Are those taking Wegovy or Ozempic also doing resistance training and increasing protein?

The question of whether this new class of weight loss drugs has negative consequences is a very good one. They are certainly the best weight loss drugs ever invented in terms of side effects and efficacy. It's taken years to come up with them and they have the potential to be life-changing for severely obese people with medical conditions arising from being overweight. This is article points to a potential problem, but there isn't any rigorous data presented.

Now, it must be acknowledged that all significant weight loss includes some muscle loss even with adequate dietary protein. You can mitigate it by doing lots of resistance and other training, but many people losing significant weight for medical reasons have limitations in exercising. So, if they can't lose weight without Ozempic then they bear the risks of being overweight. If the lose weight with Ozempic, then they may lose some muscle mass. Which is better? It's very hard to say without a long-term clinical trial.

I am a swim-ride-runner and I'm currently cutting. I expect I'm losing some muscle in the process, but my goal is maintain (or even increase) my speed and endurance, which is more a matter of power output per unit body-weight (e.g., watts/kg, most easily measured on a bicycle). The point is that muscle loss during weight loss isn't a total killer, because you become lighter and don't need to carry as much around.

AnnPT77 wrote: »

I agree with the OP.
I'm utterly confident that most people can benefit from gradually increasing exercise, starting with whatever is just a mild, manageable challenge to current capabilities. Keep the challenge in the picture, keep improving over time.

Some people thing lifting weights is necessarily struggling with giant loads. It's not. Whatever challenges current capability (while avoiding injury risk) is perfect. Doing high reps with soup cans at home is useful, as long as it's a bit of a challenge. And like I said, lifting isn't the only way, it's just the most efficient way.

I take ozempic. I hope not for too long. I worry about the side effects of all drugs.I totally agree with Anne. I’ve just started to add exercise and weight resistance to my life. Up until now, I’ve felt incapable of it. Today I did little 3 lb. Weights for the first time in years and it felt so very good. I even tried the universal machine at my gym and ( without any added weights) pulled down on the bar. This may seem like nothing to some people, but to me, who’s on a huge quest to get healthy, it was amazing. I am older and really want to get stronger.

I’ve been on medication for a year. I started with Saxenda and now use Wegovy. I’ve lost 65 pounds and need to lose another 65 -75. My doctor encouraged three things: meet with a nutritionist; stay hydrated; get exercise by WALKING.

The nutritionist did encourage me to focus on protein, not carbs, but wasn’t overly concerned about it. The doctor was more concerning with cardio (walking) than with weight training.

Your discussion about protein and resistance training is completely foreign to my experience, and I think I’m pretty much the average Wegovy patient,

What you also don’t understand. I knew going into this that I’d probably be in Wegovy forever. I lost 70 pounds twelve years ago. I lost those sane 70 pounds six years ago. This time I want the weight to stay off.

threewins wrote: »

When people lose weight and don't have muscle building exercise during the process, does that loss of muscle stay with them for the rest of their life? When people gain weight through an increase of fatness, does their muscle weight increase?

Suppose you have two identical twins. At the age of 20, one starts gaining weight at the rate of 10 kg per year, for 3 years, and then over 2 years loses those 30 kilograms. No exercise during the weight loss. They repeat the process every 5 years, at the age of 60 they've done 8 cycles and gained/lost 240 kg. How does their body compare to their twin who hasn't gone through the cycles?

I'm not convinced that a loss of muscle mass is that big of a deal. I would love to see real world examples of people who lost too much muscle, while using weight loss medicine and under the care of a doctor. What is happening to these people?

Your identical twin hypothesis would be cool to see, but that's not going to happen, but I do agree somewhat that muscle loss in the context of losing weight in the obese population is a little overstated.

As far as what might happen is hard to tell but again in the obese population after gaining a lot of visceral fat the one place where that fat also goes is into muscle tissue, in beef we would call it marbling. Anyway this can lead to sarcopenia which is common in the obese population even though that sounds counter intuitive and cycling through 8 periods of weight loss and gain I suspect that the strength and muscle mass compared to their twin to be noticeable visually and also suspect not as mobile and suspect bone health to be quite different, but again this is just speculation. Anyway if this actually took place sarcopenia or muscle loss would probably just be one of many health conditions associated with this, cheers.

threewins wrote: »

When people lose weight and don't have muscle building exercise during the process, does that loss of muscle stay with them for the rest of their life? When people gain weight through an increase of fatness, does their muscle weight increase?

