While drugs like Ozempic and Wegovy offer powerful benefits for weight management, they also introduce challenges. While patients tend to seek out the medications in hopes of losing fat, there is growing concern that they may lose muscle mass at the same time. A new study published in The Lancet Regional Health found that use of GLP-1 receptor agonists in the context of weight-loss treatment is associated with declines in lean (muscle) mass unless accompanied by targeted strength training interventions.
As these therapies become more widespread, physicians are tasked with balancing profound weight loss against the potential for sarcopenia and long-term frailty. The dialogue within the global Sermo community reveals a nuanced perspective. This article explores how physicians are actively debating how to maximize the benefits of GLP-1s while mitigating the risks, sharing clinical observations and crowdsourcing best practices for patient care.
Weight loss drugs and muscle loss: a growing concern
The introductions of semaglutide (Ozempic, Wegovy) and tirzepatide (Zepbound, Mounjaro) have revolutionized healthcare, but physicians are finding that patients often lose a significant portion of their lean muscle mass while on the medications. In a poll of Sermo members, most physicians reported that they see signs of muscle loss either frequently (22%) or occasionally (41%) in their patients taking GLP-1s.
Studies on the effects of GLP-1s have also highlighted the prevalence of this concern. Research suggests that muscle loss—as indicated by decreases in fat-free mass (which includes muscle as well as bones, water, and organs)—with the medications ranges from 25% to 39% of total weight loss throughout 36 to 72 weeks, according to a 2024 study.
The primary issue is that “meds are replacing exercise and diet, resulting in more muscle loss,” argues one rheumatology and internal medicine physician on Sermo. Healthy weight loss aims to reduce adipose tissue while preserving metabolically active muscle. However, when patients rely solely on medication without adjusting their lifestyle, they risk losing substantial lean mass, which can have long-term consequences for metabolic health, strength and overall function.
Researchers are still uncovering aspects of GLP-1s, and the extent of their effects on muscle mass is still unclear, according to a lab scientist on Sermo. “Between augmented gluconeogenesis and sarcopenia, it is difficult to decipher how much impact the GLP-1’s have on the diminution of muscle mass; no doubt more data is needed,” they write. What’s clear is that patients are losing muscle, and physicians are taking notice.
Ozempic and Wegovy risks: what physicians are noticing
The potential risk for muscle loss from GLP-1 therapies is significant enough that many clinicians are in favor of cautionary steps around prescribing and monitoring. Among polled Sermo members, 51% of prescribing physicians believe the risk of muscle loss “warrants better follow-up” for patients on these medications. An additional 14% feel the risk is serious enough that it should affect eligibility or duration of treatment. Characteristics that make certain patients at higher risk for sarcopenia—e.g. older age, poor nutrition, or lack of exercise—may influence the selection of appropriate candidates for GLP-1 treatments, according to a 2024 study.
Discussions on Sermo show that one of the biggest challenges physicians face is patient perception. Patients may underestimate the importance of concurrent lifestyle changes that could minimize muscle loss. “Patients should not think these medications are a simple quick fix,” emphasizes an OBGYN on Sermo. This perception can lead to non-adherence with crucial diet and exercise recommendations, like strength training and adequate protein intake.
“Much of the problem isn’t the medication itself, but lack of discipline in diet/exercise,” echoes a general practitioner. A Sermo poll quantified just how common the issue is; 41% of respondents said “about half” of patients follow dietary exercise/guidelines, and 31% said that “very few” do.
One psychiatrist on Sermo takes a measured approach in hopes of getting through to patients. “If I use the word exercise it creates anxiety in most of my patients,” they explain. “But the weight loss benefits outweigh the risks of muscle. I want to get weight off people so they feel better… I do motivational interviewing for diet changes along with education…I have had some success once the weight is off and hope has been restored.”
Preventing muscle loss on GLP-1s: nutrition and exercise
A majority of polled Sermo members believe that proactive counseling on nutrition and exercise is important to mitigate the risk of muscle loss on GLP-1s. 53% of respondents “always” counsel patients on diet and exercise to preserve muscle, and another 22% do so “sometimes.”
Physicians on Sermo shared several key strategies:
1. Resistance training
Aerobic exercise is important for cardiovascular health, but resistance training is more effective for preserving muscle mass. Lifting weights, using resistance bands or performing bodyweight exercises can help patients maintain and build muscle tissue, ensuring that weight loss comes primarily from fat stores.
2. Adequate protein intake
Exercise is one piece of the puzzle, along with diet. “Concurrent resistance training and nutrition support is definitely beneficial,” states a family medicine physician on Sermo. Specifically, protein is important, according to a neurology and general practice physician. When someone is in a caloric deficit, their body can turn to muscle for energy. Adequate intake of high-quality protein provides the necessary amino acids to prevent this breakdown. Counseling scripts for patients can include specific protein targets (e.g., 1.3 to 1.6 grams per kilogram of body weight) and examples of protein-rich foods.
3. Multidisciplinary collaboration
Some Sermo members have begun making referrals a standard part of their practice. “For me it’s mandatory to include exercise and dietary recommendations with referral to a dietitian,” notes a gastroenterology and internal medicine resident. Collaborating with dietitians, nutritionists and physical therapists can provide patients with specialized support, improving adherence.
Balancing GLP-1 risks and benefits: physician perspectives
Muscle loss is among several concerns that physicians have around GLP-1s. In a poll where Sermo members shared their biggest concern when prescribing GLP-1 drugs, muscle loss/frailty was the third most popular answer, with 19% of votes. The top two concerns were “cost and access” (32%) and “adherence and expectations” (21%), reflecting practical barriers to treatment.
Despite these hurdles, many physicians remain optimistic about the role of GLP-1s. “At this time I still think the benefits outweigh the risks,” writes an internist on Sermo. Other members tend to agree that the benefits—including significant reductions in cardiovascular risk, improved glycemic control and enhanced quality of life—tend to outweigh the potential downsides, provided the risks are managed properly.
A new standard of care for weight management
Insights from the Sermo community indicate that physicians recognize the transformative power of GLP-1 weight loss drugs, but are also aware of risks concerning muscle loss. Data from member polls and commentary reveals that a majority of prescribers are already observing muscle loss and believe it warrants closer patient monitoring.
The emerging consensus is that GLP-1 therapies should not be a standalone treatment. They are most effective when integrated into a comprehensive care plan that includes nutrition counseling and strength training. While patient adherence remains a challenge, physicians are finding ways to motivate and support their patients, often in collaboration with dietitians and other specialists.
Ultimately, drugs like Ozempic and Wegovy are powerful tools. By pairing them with diligent monitoring and patient education, physicians can harness their benefits while protecting patients from the long-term risks.
