How to Prevent Ozempic Face and Muscle Loss on GLP-1s (2026 Guide)

By Dr. Francis Yap · Aesthetics Advisor / One Day Media Network · Originally published June 2026 · Updated October 8, 2026 · About 14 min read

Quick Answer

“Ozempic face” is facial volume loss and skin laxity that can follow substantial weight loss on GLP-1 medicines. The best evidence links it to the amount of weight lost, not a proven direct drug effect. About 25–40% of weight lost in trial substudies is lean mass (not all of it muscle). Strength training, adequate protein, and a maintenance plan lower the risks; stopping treatment typically brings back roughly 0.8 kg a month.^[1][2][3][5]

Key takeaways (October 2026)

• Facial change tracks weight lost. Imaging in 20 patients showed about 7% midfacial volume loss per 10 kg lost; the study had no control group.^[5]
• Lean mass loss is real but often misread. Lean mass was roughly 25% (tirzepatide) to 38% (semaglutide) of weight lost in DXA substudies, and it includes water, organs, and bone, not only muscle.^[1][2]
• Muscle protection has a plan: resistance training at least three times a week, about 1.2–1.6 g/kg/day of protein, steady (not maximal) loss, and follow-up of strength, not only the scale.^[2]
• Stopping has a cost. Regain averages about 0.8 kg per month after semaglutide or tirzepatide, and no controlled trial yet shows that lifestyle support prevents it.^[2][3]
• Two corrections to the June version: the headline lean-mass range is now a consistent 25–40%, and the “boost GLP-1 naturally” claim is softened to match the evidence.

Medical and affiliate disclosures

Medical disclosure: This article is educational and is not medical advice, diagnosis, or treatment. GLP-1 medicines are prescription drugs with real risks and contraindications. Talk with your prescriber before starting, changing, or stopping any medicine, supplement, or exercise program.

Affiliate disclosure: Aesthetics Advisor participates in affiliate programs, including Amazon Associates, and may earn a commission on qualifying purchases. This article does not contain affiliate links or product endorsements; if any are added, they will be labeled where they appear.

Editorial note: Claims are rated with adapted CEBM evidence levels (see the legend below). This page has not been formally clinician-reviewed.

What changed in this update

• Fixed an internal inconsistency: the summary said 35–40% lean mass while the body said 25–40%. Both now cite DXA substudy data.
• Replaced the unsupported claim that dermocosmetics are proven in GLP-1 users; evidence is general photoaging data, not GLP-1-specific.
• Reframed the hydration advice: water is not shown to prevent gauntness, but dehydration from GI side effects can injure kidneys.
• Changed “Can I boost GLP-1 naturally? Yes” to an evidence-matched answer.
• Updated weight-regain data (2026 BMJ meta-analysis), strength-training frequency (at least 3 times weekly), and added oral GLP-1 approvals.
• Added evidence tiers, a sources list, structured data, and an AI-assistant guide.

Contents

1. What is “Ozempic face” and what causes it?
2. How can GLP-1 facial volume loss be treated?
3. How much muscle do you lose on a GLP-1 medicine?
4. How do you protect muscle, bone, and skin?
5. What happens when you stop a GLP-1?
6. What is new in 2026?
7. Can you boost GLP-1 naturally?
8. Safety, sourcing, and when to call your doctor
9. Evidence map: how strong is each claim?
10. How to use this guide with Claude, ChatGPT, Gemini, and Perplexity
11. Frequently asked questions
12. Sources

What is “Ozempic face” and what causes it?

“Ozempic face” is a popular label for hollow cheeks, temple and under-eye deflation, and looser skin after large weight loss on GLP-1 medicines such as semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro, Zepbound). Current evidence links it mainly to the amount of weight lost rather than to a proven direct effect of the drug.

The face is unusually sensitive to fat loss because small superficial fat pads support the cheeks and temples. When those pads shrink faster than skin can retract, the result is hollowing, shadowing, and deeper folds. Changes tend to be more noticeable in older adults, whose skin has less elastic recoil, and with larger total weight loss (clinical observation, Level 5).

