Ozempic and Muscle Loss: Preserving Muscle Mass on GLP-1 Medications

Ozempic: arguably one of the most popular and debated medications on the market right now. Ozempic is the brand name for a medication called semaglutide and is part of a broader class of drugs called GLP-1 agonists. (A few other medications in this category include Wegovy, Mounjaro, and Trulicity.) Ozempic was first approved to treat type 2 diabetes but has recently boomed in popularity for one of its off-label uses — helping people achieve a healthier body weight. Wegovy is the only GLP-1 medication that is FDA-approved for weight loss, as well as reducing serious heart problems in obese adults.

GLP-1 agonists have proven to be very effective in helping people lose weight, which is a large part of their appeal. But how quickly weight loss happens has raised some concerns, one of which is the link between medications like Ozempic and muscle loss.

“Rapid weight loss can pose challenges with nutrient deficiencies, body composition, and metabolism,” says Jennifer Hayes, PT, DPT, a physical therapist at Hinge Health. But the big thing is muscle. “Whenever you lose weight, you lose some muscle along with fat. The faster the weight comes off, the more muscle you lose. That’s where we start to see issues with muscle weakness and fatigue, and a decreased ability to do everyday activities easily.”  

Read on to learn more about Ozempic and muscle loss and get tips from Hinge Health physical therapists on maintaining muscle mass while taking GLP-1 medications.

Why Muscle Is Important

Muscle is about more than just helping you heave heavy objects and making your arms look toned. It plays a pivotal role in maintaining overall health and function, particularly as you age. Over time, we naturally lose some muscle mass — about three to eight percent every decade starting at age 30. But losing too much muscle can be problematic. 

Here’s how healthy muscle mass helps you in everyday life:  

• Performing daily activities. This seems obvious, but your muscles allow you to stand, sit up straight, move, lift, and do everything that you do each day. The more muscle mass you have, the easier and less tiring your daily tasks become. 

• Preventing musculoskeletal issues. “Strong muscles support bone and joint health, which helps prevent issues like osteoporosis and fractures,” says Dr. Hayes. This can be especially important for those in or nearing menopause, when loss of bone mass often occurs. Muscle also plays a crucial role in maintaining flexibility and range of motion in your joints. With decreased muscle mass and flexibility, you may experience increased stiffness that makes it difficult to move — which is important for sustaining weight loss and maintaining health and function.

• Boosting metabolism. Muscle tissue is metabolically active, meaning it burns calories even at rest. Having more muscle mass increases your basal metabolic rate (BMR), which is the amount of energy your body uses to maintain basic functions, such as breathing. Translation: More muscle means a faster metabolism, which helps with maintaining a healthy weight and body composition.

• Improving insulin sensitivity. Muscle improves the effectiveness of insulin, which is a hormone that regulates blood sugar. Muscle cells love to gobble up glucose (sugar) from your blood, especially when you're moving around. They need more energy when you're active, so they grab more glucose. This makes them better at using insulin. Muscles also stash away extra glucose as glycogen, like a backup fuel. All of this helps keep blood sugar levels steady, prevents blood sugar spikes that can impair insulin sensitivity, and lowers the risk of type 2 diabetes and other metabolic disorders.

• Reducing fall risk and injury. Muscles provide the strength and stability needed to maintain balance, prevent falls, and reduce the risk of injury. Strong leg muscles, for example, help you stay steady on your feet and react quickly if you start to stumble.

How Does Ozempic Work?

Ozempic (semaglutide) belongs to a class of medications called glucagon-like peptide-1 receptor agonists (GLP-1 agonists). It works by binding to the GLP-1 receptors in the body, which enhances the effects of GLP-1. 

GLP-1 is a hormone that's released from the intestine in response to food intake and has a powerful effect on regulating different processes in the brain and body. GLP-1 functions to stimulate the release of insulin (a hormone that lowers blood sugar) while suppressing the release of glucagon (a hormone that raises blood sugar) from the pancreas. This results in improved blood sugar control. Another role GLP-1 plays in the body: It slows down gastric emptying, so you feel more full, while also acting on specific brain receptors that promote satiety (a feeling of fullness).

This explains why GLP-1 medications like Ozempic are so effective at promoting weight loss: They improve blood sugar control and reduce appetite.

While Ozempic and other GLP-1 agonists primarily target blood sugar regulation, weight loss is a common side effect, with many users experiencing reductions in body fat over time. According to a 2021 study published in The New England Journal of Medicine, 86% of participants lost 5% or more of their body weight over the course of 68 weeks using Ozempic, and 69% lost 10% or more of their body weight. 

