Ozempic Muscle Loss: Does Ozempic Cause Muscle Loss?
This article was reviewed by Craig Primack, MD, FACP, FAAP, FOMA.
GLP-1 (glucagon-like peptide-1) receptor agonists like Ozempic, Wegovy, Mounjaro, and Zepbound have become household names. And for good reason — many people are finding success using them to lose weight and achieve other health goals.
While Ozempic can be great at treating type 2 diabetes and supporting weight loss, it may also have drawbacks. It’s not uncommon to experience digestive side effects, like nausea and diarrhea, but there’s also a potential for Ozempic muscle loss.
Here’s everything you need to know about Ozempic and muscle loss, including why it might happen and what you can do to maintain muscle while still losing weight.
Does Ozempic Make You Lose Muscle?
Muscle loss isn’t listed as a direct side effect of Ozempic. But rapid weight loss from using the medication can result in some loss of lean body mass, including skeletal muscle mass and bone mass.
On average, about 20 to 40 percent of weight lost during dieting or medication-assisted body weight loss is lean muscle mass, with the rest being fat.
Clinical trials show semaglutide (the active ingredient in Ozempic) leads to significant weight loss. So you can expect some of that to be fat and some to be muscle.
Research on Ozempic and Muscle Loss
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.
A 2021 meta-analysis of 18 trials simply noted that, compared to placebos, semaglutide led to a significant decrease in lean muscle mass.
This raises concerns, especially for older adults at risk for sarcopenia (age-related muscle loss). Losing too much muscle can affect strength, mobility, and overall function.
Significant loss of muscle mass can result in lower muscle strength or endurance. For some people, it can also increase the risk of frailty and accidents like falls, which can lead to hospitalization.
But again, research shows fat loss makes up the majority of weight lost on this type of medication. In some cases, lean mass changes are minor or even proportionally improved.
For example, a 2024 systematic review of six studies found that semaglutide led to a significant loss of lean muscle mass compared to placebo. But the weight loss was still primarily from fat reduction.
Ozempic, Fat Loss, and Muscle Loss
The researchers in the systematic review pointed out that since fat mass also decreased, the level of lean mass relative to total body weight was actually improved. 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, like your age, overall health, diet, and exercise habits.
How to Prevent Muscle Loss on Ozempic
If your healthcare provider has prescribed Ozempic, you might be curious about what you can do to prevent muscle loss. Here are a few things to try.
1. Pay Attention to Quality Protein
Getting enough protein can promote weight loss by increasing energy expenditure and preventing the loss of lean mass and bone density.
The recommended daily protein intake is 0.8 grams per kilogram (g/kg) of body weight. This is about 55 grams for an adult who weighs 150 pounds. But we recommend aiming for closer to 100 grams of protein a day when taking weight loss medication.
According to a 2021 review, increasing protein intake during a weight loss intervention can minimize the amount of muscle mass lost.
For instance, a 2013 trial assessed the effect of protein intake on 39 adults on a reduced-calorie diet. It found that those who doubled the daily recommended intake (1.6 grams per kilogram of body weight) lost more fat and less muscle than people who only ate 0.8 grams of protein per kilogram of body weight.
Whatever your protein intake goals are, it’s important to choose healthy protein sources, like:
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Lean or low-fat meats like skinless chicken breasts, pork loin, ground turkey, and lean ground beef
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Seafood, particularly fatty fish high in omega-3 fatty acids, like salmon
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Beans, peas, and lentils
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Nuts and seeds
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Soy products, such as tofu or tempeh
Beyond healthy protein sources, don’t sleep on the other components of healthy eating, which can also support diabetes management and weight loss. These include fruits, vegetables, whole grains, and low-fat or nonfat dairy.
2. Exercise
A 2017 review stated that endurance (aerobic) and resistance (strength training) exercises can help preserve muscle mass while losing weight. Resistance exercises can also boost muscle strength and bone density.
A 2014 study of 75 adults underscored the importance of working out and mindful eating in preserving lean mass. The study 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 (fat around the midsection). However, those in the diet-only group had significantly greater decreases in thigh muscle size compared to the diet-and-aerobic-exercise group.
