How to Prevent Muscle Loss While Taking Weight Loss Drugs

Weight loss drugs work in a variety of ways. Some lower body weight by increasing the excretion of glucose in the urine. These are referred to as sodium-glucose co-transporter 2 (SGLT2) inhibitors. Invokana, Farixga, and Jardiance all fall into this category. Though they’ve not been approved for weight loss, they are sometimes prescribed for this purpose.

Other medications assist with fat loss by reducing appetite. This makes it easier for people to follow a low-calorie diet. Weight loss drugs known as glucagon-like peptide-1 (GLP-1) receptor agonists fall into this category. Wegovy and Ozempic are both GLP-1 RA medications.

Research indicates that prescriptions for SGLT2 and GLP-1 drugs have increased by 114.6% and 221% respectively. (1) While access to a prescription weight loss medication can help people lower their body weight, many users also face muscle loss.

Connection Between Weight Loss Medication and Muscle Loss

To be fair, lean mass loss isn’t a direct effect of these drugs. Put another way, the drug itself doesn’t “eat” lean muscle, causing it to go away. Instead, the effect is often a result of rapid weight loss.

When a person consumes drastically fewer calories than they’re used to, the body looks for other sources of fuel. Unfortunately, it can choose muscle as its fuel source. Research confirms this.

In a 2021 study, 1,961 adults with obesity took either semaglutide or a placebo. (Semaglutide is the active drug in Wegovy.) After 68 weeks, the mean weight loss in subjects taking the active ingredient was 14.9% of their original body weight compared to a 2.4% loss in the group taking the placebo or sham drug. (2)

If you look at the supplementary appendix for this study, it breaks down these losses. The sham group only lost 0.19% of their fat mass while the semaglutide group lost 10.4% of their fat. But they also had less muscle loss as well. Specifically, those taking the placebo lost roughly 0.11% of their lean mass, of which muscle mass is a part. Those taking semaglutide lost much more or approximately 3.61% of their lean mass. (3)

This discrepancy in muscle mass loss is due, in part, to the semaglutide group achieving a higher level of weight loss. The more weight you lose, the greater the lean muscle mass loss. 

Consequences of Losing Muscle

Generally speaking, losing weight is good—especially for people with obesity. Obesity can increase one’s risk of heart disease, type 2 diabetes, and musculoskeletal issues. It can even lead to poorer mental health. 

One study found that children with obesity have a 7.15 times greater risk of having a mental health disorder in their teenage years than children with a normal weight. (4) Anxiety and mood disorders are a common concern. So too is attention-deficit hyperactivity disorder (ADHD). That said, with weight loss, there are also consequences of losing muscle mass. 

When you lose muscle, everyday activities can be harder to perform. You might struggle to open a jar, for example. Or you may find it more difficult to push the mower around the yard.

A certain amount of muscle wasting or loss is common with age. This is referred to as sarcopenia. If too much muscle is lost, it can affect the older person’s level of independence. It can also increase their frailty according to the Cleveland Clinic. (5) This raises their risk of falls and fractures.

Losing too much muscle at a younger age can have the same effect. That’s why it’s important to find ways to protect muscle mass when on weight loss drugs. How can you do this?

How to Prevent Muscle Loss While Taking Weight Loss Drugs

Ask any personal trainer how to build muscle and they’ll likely give you two pieces of advice. They’ll tell you to eat more protein and to engage in resistance training. So, it only makes sense that these same strategies can also help protect against the loss of muscle mass. 

Increase Protein Intake

Protein is the building block of muscle. The body uses amino acids for both muscle growth and repair. Research has found that eating more of your calories in the form of protein helps prevent muscle loss. (6) And this approach appears to offer the greatest impact when protein intake is distributed evenly across one’s meals.

Animal-based foods are often high in protein. This includes lean meats, eggs, and dairy products. Those following a plant-based diet can also increase the protein in their diet by eating more nuts, seeds, and beans. Tofu is another good plant-based protein source, as are soy and grains. Eating more of these foods can provide the body with the nutrients it needs to maintain muscle mass. 

