Dominic Stone
Weight loss drugs like Wegovy have been shown to cause muscle loss, but it is unclear whether this muscle loss is unhealthy. While these drugs can lead to significant weight loss, there are concerns about the accompanying loss of muscle tissue. Some experts warn that patients taking Wegovy could lose some muscle in the process of losing weight. However, it is important to note that muscle loss is common during any weight loss journey, regardless of the method used. Studies have shown that despite losing lean mass, those who took weight loss medication had a lower risk of heart disease and better physical function.
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What You'll Learn
Weight loss drugs and muscle loss
Weight loss drugs can lead to muscle loss, but it is not necessarily harmful. When the body isn't getting enough energy from food, it pulls from reserves of energy stored as fat and muscle, primarily from fat. The more weight a person loses in a short period, the more muscle mass they will lose in addition to fat. This can be a problem, as the loss of muscle mass can lead to impaired physical function, reduced quality of life, and an increased risk of falls, illness, and death. It can also lead to a reduced basal metabolic rate, decreased strength, fitness, and tone, and reduced bone density.
GLP-1 drugs, such as Wegovy, Ozempic, and Zepbound, are a new class of weight management drugs that mimic the actions of glucagon-like peptide-1 (GLP-1), a hormone secreted by the gastrointestinal tract. While these drugs can lead to significant weight loss, there are concerns about the accompanying loss of muscle tissue. A recent study showed that those taking Ozempic, or any form of semaglutide, lost on average 60% fat and 39% muscle mass. Another study that looked at those taking Zepbound, or the active ingredient tirzepatide, showed that patients lost roughly 25% muscle and 75% fat during treatment.
To mitigate muscle loss while taking weight loss drugs, it is important to make lifestyle changes such as increasing protein intake and incorporating strength and resistance training into your workout routine. Specifically, it is recommended to consume 60–90 grams of high-quality protein each day and to exercise for at least 30 minutes 3–4 times a week. Additionally, people taking weight loss drugs should stay in close contact with their healthcare team to monitor muscle loss and other potential side effects, such as impacts on kidney function, salt, and electrolytes.
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GLP-1 agonist drugs and muscle loss
Weight loss drugs, including GLP-1 agonists, have soared in popularity in recent years, with some people experiencing dramatic weight loss. While these drugs are effective in inducing weight loss, there are concerns about the accompanying loss of muscle tissue.
GLP-1 receptor agonists, such as Wegovy, are effective for weight loss, but can cause substantial muscle loss. Studies suggest muscle loss with these medications ranges from 25% to 39% of the total weight lost over 36–72 weeks. This substantial muscle loss can be attributed to the magnitude of weight loss, rather than an independent effect of GLP-1 receptor agonists. However, it is important to note that there is heterogeneity in the reported effects of GLP-1-based therapies on lean mass changes. Some studies show lean mass reductions of approximately 15% or less of total weight lost, while others report reductions ranging from 40% to 60%.
The loss of muscle mass can lead to impaired physical function, reduced quality of life, and an increased risk of falls, illness, and death. It is referred to as sarcopenia, which is common in old age. Losing weight at the expense of lean muscle mass can lead to reduced basal metabolic rate, decreased strength, fitness, tone, and bone density. Therefore, it is essential to prioritize muscle preservation during weight loss.
To preserve muscle mass while taking weight-loss drugs, adequate protein consumption is crucial. Most people should aim for 60–90 grams of high-quality protein each day. Exercise is also critical, with resistance training being particularly important. Aim for at least 30 minutes of exercise 3–4 times a week to maintain muscle and bone health. Additionally, staying hydrated is vital as muscle is 76% water, and dehydration can lead to muscle cramps and fatigue.
While GLP-1 agonist drugs may cause muscle loss, the muscle changes appear to be adaptive. The improvement in insulin sensitivity and muscle fat infiltration likely contributes to an adaptive process with improved muscle quality, lowering the probability of loss in strength and function. However, older adults may be at a higher risk of sarcopenia due to the risk of age-related muscle loss.
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Preventing muscle loss on Wegovy
While drugs like Wegovy can lead to significant weight loss, there are concerns about the accompanying loss of muscle tissue. A recent study showed that those taking Ozempic, or any form of semaglutide, lost on average 60% fat and 39% muscle mass. Another study that looked at those taking Zepbound, or the active ingredient tirzepatide, showed that patients lost roughly 25% muscle and 75% fat during treatment.
However, there are ways to prevent muscle loss while taking Wegovy. Here are some tips to help you preserve your muscle mass:
- Exercise regularly: Include weight-bearing and resistance training in your exercise routine. Aim for at least 30 minutes of exercise 3-4 times a week to maintain muscle and bone health. Walking, lifting weights, jump-roping, tennis, Pilates, and resistance bands are great options.
- Prioritize protein: Ensure you are consuming an adequate amount of protein to help preserve lean muscle. Most people should aim for 60-90 grams of high-quality protein each day while taking weight loss medication. Supplements, including whey protein drinks, can be helpful if you're experiencing nausea or decreased appetite.
- Stay hydrated: Proper hydration is crucial for muscle function and recovery after exercise. Muscle is mostly made up of water, so dehydration can lead to muscle cramps and fatigue. Aim to drink half of your body weight in ounces of water per day. For example, a 200-pound person should drink about 100 ounces of water daily.
