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WEIGHT LOSS DRUGS: HIDDEN DANGERS







GLP-1 drugs like Ozempic are making headlines for their ability to help people lose weight quickly. But a new study from the University of Virginia is raising a red flag: while these medications help people shed fat, they're also causing significant muscle loss—and that could have serious consequences for long-term health.

The UVA research team points out that drugs like Ozempic have clear benefits, especially for people with obesity, type 2 diabetes, or heart failure. Patients see better blood sugar control, some improvement in heart and kidney function, and, in some cases, longer lives. But there’s a catch: the weight that comes off isn’t just fat. A sizable chunk is muscle, which people need for strength, mobility, and even heart health.

“Some of my patients told me they could feel their muscles slipping away,” says Dr. Zhenqi Liu, a professor at UVA’s School of Medicine. “That’s worrying. Muscle is critical for posture, daily movement, and overall health. Losing too much can raise your risk of heart disease and a shorter lifespan.” Liu and his colleagues warn that anyone starting these medications should be screened for low muscle mass or malnutrition—and that doctors should recommend more than just medication.

Here’s why that matters: About 40-50% of your body’s fat-free mass is muscle. When people lose weight on GLP-1 drugs, about a quarter to nearly half of the loss is muscle, not just fat. That’s a much bigger hit than the slow, gradual muscle loss people see with age. The research team, including Dr. Siddhartha Angadi, dug into the available studies and found that although these drugs can improve some aspects of heart function, they don’t improve cardiorespiratory fitness (CRF)—your body’s ability to use oxygen during exercise, which is a key measure of long-term health. Their global review showed that CRF is a much stronger predictor of mortality than body weight alone.

So what’s the source? Exercise appears to be important, but so far, studies looking at combining exercise with GLP-1 drugs have been small and not very rigorous. The UVA researchers say larger, better-controlled research is needed to know for sure how best to preserve muscle and boost fitness for people on these medications.

In the meantime, there are a few strategies experts recommend: get enough protein, stay active, and talk with your doctor about your risks before starting a GLP-1 drug. The American Diabetes Association now recommends screening for malnutrition and muscle loss risk for anyone considering these medications.

There are new treatments—like monoclonal antibodies designed to preserve muscle—that could eventually help, but they’re not yet available. Until then, the takeaway is clear: rapid weight loss isn’t always as straightforward as it seems. If you’re using Ozempic, don’t just watch the scale—pay attention to your overall strength and fitness, too.

The UVA team’s whole team appears in the Journal of Clinical Endocrinology & Metabolism. The National Institutes of Health supported their work.

Key Takeaways:

  • GLP-1 drugs like Ozempic help people lose weight, but a significant portion of that weight is muscle.

  • Losing muscle can harm long-term heart health, physical function, and lifespan.

  • Exercise and adequate protein are critical for people on these drugs.

  • Speak with your healthcare provider about risks before starting GLP-1 therapy.

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