Does Ozempic cause muscle loss?

If you are taking Ozempic or another GLP-1 medication, you may have heard that it can cause muscle mass loss. First, let us reassure you: it is possible to lose muscle mass whenever you experience rapid weight loss—as many people do while taking Ozempic—but there are healthy, concrete steps to stave off or mitigate this potential unwanted effect. 

Ahead, we take a closer look at Ozempic muscle loss and offer tips on how to prevent the side effect from occurring whether you’re taking Ozempic or another GLP-1 medication or simply losing weight at a fast pace.

Ozempic (semaglutide) is a glucagon-like peptide 1 (GLP-1) receptor agonist. The drug’s active ingredient, semaglutide, mimics GLP-1, a hormone produced in your gut. GLP-1 works on GLP-1 receptors throughout your body and is involved in many processes that affect your appetite and metabolism. 

For one, GLP-1 stimulates insulin release from the pancreas, helping to control blood sugar levels. GLP-1 also slows down your digestion, so food stays in your stomach longer, lowering your appetite. Finally, GLP-1 tells your brain when you’re full, and may even alter your brain’s preferences for certain foods. 

Indeed, semaglutide’s interactions with your brain’s food reward system are thought to make it easier for people to control how much they eat and reduce their cravings for high-fat foods in particular. As high-fat foods tend to be more calorie-dense, this change in food preferences may lead you to eat less while on Ozempic, resulting in further weight loss. 

Ozempic is meant to be taken in combination with lifestyle changes such as diet and exercise, which also contribute to weight loss. Ideally, when you take Ozempic, you’re going after weight loss with a three-pronged approach: medication, diet, and exercise.

Like several GLP-1 medications, Ozempic was originally developed to treat type 2 diabetes by improving blood sugar control. However, researchers soon noted how people, many of whom were obese or overweight, were experiencing significant weight loss in clinical trials. Cut to today where some GLP-1 medications are now approved by the US Food and Drug Administration (FDA) for obesity (e.g. Saxenda and Wegovy), and others, such as Ozempic, may be prescribed off-label for weight loss.

It’s possible. Losing significant amounts of weight quickly through calorie restriction can lead to a loss of muscle mass, and it is not uncommon to experience rapid weight loss when taking GLP-1 medications, such as Ozempic. People taking 1 mg of Ozempic can expect to lose an average of 7% of their body weight in the first year of treatment. 

Whenever you lose weight, you lose varying amounts of fat and muscle. But when you lose weight quickly, you are more likely to lose lean muscle mass,especially if you’re not being careful about your diet and exercise (more on that below). For example, studies of people who have undergone bariatric surgery show that most of their lean body mass, fat-free mass, and skeletal muscle mass loss occurs in the first three months after surgery. 

While weight loss in people with overweight or obesity comes with many health benefits, losing weight rapidly can also cause a decrease in muscle mass and lessen bone density. This could lead to sarcopenia, a condition where you progressively lose muscle mass and strength that’s usually more of a concern for older adults aged 60 and above. The more muscle mass, the more calories a person burns at rest (aka basal metabolic rate). When a person loses muscle mass, the resting metabolic rate decreases, too. 

What about Ozempic muscle loss, in particular, and sarcopenia? Studies have found that semaglutide leads to a significant decrease in fat-free mass (aka muscle mass) compared with a placebo. However, a recent article published in JAMA suggests that data does not support the concern that GLP-1-based anti-obesity medications cause physical frailty or sarcopenia due to significant weight loss. In fact, the paper argues that even though weight loss leads to a decline in skeletal muscle mass (SMM), individuals with obesity generally have high baseline levels of fat-free mass (FMM) and SMM compared to leaner individuals. So, the decrease in SMM represents only a small fraction of their total body SMM, meaning it’s unlikely to impair physical function (read: cause a condition such as sarcopenia).

Other studies of semaglutide have found that at six months, most of the weight loss was due to a loss of visceral fat and overall fat mass, while SMM and FMM—along with muscle strength—were minimally affected. And still, other studies of Wegovy (which contains a higher dosage of semaglutide) have found that while lean body mass decreased overall by nearly 10%, the remaining lean body mass made up a higher percentage of the person’s overall body weight. In other words, the proportion of lean body mass relative to total body mass increased, which is a good thing. Plus the more weight they lost, the better their ratio of lean muscle mass to fat mass. 