Suppose you have two identical twins. At the age of 20, one starts gaining weight at the rate of 10 kg per year, for 3 years, and then over 2 years loses those 30 kilograms. No exercise during the weight loss. They repeat the process every 5 years, at the age of 60 they've done 8 cycles and gained/lost 240 kg. How does their body compare to their twin who hasn't gone through the cycles?

I'm not convinced that a loss of muscle mass is that big of a deal. I would love to see real world examples of people who lost too much muscle, while using weight loss medicine and under the care of a doctor. What is happening to these people?

Can we ignore Wegovy/Ozempic for a minute, and just talk about (relatively) fast weight loss? I assume that you'd agree that for some/many people, the drugs can facilitate fast(er) weight loss.

While your twin study is logistically unrealistic, there's reasonable research support for the idea that repeated weight loss and regain degrades muscle mass over time. It's primarily retrospective and statistical, but indications are fairly strong, though there are some caveats.

For example, here's an article from the MFP blogs, which I'll follow with a link to the abstract of an article in the research journal Obesity, which is the study underlying the MFP article.

https://blog.myfitnesspal.com/the-negative-impact-of-yo-yo-dieting-on-your-muscles/

From the research journal's abstract of the study:

In adults with obesity, weight cycling is associated with lower muscle mass and strength and a greater likelihood of developing sarcopenic obesity.

from:
https://onlinelibrary.wiley.com/doi/10.1002/oby.22493

(BTW, sarcopenic obesity is major bad news in terms of things like metabolic syndrome, insulin resistance, independence, quality of life, probable longevity . . . .).

There are other similar studies. It's generally accepted that weight loss can trigger some loss of muscle mass, and that exercise can limit that loss to some extent. Rate of loss probably matters, and total fat mass available to lose also appears to matter, i.e. very obese people may have lower risk when losing relatively faster compared to thinner people losing at the same rate.

The effect of repeated bouts of weight loss is less clear (in the general research literature I've run across), but the correlation of relatively more muscle loss with fast weight loss seems fairly strong. There's also some evidence that regain is more likely to be fat regain than muscle regain for physiological reasons.

As with any research, there are nuances, exceptions, caveats, but the through-line is generally that weight loss involves loss of lean mass, faster loss typically results in losing a higher proportion of lean mass, and exercise limits lean mass loss somewhat.

See, for example:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5161655/

Unlike what some say here on MFP, IMU aerobic exercise has some beneficial effect in that way, even walking . . . but strength exercise shows a stronger beneficial effect. Note that the study linked below used exercise aerobic exercise at lactate threshold, which is more intense than normal walking:

https://pubmed.ncbi.nlm.nih.gov/24457527/

You may feel that the differences in these studies are not large enough to be meaningful you. Obviously, that's a personal decision. With a close reading, you may also find that the daily life functional implications appear undramatic to you. That's also an individual judgement, of course.

With a close reading of these and other studies, you may find a basis for critiquing the research methodologies. That wouldn't be remotely surprising, since study designs for these issues in humans are limited by ethical concerns, compliance, costs, and various other factors.

One thing I find odd about humans is the most of us like to believe that a method or approach we subjectively prefer is the best route. That can invoke confirmation bias, i.e., giving extra weight and attention to sources that support our view. I'm just as subject to that as the next person, of course. I do try to stay clear-headed about the evidence, though.

Personally, I don't enjoy strength training, and as a consequence do relatively little of it, hedonist that I am. However, I usually recommend to people here that they do some strength-challenging exercise during weight loss (not necessarily weight lifting), because I think that's the best and most health-promoting approach.

I believe that strength-challenging exercise limits loss of muscle mass, that muscle mass retention is hugely important as we age, that people with relatively higher muscle mass will have a slightly higher TDEE for complex treasons (thus making maintenance or - if necessary - future loss relatively easier), and more.

Purely anecdotally, when I look around me at age-peers in my personal social circle, I do feel that there's a pattern of those who've repeatedly dieted and regained, and who've been inactive or only done cardio alongside, to have worse health and quality of life outcomes by our current age (I'm 67). Most of the time, the diet phase among my peers has been extreme/faddy (fast loss, eating mostly salad/veg so limited protein), and regain has involved "going back to normal" which was very little exercise and high carb/fat intake (still relatively little protein, which for some reason seems common among women my age).