Weight Lifting to Combat Muscle Loss
Resistance training makes your muscles do more work than they’re typically used to, stimulating muscle-protein synthesis. And lifting weights isn’t the only way to build muscle while on Ozempic.
You can also use resistance bands or your own body weight to perform movements like sit-ups, lunges, squats, and push-ups. Even gardening, yardwork, cleaning, and other everyday activities count, according to the Physical Activity Guidelines for Americans.
Aerobic Exercise
Aerobic exercise is any activity that boosts your breathing and heart rate, like running, cycling, swimming, dancing, stairclimbing, or even a brisk walk outside.
Everyone taking Ozempic responds to the medication differently and has unique health needs. So talk to your healthcare provider before making significant changes to your diet or exercise routine.
3. Prioritize Your Sleep
Sleep is often overlooked, but it plays a key role in preserving muscle mass, especially during a weight loss journey. Poor sleep can increase cortisol (a stress hormone), disrupt appetite hormones like ghrelin and leptin, and even reduce muscle recovery and growth.
Research suggests that sleep deprivation can impair muscle protein synthesis and lead to greater lean mass loss when you’re restricting calories. Plus, when you’re feeling groggy, you’re much less likely to want to hit the gym (or make the best eating choices).
Aim for seven to nine hours of quality sleep each night, and try to maintain a consistent sleep schedule.
Creating a relaxing bedtime routine, limiting screen time before bed, and avoiding caffeine late in the day can all support better sleep and better results while on Ozempic.
Do Other GLP-1 Medications Cause Muscle Loss?
Yes. Other GLP-1 drugs, such as exenatide (Byetta) and liraglutide (Victoza), have been linked to 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).
Other weight loss strategies, such as calorie restriction and bariatric surgery, can cause lean mass loss as well. The standard typically quoted for a regular weight loss diet is 75 percent of the weight lost is fat and 25 percent is muscle loss.
Are There Medications That Can Help Prevent Ozempic Muscle Loss?
New treatments are being explored to help reduce the risk of muscle loss that can occur with GLP-1 medications like Ozempic. Though research is still in the early stages, there are some promising developments.
Eli Lilly, the company behind tirzepatide (sold as Mounjaro and Zepbound), is developing a drug called bimagrumab (LY3985863). It’s a monoclonal antibody designed to block receptors involved in muscle breakdown.
In an ongoing Phase 2B clinical trial called BELIEVE, bimagrumab is being tested both alone and alongside semaglutide. The goal is to see whether combining these drugs can lead to greater fat loss while helping preserve muscle mass, potentially offering a more balanced approach to obesity treatment.
Ozempic Muscle Loss: The Bottom Line
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 semaglutide muscle loss:
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Ozempic muscle loss can happen if you lose weight quickly. The same goes for Wegovy, Mounjaro, and other GLP-1 agonist drugs that cause rapid weight loss.
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Can you build muscle on Ozempic? Absolutely. There are ways to effectively counteract muscle loss that can happen with weight loss, including eating more protein and doing resistance training.
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Ozempic could help improve your overall health. Weight loss can have many other benefits, including lower blood sugar levels, reduced blood pressure, and lower LDL (low-density lipoprotein, aka “bad”) cholesterol, along with a reduced risk for other health conditions, like cardiovascular disease, obstructive sleep apnea, and osteoarthritis.
If you’re taking Ozempic and are concerned about muscle loss or notice changes in your muscle mass or strength, contact your healthcare provider. They can assess your situation and help you figure out your next move.
At the end of the day, everyone’s wellness journey is different. In some situations, weight loss drugs like Ozempic may not be the best way to manage diabetes or weight. Your provider can go over Ozempic alternatives, including other weight loss medications like Wegovy, and work with you to find a method that’s effective for your needs.
Related:
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Can I take Wegovy while pregnant?
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Can I use Ozempic after gastric bypass?
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This article originally appeared on Forhers.com and was syndicated by MediaFeed.org
