Does Ozempic cause muscle loss?
LAST UPDATED: Aug 07, 2023
5 MIN READ
HERE'S WHAT WE'LL COVER
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 avoid or mitigate this potential unwanted effect. Let’s explore.
Get access to GLP-1 medication (if prescribed) and 1:1 support to meet your weight goals
How does Ozempic work for weight loss?
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 like 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 FDA-approved for obesity (e.g. Saxenda and Wegovy), and others, like Ozempic, may be prescribed off-label for weight loss.
Ozempic Important Safety Information: Read more about serious warnings and safety info.
Can Ozempic cause muscle mass 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 like 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, lessen bone density, leading to sarcopenia—a condition where you progressively lose muscle mass and strength, and usually more of a concern for older adults aged 60 and above. The more muscle mass, the more calories a person burns at rest (also called metabolic rate). When a person loses muscle mass, the resting metabolic rate decreases, too.
What about Ozempic and sarcopenia? Studies have found that semaglutide leads to a significant decrease in fat-free mass (aka muscle mass) compared with a placebo. However, 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 skeletal muscle and fat-free mass — 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%, it 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 on 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. However, it is difficult to lose more than 5% of body weight and keep it off using diet and exercise alone. That’s where medications like Ozempic can help. The key is to make sure you are losing weight safely without losing your muscles.
Get access to GLP-1 medication (if prescribed) and 1:1 support to meet your weight goals
How to avoid muscle mass loss
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 like soy, grains, nuts, seeds, and legumes.
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 obese older adults 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 like squats, push-ups, and bicep curls are all examples of resistance training. Even certain yoga poses, like a 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 be obese and have 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
Performing deep breathing exercises
Seeing a therapist
Speak with a healthcare professional if you have concerns about experiencing muscle mass loss while 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.
If you have any medical questions or concerns, please talk to your healthcare provider. The articles on Health Guide are underpinned by peer-reviewed research and information drawn from medical societies and governmental agencies. However, they are not a substitute for professional medical advice, diagnosis, or treatment.
Anam, M., Maharjan, S., Amjad, Z., et al. (2022). Efficacy of Semaglutide in Treating Obesity: A Systematic Review of Randomized Controlled Trials (RCTs). Cureus, 14(12), e32610. doi:10.7759/cureus.32610. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840940/
Ardeljan, A. D. & Hurezeanu, R. (2022). Sarcopenia. StatPearls. Retrieved Aug. 1, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK560813/
Chao, A. M., Tronieri, J. S., Amaro, A., et al. (2022). Clinical Insight on Semaglutide for Chronic Weight Management in Adults: Patient Selection and Special Considerations. Drug Design, Development and Therapy, 16, 4449–4461. doi:10.2147/DDDT.S365416. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9807016/
Collins, L. & Costello, R. A. (2023). Glucagon-like peptide-1 receptor agonists. StatPearls. Retrieved on Aug. 1, 2023 from https://www.ncbi.nlm.nih.gov/books/NBK551568/
Davies, M., Færch, L., Jeppesen, O. K., et al. (2021). Semaglutide 2·4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet (London, England), 397(10278), 971–984. doi:10.1016/S0140-6736(21)00213-0. Retrieved from https://pubmed.ncbi.nlm.nih.gov/33667417/
Ghusn, W., De la Rosa, A., Sacoto, D., et al. (2022). Weight Loss Outcomes Associated With Semaglutide Treatment for Patients With Overweight or Obesity. JAMA Network Open, 5(9), e2231982. doi:10.1001/jamanetworkopen.2022.31982. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9486455/
Ida, S., Kaneko, R., Imataka, K., et al. (2021). Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Current Diabetes Reviews, 17(3), 293–303. doi:10.2174/1573399816666200705210006. Retrieved from https://pubmed.ncbi.nlm.nih.gov/32628589/