The measurement evidence is thin but consistent. A 2025 retrospective series compared CT or MRI scans before and after GLP-1 treatment in 20 patients. It reported a median 9% decrease in midfacial volume, about 7% for every 10 kg lost, concentrated in superficial fat compartments.^[5] There was no control group, so the study cannot separate drug effects from weight-loss effects. A 2026 critical review of the 2024–2026 literature describes “Ozempic face” as a useful but potentially oversimplified, multifactorial label, and notes that it is not unique to semaglutide.^[6]

What about a direct drug effect? Laboratory studies have raised the possibility that GLP-1 signaling influences skin and fat stem cells. Whether that matters in human faces is unproven (Level 5), so this guide treats weight loss as the established driver and the direct effect as an open question.

How can GLP-1 facial volume loss be treated?

Volume loss is best treated with volume (fillers, biostimulators, or fat grafting), while skin laxity responds to tightening devices or surgery. No option has been shown in a controlled trial to be best for GLP-1 patients specifically, so tiers below reflect the weaker GLP-1-specific evidence.

Table 1. Treatment options for GLP-1-related facial changes

Option	What it does	Evidence tier	Practical notes
Hyaluronic acid (HA) fillers	Immediate volume in cheeks, temples, and under-eye hollows; dissolvable with hyaluronidase	Level 4–5 (general filler trials are stronger; GLP-1-specific data are limited)	Risk of overfilling if weight keeps falling. Use a licensed physician.
Biostimulators (poly-L-lactic acid such as Sculptra; calcium hydroxylapatite)	Gradual collagen stimulation and structural support over months	Level 4–5	Usually several sessions. Often favored by clinicians for skin quality plus volume.
Fat grafting	Restores volume with your own fat; longer-lasting for many patients	Level 4	Surgical; requires donor fat, which can be limited after major weight loss. Clinician surveys report rising demand.
Radiofrequency and ultrasound devices (for example RF microneedling, RF-assisted tightening, Ultherapy)	Skin tightening and collagen remodeling; does not replace lost volume	Level 2–4 (general tightening evidence, not GLP-1-specific)	Modest, gradual results; best for mild to moderate laxity.
Topicals: sunscreen, retinoids, vitamin C, hyaluronic acid	Improve texture, hydration, and photoaging	Level 1–2 for photoaging in general; none GLP-1-specific	Cannot restore volume. The June version’s claim of proven benefit in GLP-1 users has been removed.
Facelift, neck lift, or midface lift	Definitive correction of significant laxity	Level 4	Usually considered after weight has stabilized.

Many aesthetic clinicians stage treatment while weight is still changing, adding modest volume first and refining later (expert opinion, Level 5). Always tell your injector which GLP-1 medicine you take and your current dose. For related reading on this site, see our guides on dermal fillers, sagging skin, and collagen.

How much muscle do you lose on a GLP-1 medicine?

About 25–40% of the weight lost in trial body-composition substudies was lean mass, but lean mass is not the same as muscle. It also includes water, organs, and bone, and the loss is similar to what other large weight-loss methods produce.^[1][2]

Table 2. Body-composition substudies (adapted CEBM Level 2, small DXA subsets)

Trial (substudy)	Drug and duration	Weight change	Lean mass as share of weight lost	Notes
STEP 1 DXA substudy (n≈140)[2][10]	Semaglutide 2.4 mg, 68 weeks	Average loss 13.6 kg: 8.3 kg fat, 5.3 kg lean	≈38%	Muscle is about half of lean mass, so roughly 20% of total weight lost.
SURMOUNT-1 DXA substudy (n=160)[1]	Tirzepatide, 72 weeks	Weight −21.3%, fat −33.9%, lean −10.9%	≈25%	About 25% lean in the placebo group too.

• Function usually holds up. A 2026 narrative review found lean-mass loss that is proportional to weight reduction, generally without meaningful declines in strength or performance, and notes that sarcopenia requires low strength and function, not just lower lean mass.^[7] A one-year observational study of semaglutide 2.4 mg (SEMALEAN) reported improved muscle function alongside preserved lean mass (Level 3).^[8]
• Some people lose more. Higher risk is linked to older age, menopause, low testosterone, inactivity, low protein intake, and no strength training. Modeling suggests muscle loss of about 10–15% of total weight lost in women and 20–25% in men without structured strength training.^[2]
• Tirzepatide vs semaglutide. A 2026 preprint of routine-care data reported greater lean-mass decline with tirzepatide, possibly reflecting its larger total weight loss. It is not yet peer reviewed (Level 3).^[9]
• Bone matters too. Large, fast weight loss (the advisory cites 14% or more within 3–4 months) is associated with bone loss, and a randomized trial found that adding exercise to GLP-1 therapy preserved bone mineral density.^[2]

How do you protect muscle, bone, and skin?

