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Prescription weight loss that puts you first
You can’t go far lately without seeing news and social media coverage of GLP-1 (glucagon-like peptide-1) receptor agonists like Ozempic®, Wegovy®, Mounjaro®, and Zepbound®.
While Ozempic can be great at treating type 2 diabetes and supporting weight loss, it can also have some drawbacks. You might be familiar with the drug’s digestive side effects, like nausea and diarrhea, but you may not know about is the potential for muscle loss. Should you be worried about Ozempic muscle loss?
Here’s everything you need to know about Ozempic and muscle loss, including why it might happen, what the research says, and what you can do to prevent it.
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Before we get into Ozempic muscle loss, let’s go over the basics of this drug.
Ozempic is a glucagon-like peptide 1 (GLP-1) receptor agonist. It’s approved by the Food and Drug Administration (FDA) for managing blood sugar levels in people with type 2 diabetes alongside lifestyle changes like diet and exercise.
The FDA has also approved Ozempic to prevent major cardiovascular events like heart attack or stroke in those with type 2 diabetes who also have preexisting cardiovascular disease.
A healthcare provider may prescribe Ozempic off-label for weight loss. Off-label is when a medication is prescribed for a disease or condition it’s not approved by the FDA to treat.
There’s actually a semaglutide product approved by the FDA specifically for weight loss. It’s sold under the brand name Wegovy® and is produced by Novo Nordisk, the same company that makes Ozempic.
Semaglutide, the active ingredient in Ozempic, has several effects on the body. It increases insulin production and inhibits glucagon production, helping to lower blood sugar. It also reduces your appetite by slowing stomach emptying and interacting with receptors in the brain associated with feeling full.
Muscle loss isn’t listed as one of the potential side effects of Ozempic. Concerns about the risk of muscle loss have more to do with the effects of significant, rapid weight loss on the body in general.
Do you lose fat or muscle on Ozempic? Probably a bit of both.
When we think about losing weight, we often believe it’s just fat mass being lost. However, you can lose lean body mass as well, which includes skeletal muscle mass.
When you reduce your body weight, an estimated 20 to 40 percent of the total lost is lean mass. The remaining 60 to 80 percent is fat mass.
Clinical trials have demonstrated significant weight loss when using semaglutide compared to placebo.
A 2021 clinical trial found that participants taking semaglutide lost an average of 14.9 percent of their body weight after 68 weeks, compared to 2.4 percent of those taking a placebo. What’s more, 50.5 percent of those who took semaglutide lost 15 percent or more of their body weight after 68 weeks, compared to 4.9 percent in the placebo group.
Because of this significant weight loss, concerns have been raised about loss of lean mass, including loss of muscle mass, while on semaglutide products like Ozempic and Wegovy.
Significant loss of muscle mass can result in lower muscle strength or endurance. In some people, it can also increase the risk of frailty and accidents like falls, which can lead to hospitalization.
This is especially true for older adults with a higher risk of sarcopenia — a loss of muscle that happens with age and reduced physical activity.
There’s no firm number on how much muscle loss happens when you take Ozempic.
A 2021 meta-analysis of 18 trials simply noted that, compared to placebos, semaglutide led to a significant decrease in lean muscle mass.
A 2019 review looked into the effects of diabetes drugs on lean mass. It only included one study on semaglutide, but the researchers estimated that 20 percent of the total weight loss while on semaglutide was associated with loss of lean mass.
Not every study expresses concerns about Ozempic and muscle loss.
For example, a 2024 systematic review of six studies found that semaglutide led to a significant loss of lean muscle mass compared to placebo.
However, the researchers also pointed out that since fat mass also decreased, the level of lean mass relative to total body weight was actually improved. And this is a good outcome as far as body composition is concerned.
Other studies haven’t seen the same effects on lean muscle mass in the first place. For instance, a 2022 real-life study looked at the body composition of people who had taken semaglutide for 26 weeks to manage type 2 diabetes.
The researchers found that weight loss with semaglutide was mainly due to reductions in visceral fat and total fat mass. Changes in lean mass and muscle strength weren’t clinically relevant.
Whether or not to be concerned about muscle loss on Ozempic can depend on many individual factors. These include things like your age, overall health, the food you eat, and your exercise habits.
If your healthcare provider has prescribed you Ozempic, you might be curious about what you can do to prevent muscle loss.
There are absolutely steps that you can take to do this – and they’re actually pretty in line with the fact that Ozempic should be used along with diet and exercise.
Remember that every person taking Ozempic responds to it differently and has unique health needs. So talk to your healthcare provider before making significant changes to your diet or exercise routine.
Getting enough protein is an essential part of eating a healthy diet. It can also promote weight loss by increasing energy expenditure and preventing the loss of lean mass.
Regardless of age, the recommended daily protein intake is 0.8 grams per kilogram (g/kg) of body weight. After a quick unit conversion, this is about 55 grams of daily protein for an adult who weighs 150 pounds.
According to a 2021 review, some studies have found that increasing protein intake during a weight loss intervention can minimize how much muscle mass is lost.