The recommended protein intake for the average person is generally between 0.7 and 0.9 grams per kilogram of body weight per day. However, some need more, such as those with higher levels of physical activity. A dietitian or nutritionist can help determine the best amount to consume based on a person’s situation and needs. 

Engage in Strength Training Exercise

Another way to protect lean mass when taking weight loss drugs is with resistance training. Resistance training promotes muscle growth. It makes muscle bigger and stronger. This helps combat muscle mass loss. 

Gaining muscle provides another positive effect for people interested in losing weight. It increases calories burned. The body requires more energy to maintain muscle than fat, which means greater fat burn all day long. This makes weight loss easier by contributing to a higher calorie deficit. This leads to a reduction in body fat.

There are numerous ways to structure a strength training workout. You can do full-body workouts, hitting every muscle group in the same session. Or you can do more of a split schedule, working one muscle group one day and a different one the next. Both approaches can help protect and grow muscle mass. Aim to work on each muscle group 2-3 times per week. 

Importance of Diet and Exercise When Taking a Weight Loss Drug 

A weight loss drug is a tool available for people interested in losing weight. But it isn’t necessarily designed to be the only tool used. The Obesity Medicine Association reports that this type of drug is “most effective when they are used as part of a comprehensive treatment plan.” (7) In short, diet and exercise are also important.

Eating healthy foods and getting regular exercise helps protect lean body mass while contributing to weight loss. They’re also critical for weight management. If you achieve weight loss with only a medication, you haven’t developed the habits necessary to sustain that loss. You may even set yourself up for weight gain when stopping the drug.

Working with a personal trainer and nutritionist can go a long way in supporting lasting weight loss. These professionals can teach you how to develop lifelong habits for better body composition. You can also learn both aspects of the fitness industry through certification courses, enabling you to help yourself and others achieve and maintain effective weight loss. 

ISSA offers both Personal Training certification and Nutritionist certification programs. Each course provides valuable information related to diet and exercise. When used together, you and your clients can enjoy greater (and healthier) weight loss.

References

1. Dzaye, O., Berning, P., Razavi, A. C., Adhikari, R., Jha, K., Nasir, K., Ayers, J. W., Mortensen, M. B., & Blaha, M. J. (2022). Online searches for SGLT-2 inhibitors and GLP-1 receptor agonists correlate with prescription rates in the United States: An infodemiological study. Frontiers in Cardiovascular Medicine, 9. https://doi.org/10.3389/fcvm.2022.936651

2. Wilding, J., Batterham, R. L., Calanna, S., Davies, M. J., Van Gaal, L. F., Lingvay, I., McGowan, B., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/nejmoa2032183

3. Wilding, J., Batterham, R. L., Calanna, S., Davies, M. J., Van Gaal, L. F., Lingvay, I., McGowan, B., Rosenstock, J., Tran, M. T. D., Wadden, T. A., Wharton, S., Yokote, K., Zeuthen, N., & Kushner, R. F. (2021c). Once-Weekly Semaglutide in Adults with Overweight or Obesity - Supplementary Appendix. The New England Journal of Medicine, 384(11), 989–1002. https://doi.org/10.1056/nejmoa2032183

4. Beltrán‐Garrayo, L., Solar, M., Blanco, M., Berna, M. G., & Sepúlveda, A. R. (2023). Examining associations between obesity and mental health disorders from childhood to adolescence: A case-control prospective study. Psychiatry Research, 326, 115296. https://doi.org/10.1016/j.psychres.2023.115296

5. Professional, C. C. M. (n.d.). Sarcopenia. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/23167-sarcopenia

6. Carbone, J. W., & Pasiakos, S. M. (2019). Dietary Protein and Muscle Mass: Translating science to application and health benefit. Nutrients, 11(5), 1136. https://doi.org/10.3390/nu11051136

7. Obesity Medicine Association. (2024, January 29). Top weight loss medications. Obesity Medicine Association. https://obesitymedicine.org/blog/weight-loss-medications/