The strongest protection is structured resistance training plus adequate protein, with steady rather than maximal weight loss and regular checks of strength. Protein alone is unlikely to be enough.^[2]

Table 3. Practical muscle, bone, and skin protection plan

Strategy	Recommendation	Why	Evidence tier
Pace of loss	Ask your prescriber about slower dose escalation or staying at a dose until side effects settle. A general lifestyle-program target of about 0.5–1 kg per week is often cited but is not GLP-1-specific.	Lean-mass and bone loss relate to how rapid the loss is. No trial shows a specific rate prevents facial changes.	Level 5
Protein	About 1.2–1.6 g/kg/day has been proposed during active weight loss. For people with obesity, using fat-free mass (about 1.5 g/kg) or a fixed 80–120 g/day can be more practical. Avoid prolonged intakes of 2 g/kg/day or more.	Reduced appetite makes protein easy to miss. Eat protein first at meals and use dense options (fish, eggs, Greek yogurt, cottage cheese, legumes).	Level 5 (consensus advisory)
Resistance training	At least 3 sessions per week, progressive, covering major muscle groups; the June version said 2–3.	Best-established way to preserve lean mass and bone during weight loss.	Level 2 (mostly non-GLP-1 trials; GLP-1 trials ongoing)
Aerobic activity	At least 150 minutes of moderate-intensity activity per week.	Cardiometabolic benefit; less effective than strength work for preserving lean mass.	Level 2
Fluids	Drink enough to keep urine pale yellow, and more if you have vomiting or diarrhea. People with kidney or heart conditions should follow their own fluid advice.	Dehydration from GI side effects can cause acute kidney injury. There is no evidence that a set number of liters prevents gauntness (the June claim was removed).	Level 5
Micronutrients	Prioritize nutrient-dense foods; ask about vitamin D, calcium, B12, or a multivitamin-mineral if intake is low.	Appetite and calorie intake can fall 16–39%, risking deficiencies.	Level 5
Monitoring	Track strength (for example sit-to-stand, stair climb) and consider body-composition checks (bioimpedance or DXA) at baseline and follow-up.	The scale cannot distinguish fat from muscle.	Level 5

Skin care while losing weight: daily sunscreen is the highest-yield habit. Retinoids and vitamin C have general photoaging evidence and can be used if tolerated, but they do not restore lost facial volume. Clinical trials testing exercise and protein during GLP-1 therapy are underway (for example NCT07457437 and LEAN-PREP), so recommendations may be refined.^[15][16]

What happens when you stop a GLP-1 medicine?

Weight typically returns after stopping: about 0.8 kg per month for semaglutide and tirzepatide in a 2026 BMJ meta-analysis, with a projected return toward baseline in roughly 1.5 years. Blood pressure and cholesterol benefits also tend to fade.^[3][4]

Table 4. Weight regain after stopping

Evidence	What happened	Evidence tier
STEP 1 extension (semaglutide 2.4 mg)[11]	After 68 weeks of treatment (average loss 17.3% in the extension cohort), people regained about two-thirds of the loss within a year of stopping.	Level 2
SURMOUNT-4 (tirzepatide)[12]	After a 36-week lead-in with about 21% loss, continuing tirzepatide produced a further 5.5% loss, while switching to placebo led to a 14% regain.	Level 2
BMJ 2026 systematic review and meta-analysis (37 studies, 9,341 adults)[3][4]	Average regain of 0.4 kg per month across weight-loss drugs and 0.8 kg per month for semaglutide and tirzepatide; regain was faster than after behavioral programs. Only 8 studies covered newer GLP-1 drugs and none followed people beyond 12 months.	Level 2 (mixed designs; extrapolated beyond 12 months)

What to do with this. The June version recommended “transitioning to a maintenance dose.” Whether a lower dose reliably holds weight is not settled, and the 2025 joint advisory states that structured nutrition and lifestyle therapy to blunt regain after stopping has not been tested in controlled trials.^[2] A reasonable approach is to decide on a stop-or-continue plan with your prescriber in advance, build strength and protein habits while still on treatment, and agree on a weight or waist threshold that triggers a check-in. The advisory also warns that repeated start-stop cycling may worsen muscle and bone loss and raise the risk of sarcopenic obesity.^[2]

What is new in 2026?

