Written by Garett Reid | NSCA, CSCS, CISSN, M.S.E.S.S
Fact checked by Tyler DiGiovanni, BSBM
FACT CHECKED
What originated as a promising tool to treat diabetes, Ozempic was quickly picked up by Hollywood and now sits as the new miracle fat loss drug. Of course, there have been plenty of other miracle drugs and diets in the past, but this one is different. It seems to actually be very effective—like really, really effective—possibly too effective.
Like a dream, these drugs allow you to give yourself a small injection once a week, and then you stop eating! Sounds simple, and it is, as these weekly injections have been proven to result in a massive amount of weight loss. However, due to the extreme loss, people have started losing a ton of muscle as well.
The muscle loss is so bad that it results in becoming "skinny fat" or having saggy skin. This effect is so pronounced that it has even given birth to names like "Ozempic face" or "Ozempic butt."
We're unsure who came up with those names, but they don't sound nice. Fortunately, we do know how you can mitigate, if not completely eliminate them from developing on your body.
Before we go any further, we need to make a disclaimer. We are not qualified doctors and are in no way suggesting anyone use these drugs. We are merely giving advice based on the current information on how to best deal with muscle loss if you take it.
Still, it's important to know that these drugs are new, and there are only a handful of studies on them, so we are making our best guess. That said, always seek professional medical treatment before you seek treatment.
***If you're reading this, I'm assuming you are fairly familiar with Ozempic and Wegovy. That being said, the next couple of sections are a pretty quick read and give some great information. If you're only concerned with preventing muscle loss, scroll down to the second to last section.***
What Is Ozempic And Wegovy?
Let's start at the beginning by explaining what these drugs even are. Luckily, we don't need to go too far back, as Ozempic has only been approved since 2017 and Wegovy since June 2021. So what are they?
Ozempic and Wegovy are both types of semaglutide medication but are approved for different uses; Ozempic is used to treat diabetes, and Wegovy is used for weight loss.
However, their primary difference is really just the dosing and delivery system, with Wegovy using higher doses and single-use pens while Ozempic uses lower doses and multiple-use pens. Other than that, it's basically the same medication, and both have been used for weight loss.
So what’s Semaglutide?
Semaglutide mimics the effects of Glucagon-like peptide-1, or GLP-1. GLP-1 is a powerful peptide that's released in your body as a response to eating because it signals the release of insulin. As we know, insulin acts to lower a person's blood sugar, and this is what originally made it attractive to researchers for treating diabetes.
At the same time, it decreases the amount of glucagon released and slows gastric emptying. Still, it also acts on parts of the brain that decrease appetite and keep you feeling full. In short, you just don't eat as much! And since people taking these drugs don't eat, they lose weight—a lot of weight!
One of the clinical trials for Ozempic was done in 2021 and showed very promising results. In it, 2,000 obese adults received a semaglutide treatment alongside a regimen of diet and exercise. Their weight loss was then compared with those who simply adopted lifestyle changes but without semaglutide.
After 68 weeks, half of the participants using semaglutide lost 15% of their body weight, while nearly a third lost 20%! Conversely, participants who relied solely on lifestyle changes saw a loss of just 2.4%!¹ So yea, that's what all the hype is about!
Ozempic, Wegovy, And Muscle Loss?
If you think this is too good to be true, well, you're wrong! It's very true. However, weight loss this crazy doesn't come without risks, and this is true for Ozempic and Wegovy as well.
We're not going to address all of the possible side effects in this article but there is one we need to talk about. Muscle loss. Researchers have found that muscle mass actually accounts for a large percentage of weight loss.
Now, some muscle loss may be expected during weight loss if the individual isn't working out or following precautions (we'll get to this later). But putting all that aside, people were still losing a much higher percentage of muscle than expected.
Several studies have shown that muscle loss accounts for around 40% of a person's total weight loss. For example, remember the clinical trial above? Well, on average, the participants lost 30 pounds of weight. Awesome! However, this consisted of 12 pounds of muscle. Not awesome.
Another study from 2020 showed that 12.5 pounds of total weight loss consisted of 5 pounds of lean muscle.² Again, not awesome.
Under normal conditions, researchers would expect the total weight loss to be just 20% of muscle. Keep in mind this number is for the average patient who isn't lifting weights, as even 20% is a lot! Regardless, this means people are losing twice as much muscle as they should!
These numbers are similar to those of someone who had gastric bypass surgery, so what's going on?
Why Are People Losing Muscle On Ozempic And Wegovy?
If you were to do a Google search, you will see several headlines such as "The Race To Stop Ozempic Muscle Loss" or "Ozempic Makes You Lose More Than Fat".
These headlines can suggest some underlying mechanism by which the drug causes your muscles to waste away. Like maybe it increases cortisol or promotes catabolic activity.
However, this is not so, and the answer is quite simple. Before we go further, we again want to clarify that there is still a lot of information lacking, so what we're about to say is based on current information.