Does Ozempic Cause Muscle Loss Too? 

Research suggests that any kind of rapid weight loss, characteristic of Ozempic and GLP-1 usage, may lead to muscle loss alongside fat reduction. The extent of muscle loss varies among individuals and depends on factors such as diet, exercise, and overall health status. 

Studies published in Current Diabetes Reviews and Endocrinology and Metabolism have found that semaglutide (Ozempic) can ultimately lead to sarcopenia, which is characterized by loss of muscle, strength, and function. It’s typically associated with aging, but rapid weight loss without proper nutrition or exercise can also cause sarcopenia. “When the weight comes off really quickly, you have less opportunity to preserve and rebuild your muscle,” says Dr. Hayes. 

It’s normal to lose some muscle whenever you lose any amount of weight. (About a third to a quarter of total weight lost is from lean body mass.) When you consume less food relative to what you expend, your body taps into its fat and muscle reserves for energy. Your body initially targets fat for the most part, but it's typical for some energy to come from muscle reserves too. This isn’t necessarily bad — you need less muscle to support less body weight. 

But the faster the weight comes off, the more your body needs to rely on breaking down muscle for additional energy, leading to a higher percentage of body fat relative to muscle. This is sometimes referred to as sarcopenic obesity, or "skinny fat."

Individuals may appear thin or have a normal body weight but the combination of body fat relative to low muscle mass is associated with increased health risks, similar to those seen in both obesity and sarcopenia (e.g., insulin resistance, type 2 diabetes, cardiovascular disease, and decreased physical function and mobility). You may also notice exhaustion from normal daily activities like caring for your kids, doing household chores, or engaging in hobbies and sports. 

Expert Tips on Ozempic and Muscle Loss

The FDA recommends that those taking medications like Ozempic for weight loss also follow a diet and exercise program to promote long-term health and weight management. But because weight loss can occur so rapidly with GLP-1 drugs like Ozempic regardless of lifestyle changes, it’s important to pay extra attention to your nutritional intake and exercise habits to preserve your muscle mass. 

“There are plenty of ways you can work to preserve muscle mass while losing weight,” says Dr. Hayes. Here are some tips from Hinge Health physical therapists that can help mitigate muscle loss and optimize the health and weight loss benefits of GLP-1 drugs like Ozempic:

• Do resistance training. Incorporate strength training exercises into your routine to stimulate muscle growth and counteract the effects of rapid weight loss. “I recommend strength training two to three times per week to start,” says Dr. Hayes. “Anything you can do is going to be helpful, whether that’s lunges, squats, or using light weights or resistance bands. It all helps.” (More on this below.) 

• Make sure you get adequate protein intake. Ensure your diet includes sufficient protein to support muscle repair and synthesis. Lean meats (e.g., turkey, chicken), fish and seafood, eggs, legumes, nuts and seeds, and quinoa are all good sources of protein. Here’s more on getting enough healthy protein.

• Balance your nutrition. Ozempic will make you feel fuller quicker, which makes it really important to be intentional about prioritizing your intake of high-quality foods first. Aim for foods that provide vitamins, minerals, healthy fats and carbohydrates, and protein to support overall health and muscle preservation. Talk to your doctor about whether you would benefit from supplements, such as a multivitamin or a calcium supplement to support bone health. Consider seeing a nutritionist to make sure your diet continues to support your health needs.

• Stay hydrated. Stay adequately hydrated to support muscle function and recovery, as dehydration can impede performance and hinder muscle preservation. “Muscles hold a good amount of water, so losing a lot of muscle can contribute to dehydration and the side effects that come with it, like fatigue and muscle cramps,” says Dr. Hayes. Aim to drink about half your body weight in ounces of water each day. (That means a 150-pound person should drink approximately 75 ounces of water per day.) 

• Monitor changes in your body composition closely. Talk to your doctor about ways to make sure you’re staying at an ideal body composition for you. You can use a scale at home that offers this information, or a scale in combination with a waistline measurement. If the number on the scale is dropping but your waistline measurement is staying the same, you might be losing more lean body mass than is ideal. Other clues you can use: Are you struggling to lift loads that didn’t challenge you previously? Are you feeling more fatigued in everyday activities? Has your endurance gotten worse during exercise or hobbies? These might be indications that you’re losing too much muscle, and you may need to make adjustments to optimize your outcomes.

The Importance of Strength Training 

Resistance training is an essential form of exercise for good health. Also known as strength training, resistance training involves any exercise where you're working against some sort of external resistance, whether that’s a resistance band, free weights, or your body weight. Everything from bicep curls and push ups to squats and bridges counts as resistance training. The goal of resistance training is to challenge your muscles so they adapt and grow stronger over time.

