Losing Weight With Medication? You May Be Losing Muscle, Too

Weight-loss medications known as GLP-1s, such as Wegovy and Zepbound, have become a popular tool to help people lose weight. They’re also effective for treating related health concerns, like heart disease and kidney disease. While these medications can deliver substantial health benefits, people who use them also risk losing excess muscle mass.

University Hospitals preventative cardiologist Ian Neeland, MD, shares more about how to maintain muscle while taking weight loss medications.

The Weight-Muscle Loss Link

Weight loss is typically accompanied by muscle loss, whether through diet and exercise alone or the use of weight-loss medications. The difference, explains Dr. Neeland, is the amount of weight people tend to lose in a short period of time on GLP-1 medications. “The more weight you lose, the more muscle you lose, because muscle tends to shrink at the same time as it adapts to weight loss,” he says.

More studies are needed to understand whether the muscle loss from GLP-1 medications is harmful. In fact, some research suggests the medications can improve the overall quality and function of the muscle that is preserved.

Still, these findings should be a note of caution for people at higher risk for sudden loss of muscle mass. Weight-loss medications are not recommended for people with the following conditions:

• Age-related muscle loss (sarcopenia)
• Cancer
• Advanced heart failure
• Neuromuscular conditions

Maintaining Muscle With a Proactive Approach

If you’re taking GLP-1 medications, there are steps you can take to maintain muscle as the weight comes off. Like most weight loss advice, these strategies come down to two factors: diet and exercise.

Many people on weight-loss medications experience a reduced appetite. Dr. Neeland stresses the importance of small, high-quality meals that prioritize protein intake. “Usually, people consume about 15 percent of total calories in the form of protein, but for people on GLP-1s I recommend 25-30 percent protein intake,” he says.

In addition, exercise – which is typically recommended to help support medicated weight loss – should emphasize strength training. Dr. Neeland tells patients who are maintaining their weight to dedicate one-third of their weekly exercise to strength training. People who are actively losing weight should dedicate up to one-half of their time to strength training. “Listen to your body and start slowly,” he says. “Ideally, work up to two or three times a week as you can tolerate.”

Weighing the Risks

Though more needs to be understood about the long-term effects of muscle loss from GLP-1 medications, people should discuss those risks in the context of overall health risks.

“We have a great deal of evidence showing that these medications offer significant benefit not only for weight management, but in treating diabetes, sleep apnea, cardiovascular conditions, kidney and liver disease, and more,” says Dr. Neeland.

Related Links

The University Hospitals CINEMA program (Center for Integrated and Novel Approaches in Vascular-Metabolic Disease) offers integrated care, including GLP-1 medication management, to treat overlapping diabetes, heart and kidney disease issues.