That said, the muscle loss from taking Ozempic or Wegovy is simply due to the extreme caloric deficit from not eating. That's it. This isn't anything new as we know you risk muscle loss when losing too much weight too fast. Therefore, in a way, it's good news as we can easily mitigate this!
If you want to see some results of taking semaglutide, check out these men's and women's before and after pictures.
How To Prevent Muscle Loss From Ozempic Or Wegovy
When preventing muscle loss from Ozempic or Wegovy, you will simply follow the same protocol as any weight loss plan along with taking some specific precautions.
The first step is to increase your protein intake. Increasing protein intake has been shown to be a very powerful tool for maintaining muscle mass during weight loss; in fact, other studies suggest you could even gain!
Protein's muscle-preserving ability comes from the fact that it provides an excess of amino acids. Under normal conditions, your body will draw from your fat stores and glycogen. However, during a caloric deficit, your body may break down your muscles to access the amino acids. That's because our body can convert amino acids into glucose or ketones for energy!
Therefore, by taking extra protein, you're basically supplying extra amino acids for energy, which mitigates the need for your body to break down the muscle. Therefore, take at least 2 grams per kilogram of body weight (2 grams per 2.2 lbs of body weight).
The next thing you'll need to do is lift weights! But you can't just randomly throw around the barbell; you need to follow a proper progressive training program. You may not be able to progress much as you'll likely be in a relatively large caloric deficit.
However, you still need to train with that same mindset and intensity. Doing so will promote an anabolic environment and stimulate muscle protein synthesis.
Now, this doesn't need to be an overly complicated program. Concentrate on big, compact movements and hit every muscle group two times a week, ideally in the 4-8 rep range.
With our straightforward, proven, and easy-to-manage training, dieting, and tracking strategies, you'll not only achieve a lean, sculpted physique but also find yourself in tip-top shape...
Your last job is getting to bed early! Sleep is easily the best recovery tool and literally promotes an anabolic environment. Simply put, when you're in a caloric deficit and lack sleep, your body will break down a higher percentage of muscle mass than if you get an adequate amount.
Check this study out. A group of middle-aged adults were placed on a similar diet with a caloric deficit for 14 days. Everything else was virtually the same except one thing, their sleep. A normal sleep group aimed to get 8 hours a night while a sleep deprivation group got 5.5 hours.
At the end of the study, both groups experienced an average weight loss of 3kg. However, what differed was where this weight came from. The sleep deprivation group saw 60% greater muscle loss and 55% lower fat loss; that big of a difference from missing 2.5 hours of sleep!³
As these drugs are even more extreme with their caloric deficit, you need to get your sleep when taking Ozempic or Wegovy!
Special Considerations To Mitigate Muscle Loss From Ozempic
In addition to the above three guidelines, you can also do a few other things to prevent muscle loss. Even though Wegovy and Ozempic are very powerful drugs, that doesn't mean you need to use all of their power! If you're concerned about your body composition, there are two things you can do.
The first is to stick with smaller doses. Both drugs begin dosing at 0.25mg a week and then go up from there. Again, we will say this again, we are not doctors so we are not prescribing what dose to take.
However, it seems that if you're already seeing a 1,500 caloric deficit, why would you take more and continue this drastic drop?
Now we do know that some people who take this have severe obesity, and drastic weight loss may be a better option for health concerns. Therefore, bring this up with your doctor. If you are worried about muscle loss, ask if you need to take such a high dose.
Secondly, monitor your calorie intake and pay close attention to your protein. This medicine will suppress your appetite, so you must be more proactive about getting your calories in. Obviously, this will be easier if you heed the previous advice about using smaller doses.
The bottom line is that when you are taking Ozempic and Wegovy, you should follow the same guidelines whenever you're losing weight. As of now, it seems that the mechanism by which they work is decreasing your caloric intake so we should combat muscle loss just as with any diet; Gym. Protein. Sleep.
Must Read: The Diabetic Muscle Building Diet
References:
- Wilding, John P. H., et al. “Once-Weekly Semaglutide in Adults with Overweight or Obesity.” The New England Journal of Medicine, vol. 384, no. 11, 10 Feb. 2021, pp. 989–1002, www.nejm.org/doi/full/10.1056/NEJMoa2032183,https://doi.org/10.1056/NEJMoa2032183.
- McCrimmon, Rory J., et al. “Effects of Once-Weekly Semaglutide vs Once-Daily Canagliflozin on Body Composition in Type 2 Diabetes: A Substudy of the SUSTAIN 8 Randomised Controlled Clinical Trial.” Diabetologia, vol. 63, no. 3, 2 Jan. 2020, pp. 473–485, https://doi.org/10.1007/s00125-019-05065-8.
- Nedeltcheva, Arlet V., et al. “Insufficient Sleep Undermines Dietary Efforts to Reduce Adiposity.” Annals of Internal Medicine, vol. 153, no. 7, 5 Oct. 2010, p. 435, annals.org/aim/article-abstract/746184/insufficient-sleep-undermines-dietary-efforts-reduce-adiposity, https://doi.org/10.7326/0003-4819-153-7-201010050-00006.
Garett Reid
Author