Katsuhara, S., Yokomoto-Umakoshi, M., Umakoshi, H., et al. (2022). Impact of Cortisol on Reduction in Muscle Strength and Mass: A Mendelian Randomization Study. The Journal of Clinical Endocrinology and Metabolism, 107(4), e1477–e1487. doi:10.1210/clinem/dgab862. Retrieved from https://pubmed.ncbi.nlm.nih.gov/34850018/
Kim, K., Shin, D., Jung, G. U., et al. (2017). Association between sleep duration, fat mass, lean mass and obesity in Korean adults: the fourth and fifth Korea National Health and Nutrition Examination Surveys. Journal of Sleep Research, 26(4), 453–460. doi:10.1111/jsr.12504. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28220551/
Knudsen, L. B. & Lau, J. (2019). The Discovery and Development of Liraglutide and Semaglutide. Frontiers in Endocrinology, 10, 155. doi:10.3389/fendo.2019.00155. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6474072/
Lamon, S., Morabito, A., Arentson-Lantz, E., et al. (2021). The effect of acute sleep deprivation on skeletal muscle protein synthesis and the hormonal environment. Physiological Reports, 9(1), e14660. doi:10.14814/phy2.14660. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7785053/
Leidy, H. J., Clifton, P. M., Astrup, A., et al. (2015). The role of protein in weight loss and maintenance. The American Journal of Clinical Nutrition, 101(6), 1320S–1329S. doi:10.3945/ajcn.114.084038. Retrieved from https://www.sciencedirect.com/science/article/pii/S0002916523274274
Marsh, K. A., Munn, E. A., & Baines, S. K. (2013). Protein and vegetarian diets. The Medical Journal of Australia, 199(S4), S7–S10. doi:10.5694/mja11.11492. Retrieved from https://pubmed.ncbi.nlm.nih.gov/25369930/
Nuijten, M. A. H., Eijsvogels, T. M. H., Monpellier, V. M., et al. (2022). The magnitude and progress of lean body mass, fat-free mass, and skeletal muscle mass loss following bariatric surgery: A systematic review and meta-analysis. Obesity Reviews: An Official Journal of the International Association for the Study of Obesity, 23(1), e13370. doi:10.1111/obr.13370. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9285034/
Phillips, A. & Clements, J. N. (2022). Clinical review of subcutaneous semaglutide for obesity. Journal of Clinical Pharmacy and Therapeutics, 47(2), 184–193. doi:10.1111/jcpt.13574. Retrieved from https://onlinelibrary.wiley.com/doi/10.1111/jcpt.13574
Ryan, D. H. & Yockey, S. R. (2017). Weight Loss and Improvement in Comorbidity: Differences at 5%, 10%, 15%, and Over. Current Obesity Reports, 6(2), 187–194. doi:10.1007/s13679-017-0262-y. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497590/
Sardeli, A. V., Komatsu, T. R., Mori, M. A., et al. (2018). Resistance Training Prevents Muscle Loss Induced by Caloric Restriction in Obese Elderly Individuals: A Systematic Review and Meta-Analysis. Nutrients, 10(4), 423. doi:10.3390/nu10040423. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946208/
Strasser, B. (2013). Physical activity in obesity and metabolic syndrome. Annals of the New York Academy of Sciences, 1281(1), 141–159. doi:10.1111/j.1749-6632.2012.06785.x. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3715111/
Swift, D. L., Johannsen, N. M., Lavie, C. J., et al. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in Cardiovascular Diseases, 56(4), 441–447. doi:10.1016/j.pcad.2013.09.012. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3925973/
U.S. Food and Drug Administration (FDA). (2022). Highlights of Prescribing Information: Ozempic (semaglutide) injection, for subcutaneous use. Retrieved Aug. 1, 2023 from https://www.accessdata.fda.gov/drugsatfda_docs/label/2022/209637Orig1s009lbl.pdf
Volpe, S., Lisco, G., Racaniello, D., et al. (2022). Once-Weekly Semaglutide Induces an Early Improvement in Body Composition in Patients with Type 2 Diabetes: A 26-Week Prospective Real-Life Study. Nutrients, 14(12), 2414. doi:10.3390/nu14122414. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9227575/
Weiss, E. P., Jordan, R. C., Frese, E. M., et al. (2017). Effects of Weight Loss on Lean Mass, Strength, Bone, and Aerobic Capacity. Medicine and Science in Sports and Exercise, 49(1), 206–217. doi:10.1249/MSS.0000000000001074. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161655/
Wilding, J. P. H., Batterham, R. L., Calanna, S., et al. (2021). Impact of Semaglutide on Body Composition in Adults With Overweight or Obesity: Exploratory Analysis of the STEP 1 Study. Journal of the Endocrine Society, 5(Suppl 1), A16–A17. doi:10.1210/jendso/bvab048.030. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8089287/