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Whenever you lose weight you lose weight from muscle, fat, and lean tissue (bones and organ tissue). These losses occur whether you’re taking a weight loss medication such as a GLP-1 receptor agonist or not. Preserving muscle during weight is important because:
1. Muscle mass is directly related to your metabolic rate. The less muscle you have the lower your metabolic rate. Metabolic rate accounts for 60% to 75% of the calories you burn all day. Muscle burns about 4.5 to 7.0 calories per pound of body weight per day, approximately two to three times more than the amount of calories fat burns. The loss of muscle has implications on weight loss, and even more important, preventing regain of lost weight.
2. You can lose as much as 30% of your weight from muscle through traditional weight loss interventions such as reduced calories, even without weight loss medication. With medication, the weight loss is greater, which means more muscle could be potentially lost. In one study of muscle loss in subjects taking a maximal dose of Wegovy (semaglutide) by Wilding et al, published in the New England Journal of Medicine in 2021, subjects lost about 17% of their initial body weight after 68 weeks, and with that weight loss, they lost 41.8% of their weight from total lean body mass, mostly muscle.
3. Muscle mass decreases about 3% to 8% per decade beginning around at age 30, and speeds up after age 60, leading to a condition known as sarcopenia, the gradual loss of muscle mass, strength, and function during activities of daily living.
4. Protein, which is a major component of muscle, declines with age. Balagopal and colleagues showed that from the age of 20 to 92 muscle protein declined more than 50%. This research was published in the American Journal of Physiology in 1997.
5. Loss of muscle increases your risk of premature mortality. Wang and colleagues in the journal PLOS ONE in 2023 showed that there was a 57% increased risk of dying from any cause among subjects with the lowest levels of skeletal muscle, and the numbers were even higher in individuals who had a body mass index (BMI) over 30, which is classified as obesity.
6. Loss of muscle has metabolic consequences too. Muscle burns glucose (sugar) and fat for fuel. With less muscle comes less burning of these essential body fuels, which means more fat is left in the cells or clogging arteries, and more glucose circulating in the blood vessels, causing damage to the eyes, nerves, blood vessels, and kidneys. Think of your muscles like a car engine. The bigger the engine the more gasoline the vehicle will burn. Smaller engines burn less gasoline. The analogy is that the more muscle you have (the bigger your engine), which means your body will burn more fuel.
Future muscle-preserving medications are being developed to halt the rate of muscle loss compared to fat during weight loss. One of these medications, bimagrumab, studied by Petricoul and colleagues in 2023 and published in the journal Journal of Clinical Pharmaconetics, showed that the medication increased lean mass by 4-6% even while subjects were losing weight and fat.
A word about exercise. In a study by Geliebter and colleagues published in the American Journal of Clinical Nutrition in 1997, subjects lost aon average 22 pounds in 20 weeks onl ow calorie diets. The subjects were assigned to one of three groups: 1) diet and no exercise, 2) diet and aerobic exercise 3 times a week, and 3) diet and resistance exercise 3 times a week. The diet-only group lost 28% of their weight from muscle, the aerobic exercise group lost 20% from muscle, and the resistance exercise group lost only 8% of their weight from muscle. The take-away here is that resistance exercise is very important during weight loss, and in general, considering the possibility of sarcopenia, all adults should perform resistance exercise, even in to old age.
It’s never too late to start exercising. Fiatarone and colleagues, in a very well-known study published in the New England Journal of Medicine in 1994 showed that nursing home residents with an average age of 87, all the way up to 98 years-old, increased muscle strength 113% and an almost 3% in muscle mass in the thighs.
No one is getting stronger or building muscle as they age if they are inactive. The risks are high of loss of muscle, particularly with the large and rapid weight loss experienced in individuals taking GLP-1 receptor agonists, and so we all owe it to ourselves to take care of our bodies and keep them strong and active with resistance exercise, AT ANY AGE!
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