Obviously, there are exceptions on both sides, but it seems that my friends who've generally been close to a healthy weight, and at least somewhat active, are healthier and have better quality of life at this age, on average.

Anecdote is not data, though. But that social experience is part of what encourages me to avoid fast loss, any substantial yo-yo-ing, inactivity generally, systematic undernutrition, etc.

Back to the OP's point, though: He's sharing evidence that perhaps the weight loss from things like Wegovy/Ozempic may result in even more extreme loss of muscle mass than similar-rate weight loss by simple calorie restriction without the drug intervention.

My point is that even if that's not true, there's decent evidence that it's a better plan - more favorable to long-term good outcomes, though with no guarantees - to include some strength challenging exercise while losing weight, especially if losing weight relatively fast. Since the recommendations of nearly all mainstream health experts are that we should routinely do some strength-challenging exercise for general health and good functioning (even when not losing weight) . . . well, it seems like saying it's not important to do it is a bit of a rationalization.

Underscoring: I don't do much of it myself. I'm not going to argue that that's a good answer, though, because I think it's not.

Just my opinions, as always.

Retroguy2000 wrote: »

Ann, good post.

Yes, the research seems quite clear on muscle mass loss being higher with fast weight loss, which is something these drugs help to produce. It is interesting that they may somehow contribute to even more muscle loss. I assume we'll learn more about this before long, since there must be tons of data being collected by now, and probably a lot of studies going on.

You say you don't lift weights, but iirc you do a lot of rowing? I'm just saying that even without lifting, you're getting in full body workouts that target a lot of muscles. I think that would definitely count as muscle maintenance, and perhaps lead to muscle gain if you are rowing progressively faster/farther than last time. I expect that's a lot more muscle loading activity than many of your peers are doing, and it's probably better in that regard than typical cardio stuff.

Yes, I row lots, and yes, it's mildly progressive. (How ya gonna go faster at the same number of strokes per minute if it's not progressive, y'know?) I have more muscle mass than most women my age (67), but way less than women who seriously lift. I've gone through some periods where I did lifting more regularly, but I don't think that fully accounts for my current body composition.

That said, there is some evidence, as I mentioned, that even "cardio" during weight loss can have some muscle/strength protective effects.

For sure, strength training is a more efficient way to preserve or gain strength and muscle mass, though. It's more time-efficient day to day, and it delivers strength/muscle-mass results much faster. I'm not going to pretend otherwise just because I don't personally like doing it, so do less than what would be ideal.

I don't even like to talk about "cardio" because that's too many different kinds of activities with a wide range of attributes. At best, there's a continuum of things from more cardiovascular/aerobic exercise to more strength-y or anaerobic exercise, and different exercise modalities have different benefits (and deficits) in those and other ways.

Rowing is strength-y-er than some other "cardio", yeah. I do it because it's freakin' fun: I'd do it even if it weren't good for me, honestly. And I did it (lots) for over a decade while staying class 1 obese (with some recomp as a side effect, I think), so I'm a skeptic about "exercise your way to weight loss", too.

Smart people who want best results strength train, and get reasonable amounts of cardiovascular system challenge. I don't claim to be smart in that way; I claim to be hedonistic.

@AnnPT77 posted some really good thoughts here. I used to think that weight gain and loss was REALLY BAD. There were articles telling us not to "yo yo your weight" in the 80s.

But, if you gain some weight, should you not to try to lose it? Isn't being at a reasonable weight good for your health? Also, don't weightlifters/body builders use gain/loss cycles to build lean muscle?

I am losing weight right now and I've continued with my swim, ride, run workouts-- not doing any resistance training. But, swimming works the upper body very effectively. Running is just an incredible workout overall that really leans out your legs. I can only do it 2-3 times a week or I get all sorts of problems. Cycling is a big-muscle sport and really builds up your legs. (I actually think that running and cycling are somewhat at odds.)

In any case, I'm not lifting, but I think my activities are still helping to retain the muscle I need in order to do them, which is my main goal.

