How to combat the downside of rapid weight-loss ‘miracle’ drugs
If you shed pounds too fast, you risk losing muscle mass. Here are the ways to avoid the problem.
There’s a price to pay for every drastic approach to dieting, and the “miracle” weight-loss drug semaglutide - known by the brand names Wegovy and Ozempic - is no exception. Administered weekly with an injection pen similar to an EpiPen into the thigh, arm or stomach, it works by mimicking the hormone glucagon-like peptide-1 (GLP-1) and helps to control blood sugar levels while slowing down stomach emptying, suppressing appetite and, anecdotally, even dulling the appeal of alcohol.
It’s an open secret that semaglutide is behind the red-carpet svelteness of many A-listers, but it has also been associated with what has been nicknamed “Ozempic face” (the gaunt, deflated appearance caused by a rapid loss of facial volume) and “Ozempic butt” (loose, sagging skin on the buttocks). Clinical trials of semaglutide have found unwanted side-effects to include constipation, nausea, vomiting, headaches and diarrhoea, while some studies, including a paper in The New England Journal of Medicine and another in the Journal of the Endocrine Society, have highlighted possible long-term health risks related to muscle wastage and thinner bones.
Roy Taylor, professor of medicine and metabolism at Newcastle University, has studied the effects of very low calorie diets in people with type 2 diabetes. He says that some muscle loss is inevitable when overweight people shed pounds very quickly. If calorie intake is slashed so that you burn more energy than you consume, the body attempts self-preservation by breaking lean muscle tissue as well as fat to survive. “When a very overweight or obese person loses excess weight very quickly, most of it will be body fat but some of it will be muscle,” Taylor says. “It’s not necessarily alarming as these previously obese people gradually need less muscle to support the weight of their body in everyday activities and the positive outcomes for their metabolic health are more important.”
Use of the drugs is more concerning in people who have only moderate amounts of weight to lose, according to Dr Duane Mellor, a dietician and senior teaching fellow at the Aston Research Centre for Health in Ageing in Birmingham. As they have less body fat to spare in the first place, muscle loss is relatively more pronounced, unless they take precautions. “Sarcopenia, the natural loss of muscle from the body as we age, hits hard from our forties and fifties onwards,” Mellor says. “Drastic weight loss from any type of extreme dietary approach can exacerbate this unless you counter it with adequate protein intakes and resistance exercise.”
A recent report in Men’s Health magazine described a worrying new trend for men taking semaglutide and testosterone jabs simultaneously to lose fat and build muscle. Mellor says that it’s most risky when the drugs are used inappropriately and without adequate medical guidance.
Neglecting muscle health can have catastrophic repercussions, particularly as we get older. It is now known that the state of our muscles influences not only our metabolism and fat-burning ability, but the efficiency with which our bodies control blood sugar and offset conditions including type 2 diabetes, cardiovascular disease and strokes. Then there’s the effect on bones. A peculiar quirk of obesity is that by hauling around a heavy body we are loading our skeleton in a beneficial way.
“When weight is shed rapidly, there is also usually a corresponding decrease in bone density,” Mellor says. “That predisposes people to a greater risk of osteoporosis and fractures.”
As yet, scientists are unsure whether it is extreme dieting or the weight-loss injectables themselves that are responsible for muscle wastage. Studies in journals including Current Diabetes Reviews have identified loss of lean muscle tissue as a side-effect of the drugs. Meanwhile, in The New England Journal of Medicine’s study, almost 40 per cent of the weight some people lost came from lean mass, which includes some muscle alongside bone and organ tissue. In the same study, a sub-group of 140 obese adults in their fifties suggested they shed about 15 pounds of lean tissue and 23 pounds of fat during the 68-week trial.
However, other researchers have suggested that semaglutide has no effect, with one study in the journal Frontiers in Endocrinology last year suggesting it preserved lean mass and muscles. “Drugs like semaglutide might have some additional effect on accelerating muscle loss but the jury is still out,” Taylor says.
Despite public perception, neither Wegovy nor Ozempic is marketed as a slimming aid for the masses. Ozempic is recommended by the National Institute for Health and Care Excellence only for the treatment of type 2 diabetes and Wegovy for the treatment of high blood pressure, type 2 diabetes, heart issues or a body mass index near the top of the obese range. But some private medical clinics offer semaglutide jabs as a slimming aid, and monthly dose injection pens can be bought online for under pounds 200.
Dalton Wong, founder of TwentyTwo Training, says he works with an increasing number of clients to help them keep muscles strong after they have been prescribed semaglutide for medical reasons.
“Because the drugs kill the appetite and people are not eating much, their energy levels are low, which makes gym work and training difficult,” he says. “We cut workouts in half from 60 to 30 minutes’ duration, focus only on strength and steer away from cardio activity, which will accelerate weight loss.” His concern is that if clients lose too much muscle mass in their forties and fifties because of Wegovy-related weight loss, it may be irreversible. Still, he says, he sees people who have obtained the drugs privately. His message is that dramatic weight loss has a cost. “As we age and lose muscle mass it is incredibly difficult to put it back on. I tell my clients that if they take Wegovy and don’t really need it, there will always be a trade-off.”
The rules of preserving muscle health
1. Get enough sleep
A study of 19,770 adults published last year in the journal BMC Public Health found that muscle mass dropped and fat mass increased when sleep duration and quality deteriorated. “Ideally you should aim for seven to nine hours’ sleep a night,” Wong says. “Your muscles recover and build at night so sleep is essential.”
2. Do some form of resistance exercise
Weights are gold standard but any sort of resistance training will be beneficial. “Focus on using the body’s largest muscle groups for biggest effect: squats, deadlifts and lunges,” Wong says, “and do them several times every week.”
3. Eat proportionately more protein
“A relatively higher protein intake in the form of healthy foods such as eggs and yoghurt will support muscle maintenance,” Wong says, if it’s in conjunction with resistance training.
UK government guidelines suggest that you need roughly 0.75g of protein daily per kilogram of bodyweight, which equates to 47-63g, or 2-3 palm-sized portions, for an adult weighing 63kg (about 10st). However, research from McMaster University in Ontario has shown that intakes of up to 1.6g per kg for an active person are needed to support muscle health from middle age onwards.
The Times
