldin, who is CEO of Mood Lifters, a mental-wellness program.

Practice compassion

Research shows self-compassionate people are happier, more optimistic, more motivated and more resilient. Yet, too often, we are mean to ourselves. Treat yourself with kindness and understanding. Start by acknowledging when something is painful. (Dr Daitch recommends putting your hand on your heart and saying: “This isn’t easy.”) Then talk to yourself as you would to your best friend. And remind yourself that everyone goes through difficult times. This diminishes your stress reaction and connects you to other people.

Move your body

Research shows that aerobic exercise reduces fatigue and tension, and improves alertness, concentration, sleep, mood, and self-esteem, according to Dr Deldin. And studies show that exercise in nature has even more benefits: It reduces the body’s stress response, lowers cortisol levels and blood pressure, and it gives you a sense of awe, which boosts mood. Dr Deldin recommends 30 minutes of moderate exercise a day, which can be broken up into small periods. (Even five minutes of exercise begins to decrease anxiety, she says.)

Create a media diet

There’s too much negative news these days. Decide how much you will consume—think of this as a “news calorie count”—and stick with it. Set aside blocks of time to turn off your phone. Purge negative people from your social media feed. Look for positive streams to follow or articles to read. (My feeds are largely about sailing, scuba diving, gardening or baking.)

Choose extracurricular activities wisely

Research shows that pleasant activities, ones that give you a sense of purpose (such as volunteering), and ones that make you feel accomplished or masterful (such as learning a language) improve mental health. So pick up a new hobby, practice an instrument, work on improving at a sport. “The ability to exert control over something provides a sense of self-satisfaction and contentment,” says Brad Stulberg, an executive coach in Asheville, N.C., and author of “Peak Performance.” “And progress nourishes the soul.”

Cultivate supportive relationships

People with strong relationships are emotionally healthier. So make a commitment to connect regularly with friends and family. Set a goal to reach out to one person a day. Ask about the other person and discuss something other than the day’s awful news. And be open about how you are, because vulnerability can be bonding.

Be grateful

Especially for your loved ones. And let them know. Everyone is feeling challenged right now. When I’m annoyed with someone in my life, I think of at least five things I love about the person. Often, I’m surprised that my list goes on and on. I’m smiling before I’m done counting.

Chanel Robinson achieved exactly what the gold rush of blockbuster weight-loss drugs promised: She lost nearly 100 pounds, lowered her cholesterol to normal levels and reined in her polycystic ovary syndrome.

Yet, nearly three years into her journey on Mounjaro, the 30-year-old from Atlanta, Ga., is discovering the hidden costs of the slimmed-down life.

Robinson experiences muscle fatigue daily, feeling physically weak, frail and often cold. Robinson said she experiences bursts of sluggishness sporadically during the day, and has trouble with basic tasks like opening a jar. “It shouldn’t be this difficult,” she said.

GLP-1 drugs like Ozempic, Mounjaro and Zepbound have been a success for public health and the pharmaceutical companies that make them. Obesity rates are falling, the volume of food consumed in America is declining and retailers report a slump in sales of plus-size apparel. It has improved health and happiness for millions of people.

But for at least some of the 13 million Americans taking them, losing muscle along with fat is an unexpected downside that isn’t broadly discussed or immediately apparent.

The drugs can cause rapid and significant loss of lean muscle mass, up to 10%, comparable to a decade or more of aging, according to an analysis published by the American Diabetes Association.

The loss of lean tissue is similar to weight loss from dieting, but the magnitude over a short period can lead to frailty, instability and lack of coordination, doctors and researchers say. Another concern is that losing muscle could slow down patients’ metabolism, leading to weight regain.

“We are curing obesity by encouraging frailty,” said Daniel Green, principal research fellow at the University of Western Australia, who contributed to the analysis. Many taking weight-loss medications initially lose fat and feel great, but quickly start to feel weak and lethargic, he said.

Green’s research showed that the rate of muscle loss could be slowed significantly by regular strength workouts. “It should say ‘must be taken with resistance training’ on the box,” he said.

Drugmakers say weight-loss drugs should be taken only on the advice of a physician and as part of a long-term plan that includes diet and exercise.

A spokesperson for Eli Lilly, maker of Zepbound, said Food and Drug Administration guidelines say it should be used “with increased physical activity.” The spokesperson added: “Sustainable weight loss is about more than a number on a scale.”

Both Eli Lilly and Novo Nordisk said clinical trials showed users did lose some lean muscle tissue, though at far lower rates than fat. Liz Skrbkova, a spokeswoman for Novo Nordisk, said that trials for its drug Wegovy showed changes in muscle mass didn’t “significantly differ” from patients who took a placebo. Eli Lilly said users lost three times more fat weight than lean tissue.

