Big Deal or Nothing to Worry About?

When people lose weight using medications like Ozempic and Wegovy, they likely lose muscle as well as fat, which may be a concern for older adults.

On the surface, the formula for weight loss seems simple: eat less and move more. But giving that advice to someone with obesity is like telling someone with depression to cheer up. Weight loss isn’t easy, or we wouldn’t be facing a crisis in overweight and obesity.

Helpful medications

It is unlikely humans will ever adapt for us not to gain weight, so when a class of drugs makes it possible to lose weight and keep it off, it’s a welcome and helpful development. GLP-1R agonists, such as Ozempic, Wegovy, Saxenda, or Zepbound, have been around for about 20 years, having started their useful life as treatments for Type 2 diabetes.

Claiming magazine’s breakthrough of the year in 2023, these drugs are an absolute revelation: they give you long-lasting weight loss as long as you continue taking them. The drugs aren’t quite as effective as bariatric surgery, but they’re not far off and they do the job without surgery. These drugs may become as good as bariatric surgery at controlling weight long-term.

Fat loss and muscle loss

Losing weight by dieting (restricting energy) includes, along with fat loss, losing lean mass, about half of which is typically muscle. The general rule is that three-quarters of what we lose is fat and the rest is lean tissue. My research focuses on the positive health outcomes of maintaining muscle, especially as we age and become more susceptible to sarcopenia, the steady age-related loss of muscle mass.

Exercise and protein

There is no doubt this newly recognized class of weight-loss drugs is a watershed discovery and could improve lives for generations to come. If, as we see from early clinical trials, these drugs promote the loss of lean mass together with the loss of fat, it will be important for users to be aware and for pharmaceutical companies to adjust future generations of these drugs. Without deliberate efforts to exercise for strength and to increase their protein intake to retain muscle, there could be consequences.

Conclusion

While losing weight is an excellent way to improve our health, it should bear the caveat of not losing muscle, especially in older persons. The good of the weight loss may not outweigh the “bad” of the muscle loss. It’s still too early to know if muscle loss while taking GLP-1R agonists will be problematic in the long run, but I think it’s important to proceed with caution, especially in older persons, until trial results are available.

Frequently Asked Questions

• What are GLP-1R agonists?
  GLP-1R agonists are a class of medications that stimulate the release of insulin and glucagon-like peptide-1 (GLP-1), a hormone that helps regulate blood sugar levels.
• What are the benefits of GLP-1R agonists?
  GLP-1R agonists have been shown to be effective in helping individuals with obesity to lose weight and improve their overall health.
• What are the potential risks of GLP-1R agonists?
  The potential risks of GLP-1R agonists include the loss of lean mass, which can be a concern, especially in older adults.
• How can I maintain muscle mass while taking GLP-1R agonists?
  To maintain muscle mass while taking GLP-1R agonists, it is important to engage in regular exercise and to increase protein intake.