For instance, a 2013 trial assessed the effect of protein intake for 39 adults on a reduced-calorie diet. It found that those who doubled the daily recommended intake (1.6 g/kg of body weight) lost more fat and less muscle than people who only ate the recommended 0.8 g/kg of body weight.
Whether you’re aiming to hit the recommended daily intake of protein or boost your protein intake, it’s important to choose healthy protein sources. These include:
Lean or low-fat meats like skinless chicken breasts, pork loin, and 93 percent lean ground beef
Seafood, particularly types high in omega-3 fatty acids
Beans, peas, and lentils
Nuts and seeds
Soy products
Beyond healthy protein sources, don’t sleep on the other components of healthy eating, which can also aid you in diabetes management and weight loss. These include fruits, vegetables, whole grains, and low-fat or nonfat dairy.
Like a healthy diet, getting regular physical activity is a vital part of a healthy lifestyle. This includes both aerobic exercise and resistance training.
A 2017 review discussed maintaining healthy muscles while losing weight. It stated that endurance (aerobic) and resistance (strength-training) exercises can help preserve muscle mass while losing weight. Resistance exercises have the further benefit of boosting muscle strength during this time.
The fact that working out and mindful eating go hand in hand in preserving lean mass is underscored by a 2014 study of 75 adults. It compared people in a diet-only group to those who adjusted their diet and did aerobic exercise.
Both groups had reductions in total body fat and visceral body fat. However, those in the diet-only group had significantly greater decreases in thigh muscle size compared to the diet-and-aerobic-exercise group.
Want to start being more active but don’t know where to start? You’re not alone. Let’s look into the types of activities that count as resistance training and aerobic exercise.
Building muscle on Ozempic is crucial. Simply put, resistance training makes your muscles do more work than they’re typically used to doing.
When you think about resistance training, you might imagine lifting weights. However, pumping iron isn’t the only way to build muscle.
You can also work with a resistance band. Using your own body weight as a form of resistance works as well. This is how exercises like sit-ups and push-ups build and strengthen muscles.
Resistance training can even be incorporated into your everyday activities. For example, the Physical Activity Guidelines for Americans notes that heavy gardening can be a form of muscle-strengthening exercise.
Aerobic exercise is any activity that boosts your breathing and heart rate. There are so many types of aerobic exercises to try out, including running, cycling, and swimming.
Looking to start a little easier? A brisk walk outside can be a form of aerobic exercise. So can dancing. Even going up and down your stairs at home a few times can get your heart pumping.
Still unsure what to do? Consider having a conversation with your healthcare provider about how to get started. They can go over resistance and aerobic exercises that would be safe and effective for you.
Yes. Other GLP-1 drugs, such as exenatide (Byetta®) and liraglutide (Victoza®), have been linked with lean mass loss.
Other diabetes drugs, specifically sodium-glucose cotransporter 2 (SGLT2) inhibitors, can also lead to a reduction in lean mass. This includes canagliflozin (Invokana®) and dapagliflozin (Farxiga®).
Does semaglutide cause muscle loss when it’s compounded? It can — in the same way quickly losing weight on Ozempic can.
It’s possible for lean mass loss to happen with other weight loss strategies too. These include calorie restriction and bariatric surgery.
Demand for Ozempic and other GLP-1 receptor agonist medications has soared recently due to their effectiveness for weight loss. In fact, semaglutide topped a list of drug spending in the United States for 2023.
The Centers for Disease Control and Prevention (CDC) estimates that around 74 percent of adults in the U.S. are living with overweight or obesity, so it’s completely understandable that so many seek safe and effective weight loss methods.
Does Ozempic cause muscle loss? Not directly, but the rapid weight loss you experience on the drug might.
Here’s what to keep in mind about muscle loss with Ozempic:
Ozempic muscle loss can happen if you lose weight quickly. The same goes for Wegovy muscle loss, Mounjaro muscle loss, compounded semaglutide muscle loss, and other GLP-1 drugs that cause rapid weight loss.
Can you build muscle on Ozempic? Absolutely. There are ways to effectively counteract muscle loss that can happen with weight loss. This includes eating more protein and doing resistance training.
Ozempic could still be improving your overall health. Weight loss can come with so many other benefits, including lower blood sugar, reduced blood pressure, and lowered “bad” cholesterol, along with a reduced risk for other health conditions, like cardiovascular disease, obstructive sleep apnea, and osteoarthritis.
If you’re concerned, consult your provider. If you’re taking Ozempic and notice changes in your muscle mass, muscle strength, or muscle endurance, contact your healthcare provider. They can assess your situation and help you figure out your next move.
If you’ve been prescribed Ozempic and are worried about muscle loss, don’t be afraid to talk to your healthcare provider about it. They’re there to support you, offer guidance, and alleviate any concerns you may have.
At the end of the day, everyone’s wellness journey is different. In some situations, weight loss drugs like Ozempic may not be the optimal way to manage diabetes or weight. Your healthcare provider can go over Ozempic alternatives and work with you to find a method that’s effective for your individual needs.
Take our free online weight loss assessment to see what options are available to you.
This article is for informational purposes only and does not constitute medical advice. The information contained herein is not a substitute for and should never be relied upon for professional medical advice. Always talk to your doctor about the risks and benefits of any treatment. Learn more about our editorial standards here.
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