• Oral options arrived. The FDA approved the Wegovy pill (oral semaglutide) in December 2025 and Foundayo (orforglipron), a once-daily non-peptide pill with no food or water timing restrictions, on April 1, 2026.^[14] In the ATTAIN-1 program, the top dose produced roughly 11–12% weight loss at 72 weeks depending on the analysis. Approval and availability differ by country, so check your national regulator.
• Head-to-head data. SURMOUNT-5 reported 20.2% mean weight loss with tirzepatide versus 13.7% with semaglutide at 72 weeks (Level 2).^[13]
• Muscle-protection trials are running. Registered trials are testing progressive resistance exercise and protein during semaglutide or tirzepatide therapy.^[15][16] Until body-composition data mature for the newer agents, applying the same muscle-protection steps is a reasonable precaution (Level 5).
• Evidence on regain firmed up. The 2026 BMJ meta-analysis now quantifies the post-treatment rebound across drugs.^[3]

Can you boost GLP-1 naturally?

Not enough to replace medication. Protein, fiber, and minimally processed meals can raise your body’s own GLP-1 for a short time after eating, but no study shows this approaches medication-level weight loss. A 2025 joint advisory lists dietary modulation of endogenous GLP-1 as an area still needing research.^[2] Treat these foods as part of a muscle-friendly, nutrient-dense pattern (fruit, vegetables, legumes, whole grains, fish, eggs, yogurt, nuts) rather than as a drug alternative (Level 5). Our semaglutide alternatives resource guide covers supplements and other options; discuss any supplement with your prescriber first.

Safety, sourcing, and when to call your doctor

Use GLP-1 medicines only through a licensed prescriber and pharmacy. In Malaysia and Singapore these are prescription medicines, and registration is handled separately by each country’s regulator (NPRA in Malaysia, HSA in Singapore). The World Health Organization has issued alerts about falsified semaglutide products, and the 2025 joint advisory notes that compounded GLP-1s are not FDA-reviewed for safety or efficacy in the US.^[2]

Contact your doctor promptly if you have:

• Persistent vomiting, diarrhea, dizziness, or very dark urine (possible dehydration and kidney strain).
• Severe or persistent abdominal pain, especially with vomiting (rare pancreatitis or gallbladder problems).
• Marked new weakness, falls, or a noticeable drop in exercise tolerance.
• Heavy hair shedding, unusual bruising, poor wound healing, or skin flaking (possible nutrient deficiency).
• Worsening mood or thoughts of self-harm; seek urgent help right away.
• A history of an eating disorder: restrictive eating disorders are a general contraindication, so specialist assessment is needed first.

Evidence map: how strong is each claim?

Evidence legend (CEBM Levels of Evidence, adapted)

Level 1 systematic review of randomized trials · Level 2 randomized trial (or substudy) or observational study with a dramatic effect; also used here for meta-analyses of mixed designs · Level 3 non-randomized cohort or follow-up study · Level 4 case series, uncontrolled or historically controlled studies · Level 5 mechanism-based reasoning, expert opinion, guideline extrapolation. Tiers rate the design as applied to this specific claim, with downgrades for small samples or indirectness.

Table 5. Evidence map for the main claims in this guide

Claim	Best available evidence	Tier	Main limitation
25–40% of weight lost is lean mass	STEP 1 and SURMOUNT-1 DXA substudies	Level 2	Small subsets (about 140 and 160); lean mass is not muscle
Midfacial volume falls about 7% per 10 kg lost	Retrospective CT/MRI series (n=20)	Level 4	No control group; cannot isolate drug effect
Resistance training plus protein limits lean-mass loss	Weight-loss trials, consensus advisory; GLP-1 trials ongoing	Level 2	Indirect for GLP-1 users
Protein 1.2–1.6 g/kg/day	Consensus advisory	Level 5	Extrapolated; body-weight basis unclear in obesity
Weight returns at about 0.8 kg/month after stopping	BMJ 2026 meta-analysis	Level 2	Limited follow-up beyond 12 months for newer drugs
Fillers, biostimulators, fat grafting restore GLP-1-related volume	Expert opinion, case-based reports	Level 4–5	Controlled GLP-1-specific data are limited
Diet can replace GLP-1 medication	None identified	Level 5	Small, transient hormonal effect only

How to use this guide with Claude, ChatGPT, Gemini, and Perplexity

AI assistants can turn this article into a personal question list, a weekly training and protein plan, or a plain-language summary for your doctor visit. They cannot examine you, prescribe, or replace your clinician, and they can make mistakes. Share only what you are comfortable sharing, remove names and ID numbers, and verify medical details with your prescriber.