@Retroguy2000 : I think you are totally right about these drugs. It's the first time in human history we've had a class of drugs that addresses apatite without horrible side effects.

And, you are right to question if there are NO side effects. This article appeared on NYTimes since you started the thread

https://www.nytimes.com/2023/04/21/well/eat/ozempic-side-effects-malnutrition.html?smid=url-share

Basically, a woman became malnourished on Ozempic despite still being overweight. It sounds like she really had adverse reaction to the drug. But, many others don't report any problems at all (so I read).

Anyway: good thread.

It basically said, she was left without any semblance of appetite. Basically this particular person forgot to eat, hense the malnutrition. Anything is possible and the normal deviation will more than likely include a death somewhere as well. I see pitchforks, chaos is closing in. Cheers

@Retroguy2000 :

Almost immediately after starting Ozempic, a diabetes medication known for inducing weight loss, Renata Lavach-Savy, 37, a medical writer in North Bergen, N.J., was left without any semblance of appetite. She started setting alarms to remind herself to eat. She was so exhausted that even after 10 hours of sleep, she would collapse onto her couch after work, unable to move.

She left purses and clothes strewn across her bedroom floor, because she was so queasy all the time and worried that bending down to pick them up would make her vomit. Four months later, Ms. Lavach-Savy’s dietitian told her that she might be malnourished.

Ms. Lavach-Savy was shocked. “How can I be malnourished? I’m over 200 pounds,” she recalled thinking. She stopped taking Ozempic last fall.

(Let me recommend a subscription to NYTimes. $10/month.)

Retroguy2000 wrote: »

@cwolfman13 I'll be very surprised if these drugs don't become ubiquitous.

There's a guy on YT on his journey down from 500 pounds I think. He's in the gym. I agree though, lifting probably isn't priority #1 at the morbidly obese state, perhaps coming off years of being sedentary, but those people could and should increase their protein at least, and then start doing some resistance training when they're able.

Possibly, but at the moment insurance covers little to no cost of the prescription in most cases. My re-acquaintance is spending somewhere in the neighborhood of $1,000/mo for this. He's hoping he can go off of this after a year or so since that's basically what he budgeted. I did tell him that he's going to have to learn better nutrition and self control when it comes to food because this prescription substantially mitigates his appetite and it would likely come roaring back once he comes off and that'll probably be a tricky adjustment.

His only real complaint so far is that he's always pretty tired and fatigued...not sure if that is a side effect of the medication or not eating enough because his appetite is so suppressed...probably a combination of both I'd guess.

The woman in the NY Times article was nauseated by Ozempic, lost all desire to eat and became malnourished. It’s a rare occurrence.


Some people will experience side effects, mostly mild digestive symptoms like nausea or diarrhea. A few people will experience more extreme symptoms and should not be using the drug.

The drugs are meant for people who are morbidly obese, not for people with a few pounds to lose, and are meant to be used under a doctor’s care. When I started the medication I was instructed to follow my nutritionist’s advice on when and what to eat, and to make sure to stay hydrated.

threewins wrote: »

When people lose weight and don't have muscle building exercise during the process, does that loss of muscle stay with them for the rest of their life? When people gain weight through an increase of fatness, does their muscle weight increase?

Suppose you have two identical twins. At the age of 20, one starts gaining weight at the rate of 10 kg per year, for 3 years, and then over 2 years loses those 30 kilograms. No exercise during the weight loss. They repeat the process every 5 years, at the age of 60 they've done 8 cycles and gained/lost 240 kg. How does their body compare to their twin who hasn't gone through the cycles?

I'm not convinced that a loss of muscle mass is that big of a deal. I would love to see real world examples of people who lost too much muscle, while using weight loss medicine and under the care of a doctor. What is happening to these people?

My partner's mother was under a doctor's care (for issues other than weight loss,) lost too much muscle to be able to get on and off a toilet by herself, went to and died in a nursing home.

https://www.healthinaging.org/age-friendly-healthcare-you/care-settings/nursing-homes

...Some type of disability when it comes to performing the activities of daily living (ADLs) is the most common reason that older people live in nursing homes. Not surprisingly, people living in nursing homes generally have more disability than people living at home. Over 80% of nursing home residents need help with 3 or more ADLs (such as dressing and bathing). About 90% of residents who are able to walk need assistance or supervision.