The #1 Most Important Thing to Do if You Want to Avoid Losing Muscle While on Ozempic
Woman holding weight loss injection pen
Weight loss drugs like Ozempic and Wegovy have exploded in popularity in the past year. While there is some controversy surrounding prescription weight loss drugs—including their unpleasant side effects and if they are safe for long-term use—they have been shown to successfully help prevent type 2 diabetes and weight loss, which doctors who prescribe these drugs say would be hard for people with obesity to do through diet and exercise alone.
For individuals with obesity who have spent years struggling to lose weight, prescription weight loss drugs can be beneficial. However, taking a prescription weight loss drug can also lead to muscle loss and bone loss.
How can you lose fat while maintaining muscle while taking a prescription weight-loss drug? Keep reading to find out.
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How Prescription Weight Loss Drugs Can Cause Muscle Loss
Dr. Christopher McGowan, MD, MSCR, AGAF, FASGE, ABOM, who is triple-board certified in internal medicine, gastroenterology and obesity medicine, says that muscle loss is typical any time someone is losing a substantial amount of weight, whether they are taking a prescription weight loss medication like Ozempic or not.
“When an individual loses weight, particularly a significant amount, they will lose a combination of fat mass and lean mass. This is true regardless of the weight loss mechanism or tool. When caloric intake is reduced, the body will turn to energy stores initially in glycogen, then in fat and muscle to provide fuel,” Dr. McGowan says. “With most weight loss interventions, between one-quarter and one-third of weight loss is muscle. The remaining weight is fat. This is true of bariatric surgery, anti-obesity medications or dieting.”
Related: The Unexpected Benefit of Weight Loss Drugs Like Ozempic That No One's Talking About
Dr. McGowan points to a study showing that individuals taking semaglutide (the generic form of Ozempic), lost approximately 60% fat mass and 39% muscle mass. He says another study of tripeptide (the active ingredient in the weight loss drug Zepbound) had similar results, showing that patients lost roughly 25% muscle and 75% fat during treatment.
“These findings are similar to the muscle loss seen with other weight loss interventions and speak to the importance of preserving and maintaining muscle while actively losing weight,” Dr. McGowan says.
He explains that losing muscle lowers one’s metabolic rate—which is one reason why people may hit a weight loss plateau, adding, “Muscle is [also] critical for our overall strength, mobility and agility. Rapid muscle loss can increase the risk of injury and falls, particularly in older adults. For these reasons, we must preserve muscle mass when losing weight."
Dr. McGowan says that losing weight can also lead to losing bone density. “As someone sheds significant weight, their bones will bear less force, which may reduce bone density over time. Likewise, loss of skeletal muscle may negatively impact bone health. These effects have not been directly studied with the newer GLP-1 medications but are a risk that needs to be considered when embarking on a weight loss journey,” he explains, adding that older adults need to be especially mindful of this because they are already at increased risk for osteoporosis.
Clearly, it’s important to maintain muscle mass and bone density while losing weight. So how do you do it?
Related: What Happens When You Stop Taking Ozempic?
How to Avoid Losing Muscle When Taking a Prescription Weight Loss Drug
To avoid losing muscle while taking a prescription weight loss drug like Ozempic, Dr. McGowan says that prioritizing protein intake is key. “Adequate protein intake will help to preserve existing lean muscle,” he explains.
If you are taking a weight loss drug, Dr. McGowan says to aim to consume between 60 and 90 grams of high-quality protein each day, explaining, “Protein supplements, including whey-based protein drinks, may be necessary, especially if one’s appetite is greatly diminished, or medication side effects, such as nausea, make eating difficult."
Hitting this protein goal isn’t easy, which is why Dr. McGowan recommends working with a registered dietitian. A registered dietitian can help ensure you’re getting adequate nutrition, including protein, healthily.
In addition to prioritizing protein, Dr. McGowan says that it’s also important to exercise regularly and incorporate weight-bearing exercise and resistance training into your workout routine. This will help with maintaining both muscle and bone.
“A good general recommendation is to incorporate 30 minutes of daily walking or other weight-bearing cardiovascular exercise and two days per week of strength or resistance training. This will help to optimize your body composition as you lose weight,” he explains.
Other examples of weight-bearing cardiovascular exercise (besides walking) include running, tennis, pickleball, jump-roping and dancing. Examples of strength or resistance training include lifting weights, using resistance bands and Pilates.
Similar to how working with a registered dietitian can help with meeting nutrition goals, Dr. McGowan says that working with a personal trainer can help with meeting exercise goals safely and effectively.
Dr. McGowan says that it’s also important to focus on slow-and-steady weight loss versus rapid weight loss, which can make losing muscle and bone more likely. “In general, it can take 12 to 18 months to lose the amount of weight you will lose. Crash diets, or very low-calorie intake, may lead to more rapid weight loss in the short term but will be detrimental in the long run. This is why regular support from a medical provider and nutrition team is critical to ensure you lose weight in the healthiest manner possible,” he explains.
Eating a well-rounded diet that includes high-quality protein sources as well as exercising regularly is important for everyone. But if you are taking a prescription weight loss medication, you are at increased risk for muscle and bone loss, so it’s even more important. Put these steps into practice and you’ll be losing weight and supporting your body at the same time.
Sources
Dr. Christopher McGowan, MD, MSCR, AGAF, FASGE, ABOM, a doctor who is triple-board certified in internal medicine, gastroenterology and obesity medicine and the founder of True You Weight Loss
Common Side Effects. Ozempic
Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Open Network. 2022
Weight loss drugs can lead to muscle loss, too. Is that a bad thing? NBC News
The Risks of Taking Drugs Like Ozempic When You’re Over 65. The New York Times
Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study. Journal of the Endocrine Society. 2021
Tirzepride Reduces Appetite, Energy Intake, and Fat Mass In People With Type 2 Diabetes. Diabetes Care. 2023
