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So post-GLP-1, your knees may no longer be overloaded by mass, but theyre still: Tracking according to old alignment (valgus/varus habits, rotational patterns) Responding to trunk and pelvis strategies that were built around a forward-shifted center of gravity Low back & spinal curves Multiple studies now connect abdominal obesity with: Increased lumbar lordosis and altered spinal alignment Greater gravitational torque on the lumbar spine Higher likelihood of low-back pain independent of age and activity level

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Additive effects on weight loss were similarly demonstrated in the Efficacy and Safety of Semaglutide Once-weekly Versus Placebo as add-on to SGLT-2i in Subjects With Type 2 Diabetes Mellitus (SUSTAIN-9) and Dulaglutide as add-on therapy to SGLT2 inhibitors in patients with inadequately controlled type 2 diabetes (AWARD-10) trials [103,104]