Table 6. Example uses (check each tool’s privacy settings before sharing health information)

Assistant	Useful for	Starter prompt (paste the article text or link first)
Claude	Checking a plan against the evidence tiers and spotting unsupported claims	“Using this article’s evidence levels, review my plan (3 strength sessions, 100 g protein a day) and list what is well supported versus opinion. Add questions for my prescriber.”
ChatGPT	Building a weekly protein and training schedule you can follow	“Make a 4-week beginner resistance plan and a protein-first meal schedule for a person on a GLP-1 with low appetite. Mark anything that needs doctor approval.”
Gemini	Summarizing your notes or calendar into a visit checklist (if you choose to connect them)	“Summarize the key risks in this guide and draft a one-page checklist for my next appointment about muscle, bone, and stopping plans.”
Perplexity	Finding and comparing current sources and recent updates	“Find peer-reviewed or regulator sources from the last 12 months on weight regain after stopping tirzepatide, and say how strong each study is.”

Frequently asked questions

Is “Ozempic face” caused by the drug or by weight loss?

The best current evidence ties facial volume loss to how much weight is lost. A 2025 imaging series of 20 patients found about 7% midfacial volume loss per 10 kg lost, but it had no control group, so it cannot separate a direct drug effect from weight loss itself. Laboratory work on skin stem cells is intriguing but unproven in human faces.

Is “Ozempic face” permanent?

Nobody knows yet, because long-term controlled data are lacking. Lost fat-pad volume generally does not return unless weight is regained. Some clinicians report partial skin tightening once weight stabilizes over 6–12 months, but that is expert opinion, not trial evidence. Fillers, biostimulators, fat grafting, or surgery can restore contour if it bothers you.

How much of GLP-1 weight loss is muscle?

In DXA substudies, lean mass made up about 38% of weight lost on semaglutide 2.4 mg (STEP 1) and about 25% on tirzepatide (SURMOUNT-1), similar to placebo in that trial. Lean mass includes water, organs, and bone as well as muscle. Muscle itself is estimated at roughly half of lean mass, so about 20% of total weight lost in STEP 1.

How much protein should I eat on a GLP-1 medicine?

A 2025 joint advisory notes 1.2–1.6 g/kg/day has been proposed during active weight loss, with alternatives of about 1.5 g per kg of fat-free mass or a fixed 80–120 g/day. Protein alone will not protect muscle without strength training. People with kidney disease need an individualized target from their doctor or dietitian.

Should I stop my GLP-1 if I notice muscle or facial loss?

Not on your own. Talk with your prescriber about slower dose escalation, higher protein, and regular resistance training. Stopping the drug usually brings weight back: a 2026 BMJ meta-analysis found regain of about 0.8 kg per month after stopping semaglutide or tirzepatide, and the cardiometabolic benefits tend to fade as well.

How fast does weight come back after stopping semaglutide or tirzepatide?

A 2026 BMJ systematic review of 37 studies found regain averaging 0.4 kg per month across weight-loss drugs and about 0.8 kg per month for semaglutide and tirzepatide, projecting a return to baseline in roughly 1.5 years. Only eight studies covered newer GLP-1 drugs, and none followed people beyond 12 months after stopping.

Can I boost GLP-1 naturally instead of taking medication?

Protein- and fiber-rich meals raise your body’s own GLP-1 briefly, but the effect is small and no study shows it matches medication-level weight loss. A 2025 joint advisory lists dietary modulation of endogenous GLP-1 as an area needing more research. Treat these foods as a supportive eating pattern, not a substitute for treatment.

Can I have fillers or biostimulators while taking a GLP-1 medicine?