When losing weight, resistance training helps to preserve muscle and functional ability, ensuring that weight loss is not accompanied by a decrease in mobility or increased fall risk. Preserving muscle mass also helps keep your metabolism running well, which makes it easier to sustain weight loss over time.

Hinge Health members have access to daily exercise sessions that can have a strength training component (for example, exercises that use resistance bands). If you want to add more or different strength training moves, you can message your physical therapist or have a video visit to further personalize your plan.

Movement, Pain, and Weight Loss: A Hinge Health Perspective

Many people who take GLP-1 medications like Ozempic for weight loss may also struggle with back pain, knee arthritis, and other joint and muscle pain. This pain may understandably discourage physical activity. But engaging in regular strength training and other exercises can be crucial for weight management, pain relief, and overall health. Studies show that exercise not only alleviates pain by strengthening muscles and improving flexibility, but also helps maintain weight loss achieved with GLP-1 medications. A 2024 clinical study found that those who exercised and took GLP-1s like Ozempic kept weight off better and regained less weight when they stopped taking GLP-1s compared to those who didn’t exercise. 

About half of users stop taking medications like Ozempic after a year, which is why incorporating a daily movement routine through a program like Hinge Health can significantly enhance quality of life by reducing pain and aiding weight management. 

PT Tip: Small Movements Can Make a Big Difference 

When it comes to resistance training, you don’t have to go to the gym or lift heavy weights in your basement to see improvements. “Even small movements at your desk during the workday can help,” says Dr. Hayes.  Desk exercises, like squats, seated leg raises, or desk push-ups, help you build strength and stay active, especially if you have a sedentary job.

How Hinge Health Can Help You

If you have joint or muscle pain that makes it hard to move, you can get the relief you’ve been looking for with Hinge Health’s online exercise therapy program.

The best part: You don’t have to leave your home because our program is digital. That means you can easily get the care you need through our app, when and where it works for you.

Through our program, you’ll have access to therapeutic exercises and stretches for your condition. Additionally, you’ll have a personal care team to guide, support, and tailor our program to you.

See if you qualify for Hinge Health and confirm free coverage through your employer or benefit plan here.

This article and its contents are provided for educational and informational purposes only and do not constitute medical advice or professional services specific to you or your medical condition.

References 

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2. Wilding, J. P. H., Batterham, R. L., & Calanna, S. (2021). Once-Weekly Semaglutide in Adults with Overweight or Obesity. The New England Journal of Medicine, 384(11), 989–1002. doi:10.1056/NEJMoa2032183

3. Ida, S., Kaneko, R., Imataka, K., Okubo, K., Shirakura, Y., Azuma, K., Fujiwara, R., & Murata, K. (2020). Effects of Antidiabetic Drugs on Muscle Mass in Type 2 Diabetes Mellitus. Current Diabetes Reviews, 17(3), 293–303. doi:10.2174/1573399816666200705210006

4. Sargeant, J. A., Henson, J., King, J. A., Yates, T., Khunti, K., & Davies, M. J. (2019). A Review of the Effects of Glucagon-Like Peptide-1 Receptor Agonists and Sodium-Glucose Cotransporter 2 Inhibitors on Lean Body Mass in Humans. Endocrinology and Metabolism, 34(3), 247. doi:10.3803/enm.2019.34.3.247

5. Jensen, S., Blond, M., Sandsdal, R., Olsen, L., Juhl, C., Lundgren, J., Janus, C., Stallknecht, B., Holst, J., Madsbad, S., & Torekov, S. (2024). Healthy weight loss maintenance with exercise, GLP-1 receptor agonist, or both combined followed by one year without treatment: a post-treatment analysis of a randomised placebo-controlled trial. EClinicalMedicine, 69(102475), 102475–102475. doi:10.1016/j.eclinm.2024.102475

6. Weiss, T., Carr, R. D., Pal, S., Yang, L., Sawhney, B., Boggs, R., Rajpathak, S., & Iglay, K. (2020). Real-World Adherence and Discontinuation of Glucagon-Like Peptide-1 Receptor Agonists Therapy in Type 2 Diabetes Mellitus Patients in the United States. Patient Preference and Adherence, Volume 14, 2337–2345. doi:10.2147/ppa.s277676

7. ACSM. (2019). ACSM Guidelines for Strength Training | Featured Download. American College of Sports Medicine. Retrieved from https://www.acsm.org/blog-detail/acsm-certified-blog/2019/07/31/acsm-guidelines-for-strength-training-featured-download

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