Rayna Kingston, 30, from Denver, said her injections of Zepbound left her feeling so tired the following day that she struggled to complete anything other than basic tasks. She said she shifted her dose to a Sunday because Mondays were her least busy day. Her partner would bring her meals in bed because she felt so weak.

She stopped exercising, and said her doctor didn’t give her any guidance on strength training or muscle maintenance. “I was relying on Reddit forums to understand what was happening to my body,” she said. She got so frustrated with the fatigue she came off the medication just under two months later.

Experts say that losing muscle at such a rate can be especially dangerous for those over 50 or with osteoporosis or limited mobility as it could lead to an increased risk of injury. “Loss of muscle mass is detrimental to moving around and quality of life, but it is also not safe,” said Katsu Funai, associate professor at the University of Utah.

Elderly Americans are set to be able to get GLP-1s from Medicare from July.

There is also pushback from doctors and regulators against using weight-loss drugs as a “quick fix” to lose a bit of weight.

People who take GLP-1s regain weight four times faster than those who lose weight through lifestyle interventions, and weight regained is often mostly fat, according to a recent analysis published in the British Medical Journal. There currently are few, if any, guidelines or studies on de-prescribing the drugs, researchers say.

The nurse practitioner who prescribed Robinson the medication didn’t warn her that resistance training is essential to maintaining muscle mass, Robinson said. She said she regrets not exercising and now does Pilates once a week.

In the haste to disrupt the obesity epidemic, weight loss has been treated as the singular, undisputed metric of success, which experts say is problematic.

“People worship body weight as an outcome measure because it’s simple, quick and inexpensive,” said Green. “But what matters is fat and muscle mass, which is more expensive to measure as it requires an MRI.”

Grace Parkin, 34, a property manager from Sheffield, England, has lost 125 pounds after she started taking Mounjaro in 2024. “I don’t care about my muscle mass as long as I’m a healthy weight,” she said.

The doctor who prescribed the drug didn’t tell her to exercise, though the pharmacy that sold the medication gave her information on exercise and protein intake, she said.

She didn’t exercise and said she soon felt side effects: a “deathly cold, from the inside” likely because of the drug. Still, she vowed to keep going, saying the weight loss was worth it.

In response to some of the side effects, drug companies are hoping to develop weight-loss treatments aimed at preserving or even building lean muscle mass.

German drugmaker Boehringer Ingelheim recently said it had promising results from one such drug. Eli Lilly last September halted a trial of a similar drug.

While weight-loss medications are designed as lifelong treatments for chronic diseases, namely obesity and Type 2 diabetes, they are increasingly marketed as lifestyle fixes.

Tennis superstar Serena Williams, who used GLP-1s to slim down after having children, was featured in this year’s Super Bowl commercial promoting telehealth company Ro’s weight-loss medication.

Serena Williams holding a GLP-1 weight-loss medicine injector.

Serena Williams poses for an ad campaign for a weight-loss drug. Ro/Handout/Reuters

Women may be particularly vulnerable to the drugs’s side effects, which can also include nausea, diarrhea, migraines and rarer cases of pancreatitis.

A study last year from a university hospital in Turin, Italy, showed that women are more prone to adverse reactions to weight-loss drugs than men, including muscle loss.

Green, the researcher, said the issue is of particular concern to those taking GLP-1s recreationally and who don’t have much muscle mass to begin with. Others say a lack of oversight is compounding the issue.

“Patients are self-reporting, and telehealth companies don’t have the patient in front of them to conduct a proper medical assessment,” said Rupal Mathur, an internist in Houston whose practice specializes in weight loss.

She said medical spas are prescribing off-label drugs that don’t meet the criteria set out by the FDA that justify a prescription.

The number of people taking weight-loss drugs who are not living with obesity or Type 2 diabetes is difficult to track since it is unregulated.

However, an analysis by the FDA from 2023 found that more than half of new Ozempic and Mounjaro users didn’t have Type 2 diabetes.

Scientists are calling for more clinical trials to pin down the full effects of weight-loss drugs on muscle loss in different demographics.

“The only studies that have been done have looked at people living with obesity or Type 2 diabetes,” said Green. “That makes it all the more concerning for those using weight-loss drugs in an ad hoc or unregistered way.”

A Workout For Your Mental Health

Keep stress from the Covid pandemic and other events under control by sticking with these daily practices.

As millions flock to GLP-1s, doctors warn the drugs can cause rapid and significant muscle loss.