Yes. Aesthetic clinicians increasingly treat GLP-1 patients with hyaluronic acid fillers, biostimulators, and fat grafting. Evidence is mainly expert opinion and case-based, so choose a licensed physician, disclose your medication, and consider staging treatment as your weight stabilizes, since your volume needs may keep changing while you are still losing.

Do oral GLP-1 pills such as the Wegovy pill or Foundayo cause “Ozempic face”?

Facial change tracks the amount of weight lost, so any effective weight-loss drug can contribute. Average trial weight loss with the oral agents (about 11–12% at the top orforglipron dose) is lower than with higher-dose injectables, but no study has directly compared facial outcomes. Individual results vary widely.

Sources

1. Look M, et al. Body composition changes during weight reduction with tirzepatide in the SURMOUNT-1 study of adults with obesity or overweight. Diabetes Obes Metab. 2025 (DXA substudy, n=160). Link
2. Mozaffarian D, et al. Nutritional priorities to support GLP-1 therapy for obesity: a joint Advisory from the American College of Lifestyle Medicine, the American Society for Nutrition, the Obesity Medicine Association, and The Obesity Society. Obesity. 2025;33(8):1475–1503 (corrected April 2026). Link
3. West S, et al. Weight regain following the cessation of medication for weight management: a systematic review and meta-analysis. BMJ. 2026;392:e085304. Link
4. University of Oxford, Nuffield Department of Primary Care Health Sciences. Weight regain after stopping weight-loss drugs: research summary (2026). Link
5. Sharma RK, et al. Radiographic midfacial volume changes in patients taking GLP-1 receptor agonists. Otolaryngol Head Neck Surg. 2025;173(2):360–366 (retrospective, n=20). Link
6. “Ozempic Face: An Update and Critical Review.” 2026 literature review of studies published 2024–2026. Link
7. Skeletal Muscle Effects of GLP-1 Receptor Agonists: Molecular Mechanisms and Comparative Insights on Semaglutide and Tirzepatide, a Narrative Review. Published September 10, 2026. Link
8. SEMALEAN study: impact of semaglutide on fat mass, lean mass and muscle function in patients with obesity (observational). Link
9. Preprint (not peer reviewed): Greater lean-body-mass decline with tirzepatide than semaglutide in routine care, revealed by body-composition digital phenotyping. medRxiv 2026. Link
10. Wilding JPH, et al. Once-weekly semaglutide in adults with overweight or obesity (STEP 1). N Engl J Med. 2021;384:989–1002. Link
11. Wilding JPH, et al. Weight regain and cardiometabolic effects after withdrawal of semaglutide: the STEP 1 trial extension. Diabetes Obes Metab. 2022;24(8):1553–1564.
12. Aronne LJ, et al. Continued treatment with tirzepatide for maintenance of weight reduction in adults with obesity: the SURMOUNT-4 randomized clinical trial. JAMA. 2024;331(1):38–48.
13. Aronne LJ, et al. Tirzepatide as compared with semaglutide for the treatment of obesity (SURMOUNT-5). N Engl J Med. 2025.
14. Healio. FDA approves Foundayo (orforglipron), an oral GLP-1, for adults with obesity. April 1, 2026 (also notes the Wegovy pill approval in December 2025). Link
15. ClinicalTrials.gov NCT07457437: Function and Lean Mass Preservation With Resistance Exercise During a GLP-1RA Treatment (recruiting/ongoing). Link
16. ClinicalTrials.gov NCT06885736: LEAN-PREP, lean mass preservation with resistance exercise and protein during semaglutide/tirzepatide therapy (ongoing). Link

Related reading

• Start GLP-1 Weight Loss (2026): Compare Options, Costs & Best Strategy
• 17 Best Natural Ozempic Alternatives 2026 (Resource Guide)
• Retatrutide vs Tirzepatide vs Semaglutide (Ozempic): GLP-1 Wars — Updated Review (2026)
• Top Peptide Protocols 2026: Best Stacks for Fat Loss, Recovery, Anti-Aging & Longevity
• Jardiance vs. Ozempic: A Clinical Comparison for Weight Loss (2026)

Topics: GLP-1 · Ozempic · Weight loss

Final note

This information reflects published research and regulatory announcements available as of October 8, 2026 and should not replace professional medical advice. Always consult your healthcare provider before starting or changing any medication, supplement, procedure, or exercise regimen.