- Slow and steady weight loss: While it may be tempting to lose weight as quickly as possible, it's better for your body, bones, and muscles to lose smaller amounts of weight over a longer period. Rapid weight loss can lead to more muscle loss and be harmful in the long run.
- Medical supervision: It is essential to have heightened surveillance from both the patient and the physician when taking Wegovy. Stay in close contact with your healthcare team so they can monitor muscle loss and other potential side effects, such as kidney function, salt, and electrolytes.
- Nutrition and lifestyle changes: Work with a nutritionist or dietitian to ensure proper nutrition and prevent malnutrition. Some companies, like Daily Harvest, offer meal delivery services specifically for clients on weight loss drugs. Additionally, consider joining support programs like Noom's Muscle Defense, which includes fitness videos and a protein tracker.
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Exercise and muscle preservation
Weight-loss drugs like Wegovy have been linked to muscle loss, but the extent and implications of this are not yet fully understood. While some muscle loss is normal during weight loss, excessive muscle loss can be detrimental, leading to reduced strength, fitness, bone density, and an increased risk of falls and fractures. Therefore, preserving muscle mass is crucial when pursuing weight loss.
Exercise is a critical component of muscle preservation during weight loss. Aim for at least 30 minutes of exercise, 3–4 times a week, incorporating weight-bearing cardiovascular exercises and resistance or strength training. Strength training, in particular, helps ensure that weight loss comes from fat rather than muscle. Focus on exercises with a high stimulus-to-fatigue ratio, such as goblet squats and chest-supported rows, to maximize muscle preservation and minimize injury risk.
When it comes to strength training, aim for rep ranges of 10–30 and gradually increase weights or reps by small increments (2–5 pounds). Incorporate deload weeks with maintenance calories to optimize recovery. It's important to prioritize quality reps over volume to maximize muscle retention. Additionally, consider working with a certified personal trainer or physical therapist to ensure proper form and avoid injury.
In addition to exercise, dietary choices play a significant role in muscle preservation. Consuming adequate protein is essential for maintaining lean muscle. Most people should aim for 60–90 grams of high-quality protein daily while taking weight loss medication. Older adults engaging in resistance training may require even higher protein intake, ranging from 1 to 1.3 grams of protein per kilogram of body weight per day. Lean chicken, eggs, milk, Greek yogurt, and whey or plant-based protein powders are excellent sources of protein.
By combining strategic exercise routines with a high-protein diet, individuals can effectively preserve muscle mass while pursuing weight loss. It's important to remember that muscle loss can occur during any weight loss journey, so a slow and steady approach is generally recommended for optimal health and muscle preservation.
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Health risks of muscle loss
Muscle loss, or muscle atrophy, is a common condition that affects people as they grow older. While some amount of muscle loss is normal with ageing, certain factors can lead to a more rapid decline in muscle mass, strength, and function. This condition is known as sarcopenia and can have significant health risks and impacts on one's quality of life.
One of the primary health risks associated with muscle loss is an increased risk of falls and fractures. As muscle strength and coordination decline, individuals may experience difficulty with balance and mobility, making them more prone to falling. This is especially concerning for older adults, as falls can result in broken bones, head injuries, and other serious complications.
Muscle loss can also lead to a decrease in basal metabolic rate. Muscle tissue is metabolically active, and losing muscle mass can result in a slower metabolism, making it more challenging to maintain a healthy weight. This can contribute to a cycle of muscle loss and fat accumulation, further exacerbating the problem.
Additionally, muscle loss can increase the risk of disability and loss of independence. As muscle strength declines, individuals may find it difficult to perform daily tasks such as getting out of chairs, opening jars, or carrying groceries. This can lead to a loss of independence and the need for long-term care.
The health risks of muscle loss also extend to an increased risk of chronic diseases. Conditions such as chronic obstructive pulmonary disease (COPD), kidney disease, diabetes, cancer, and HIV have been linked to a higher risk of sarcopenia. The presence of these chronic diseases can further accelerate muscle loss and deterioration.
Furthermore, muscle loss can impact an individual's mental health and cognitive function. Studies have shown a link between muscle weakness and gradual memory loss. Additionally, the loss of independence and functional decline associated with muscle loss can contribute to feelings of depression and isolation and a reduced quality of life.
To mitigate the health risks associated with muscle loss, individuals can focus on lifestyle interventions such as regular exercise, specifically resistance and weight-bearing training, and a healthy diet rich in protein. These interventions can help slow down or even reverse the effects of muscle loss, improving overall health and well-being.
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Frequently asked questions
Yes, Wegovy may cause muscle loss. However, it is unclear whether the lean mass lost during weight loss comes from muscle.
According to data from two randomised controlled trials, up to 40% of the weight lost on Wegovy may be from lean mass. However, the average proportion of lean mass to total body weight in the participants actually increased after they lost weight.
Yes, loss of muscle mass can lead to impaired physical function, reduced quality of life, an increased risk of falls, illness, and death. It can also lead to a reduced basal metabolic rate, decreased strength, fitness, and tone, and reduced bone density.
To prevent muscle loss, it is recommended to consume enough protein, perform strength training 1-2 times a week, and get 7-9 hours of sleep per night. Additionally, staying hydrated and exercising regularly can help maintain muscle mass.