So, should you be worried about muscle mass loss or not while taking Ozempic, based on the scientific data available? It’s helpful to remember Ozempic is not the only variable in anyone’s weight loss journey. People may be following different diets and exercise routines, and have individual differences in their baseline body weight and health conditions. 

Also, weight loss of 5–10% offers many health benefits to people with overweight and obesity, including improved blood sugar, blood pressure, and cholesterol, as well as a reduced risk of diabetes. Depression, mobility, and even sexual function typically improve, too. Losing even more weight, between 10–20%, may alleviate other conditions related to obesity, like obstructive sleep apnea. It can be difficult to lose more than 5% of body weight and keep it off using diet and exercise alone. That’s where medications, such as Ozempic, can help. The key is to make sure you are losing weight safely without losing your muscles.

If you are starting a weight loss program, there are clear steps you can take to maintain muscle mass while shedding the pounds. 

1. Eat plenty of protein

Protein offers many benefits to people looking to lose weight, including increased satiety (or a feeling of fullness) after a meal and less muscle mass loss. People who follow higher-protein diets tend to experience more fat loss and weight loss overall, while maintaining their muscles. Protein may have a beneficial effect on triglycerides and blood pressure, too. 

To enjoy these benefits, some data suggests eating at least 25–30 grams of protein per meal. You can find protein in meat, dairy, eggs and from plant-based sources, such as soy, grains, nuts, seeds, and legumes.

When adding more protein to your diet—and making any dietary changes, for that matter—it can be helpful to have expert guidance, such as that from a healthcare provider or dietitian. Through Ro, for example, you can get access to ongoing care and support to help you navigate your weight loss journey and support your goals with optimal nutrition (think: advice on how to eat more protein based on your individual needs, lifestyle, and goals). 

2. Add strength training to your workouts

Exercise is an important part of any weight loss journey and is recommended for people using Ozempic. Exercise can lead to modest weight loss on its own, but is especially effective at preventing weight regain after weight loss. Plus, exercise can help you control—to some extent—how you lose weight on Ozempic. 

In one study of older adults with obesity on a diet, adding resistance training nearly canceled out all of the muscle loss they would have experienced on their diet. Other studies have reached similar conclusions: Calorie restriction alone leads to weight loss and muscle mass loss, but adding in exercise can protect against these effects, helping you lose weight without losing muscle. 

Like any physical activity, exercise burns calories, but by building strength during your workouts, you can preserve the muscle mass you do have while continuing to lose weight on Ozempic. Engaging in both resistance and aerobic exercise can help speed up your metabolism, further enhancing the weight loss effects of Ozempic.

For resistance, you can use free weights, resistance bands, or your own body weight. Exercises such as squats, push-ups, and bicep curls are all examples of resistance training. Even certain yoga poses (e.g.plank or chair pose) are resistance exercises.

3. Get enough sleep

How much sleep are you getting? A good night’s sleep does much more than help you feel well-rested. It can also affect how your body holds onto fat and muscle. 

One study found that people who are chronically sleep-deprived (fewer than 7 hours of sleep per night) are more likely to have obesity and higher levels of body fat. Interestingly, chronically oversleeping (9 or more hours per day) could be linked to losing muscle mass. 

Sleep is a lot like Goldilocks. Too much and too little can be a good thing. By regularly sleeping 7–8 hours per night, you can prevent muscle mass loss and promote fat loss. Just one night of missed sleep can make it tougher for your body to repair and build muscle, according to another study.

4. Stress less

If you're not getting enough sleep, you may feel stressed, which can also negatively impact your lean muscle mass. Increased cortisol levels, which occur with sleep deprivation, can accelerate sarcopenia and reduce muscle strength and mass.

Try to relieve your stress levels by:

• Getting at least 7 hours of sleep per night

• Exercising regularly

• Practicing visualization or meditation

• Performing deep breathing exercises

• Seeing a therapist

Speak with a healthcare provider if you have concerns about experiencing muscle loss on Ozempic. They may recommend different dietary changes or workout routines to prevent muscle loss, or they may reassure you that what you are currently doing is just right.

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Every article on Health Guide goes through rigorous fact-checking by our team of medical reviewers. Our reviewers are trained medical professionals who ensure each article contains the most up-to-date information, and that medical details have been correctly interpreted by the writer.

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Current version

June 07, 2024

Written by

Amelia Willson

Fact checked by

Raagini Yedidi, MD

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About the medical reviewer

Raagini Yedidi, MD

Raagini Yedidi, MD, is an internal medicine resident and medical reviewer for Ro.