Anonymous wrote:

Anonymous wrote:I’m on Wegovy. It’s not the medication. My weight loss clinic does a body scan at each appointment to see what’s going on with body fat and muscle composition and flag any decrease in muscle. Their diet plan includes a lot of protein to make sure patients are maintaining or gaining muscle. I’ve added strength training to my fitness routine to build even more muscle. At my last appointment, I had gained a pound of muscle, and had lost 3 pounds of fat. Eating a lot of protein is key.

But how many people are taking these meds and being scanned or otherwise having their fat vs. muscle loss measured? None of the folks I know on them.

I have listened to some doctors on podcasts (e.g., Peter Attia, who is a proponent of GLP1 medications) and on Doctor Radio discuss concerns about muscle loss with the use of these drugs. Primarily that they're just handed out now like candy, with no monitoring and discussion of the importance of protein intake.

Anonymous wrote:The study showing that close to 40% of weight lost was lean muscle is discussed in this article.

https://www.healthline.com/health-news/ozempic-muscle-mass-loss#What-the-science-says-about-sarcopenia-and-GLP-1-drugs-like-Ozempic

Here is what an expert had to say (with emphasis added):

Data that is raising concern about sarcopenia as it relates to GLP-1 drugs is driven by a small portion of participants who underwent DEXA (dual-energy X-ray absorptiometry), which measures bone mineral density using spectral imaging, said Dr. Karl Nadolsky, endocrinologist and diplomate at the American Board of Obesity Medicine.

“Of this subset, the total mass loss was nearly 14 kg and while nearly 8.5 kg (about 60%) was fat loss, the 5 kg lean mass loss reported was 38%, which is on the high end of what we’d expect,” he told Healthline. “That said, DEXA is certainly imperfect in splicing the details of this body composition change as adipose tissue includes plenty of ‘lean mass.’ Additionally, the placebo group lost more lean mass (-1.83kg) than fat mass (1.37kg), which shows potential error.”

Nadolsky pointed out that rapid weight loss, in general, will reduce resting metabolic rate to some degree.

For instance, a meta-analysis showed that people who underwent bariatric surgery demonstrated over 8kg of fat-free mass and lean body mass loss within 1 year post-bariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.

“Any time people lose weight, one-quarter to one-third of that weight can be muscle, and the faster we lose, the more likely we are to lose muscle. While 20% reduction in muscle mass seems normal for someone losing weight, the problem is the length of time in which this muscle loss occurs,” said Kumar.

The jury is still out on this, but the article has advice on how to minimize the loss of muscle mass while taking these medications.

Anonymous wrote:Bottom line for anyone interested in these meds for weight loss:

*You have to be clinically obese to be prescribed them. If someone is prescribing them to you to lose 10-15 pounds for cosmetic reasons or handing them out "like candy" as an earlier poster said, run.

*Whoever prescribes these meds to you should also offer 1) medical oversight such as ordering bloodwork, checking your bp, and monitoring potential side effects; 2) they should counsel you about the importance of prioritizing protein in your meal plan as a way to preserve muscle mass; and 3) they should monitor your muscle mass through the use of body composition scans like the Inbody or refer you for a Dexa scan. Providers who just prescribe and don't do the above are not being responsible. And you, as the patient, have the responsibility of making life-long changes to your diet and exercise habits to keep the weight off--just like with any other weight loss method, including surgery.

*For those of you that have decided not to take the medication for whatever reason, then JUST DON'T. No one is forcing you to.

Data that is raising concern about sarcopenia as it relates to GLP-1 drugs is driven by a small portion of participants who underwent DEXA (dual-energy X-ray absorptiometry), which measures bone mineral density using spectral imaging, said Dr. Karl Nadolsky, endocrinologist and diplomate at the American Board of Obesity Medicine.

“Of this subset, the total mass loss was nearly 14 kg and while nearly 8.5 kg (about 60%) was fat loss, the 5 kg lean mass loss reported was 38%, which is on the high end of what we’d expect,” he told Healthline. “That said, DEXA is certainly imperfect in splicing the details of this body composition change as adipose tissue includes plenty of ‘lean mass.’ Additionally, the placebo group lost more lean mass (-1.83kg) than fat mass (1.37kg), which shows potential error.”

Nadolsky pointed out that rapid weight loss, in general, will reduce resting metabolic rate to some degree.

For instance, a meta-analysis showed that people who underwent bariatric surgery demonstrated over 8kg of fat-free mass and lean body mass loss within 1 year post-bariatric surgery, which reflected 21% and 22% of total body weight loss, respectively.

“Any time people lose weight, one-quarter to one-third of that weight can be muscle, and the faster we lose, the more likely we are to lose muscle. While 20% reduction in muscle mass seems normal for someone losing weight, the problem is the length of time in which this muscle loss occurs,” said Kumar.

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:That's what a sudden and extreme caloric deficit will do. It's important to eat 1g protein per kg of body weight to prevent muscle loss when losing weight, but when you're inducing mild gastroparesis it's impossible to consume that much.

No. Studies have already shown that people who use GLP1s lose a greater percentage of muscle weight than those who lose the same amount of weight without GLP1s.

Right, but as PP suggested, it’s the rapid weight loss that is doing this. Those losing weight without glp1s are not losing weight that quickly.

Not everyone loses weight rapidly on the meds. I'm the pp who's losing one to two pounds a week, which isn't rapid. I also haven't lost muscle and I don't have any loose skin, so I'm very happy with it.