Ozempic (semaglutide) is being hailed as a game-changer for weight loss and metabolic health. Originally designed to manage blood sugar in type 2 diabetes, it’s now widely used off-label for appetite suppression and drastic weight loss.

But as the scale drops, so can your lean muscle mass – a fact that has serious implications for your metabolism, long-term health, and the quality of weight loss you’re actually looking to achieve.

Let’s unpack the science behind Ozempic and muscle loss, and what you can do to protect your muscle and your metabolism.

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Not All Weight Loss is Created Equal

We’ve come to associate weight loss with success but that number on the scale doesn’t tell you what you’re losing. Is it fat? Water? Or lean body mass – including skeletal muscle, one of your most metabolically active tissues?

A 2023 study published in Nature revealed that up to 40% of the weight lost on GLP-1 medications like Ozempic may come from lean tissue. That includes muscle mass, which plays a central role in everything from blood sugar control to longevity.

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How Ozempic Contributes to Muscle Loss

Ozempic works by mimicking glucagon-like peptide-1 (GLP-1), a hormone that reduces appetite, slows gastric emptying, and enhances satiety. This leads to fewer calories consumed, but with it, often, fewer nutrients needed to maintain muscle mass and overall health.

Here’s why that matters:

• Appetite suppression means lower protein intake
• Reduced energy availability results in a catabolic (muscle-breakdown) state – your body literally scavenges muscle for fuel
• Less resistance training due to fatigue leads to no stimulus to preserve lean mass
• GLP-1 may also downregulate pathways like mTOR, a key anabolic signal for muscle growth. So if you’re not carefully managing diet and training, your muscle can melt away alongside fat.

Even in people eating a seemingly “adequate” diet, these drugs can lead to negative nitrogen balance, meaning the body breaks down muscle faster than it can build it.

“A suppressed appetite might feel like a blessing—but it can mean you’re not hitting your minimum amino acid needs, resulting in protein deficiency. Muscle tissue becomes collateral damage in the body’s scramble for energy and amino acids.”

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Why Muscle Loss Is Metabolically Dangerous

Muscle isn’t just about looking toned. It’s central to metabolic, hormonal, and structural health. Your muscle tissue plays an enormous role in:

• Glucose control: Muscle tissue is the primary site of glucose uptake
• Resting metabolic rate: Muscle burns more calories at rest than fat
• Myokine production: Muscle secretes anti-inflammatory compounds
• Bone health: Muscle tension stimulates bone density via mechanotransduction
• Mobility and independence: Particularly critical as we age

Losing muscle during weight loss makes you more likely to experience metabolic slowdown, fat regain, and reduced resilience against ageing.

“Metabolism isn’t just about how many calories you burn, it’s about hormonal cross-talk, inflammation control, and nutrient partitioning. Muscle does all of that.”

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Midlife Women and Sarcopenia: A Double Threat

For women in perimenopause and beyond, this risk is amplified. Hormonal shifts – reduced oestrogen, progesterone and testosterone already accelerate the risk of sarcopenia, the age-related loss of muscle mass and strength.

Add in a catabolic drug like Ozempic, and you’re looking at a perfect storm of:

• Accelerated muscle wasting
• Weaker bones and joints from declining bone density
• Increased insulin resistance and visceral fat gain
• Greater risk of falls or frailty later in life

This isn’t about aesthetics – it’s about protecting your longevity and autonomy.

“For women in perimenopause and beyond, protecting muscle isn’t just about physique—it’s about future-proofing your health, strength, and independence.”

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How to Protect Your Muscle While Using Ozempic

1. Prioritise Protein—Religiously, even when you don’t feel like eating.

Muscle is made of amino acids, and you need a steady supply to maintain it. Aim for:

• 1.6 – 2.2g of protein per kg of body weight per day
• Distribute protein evenly across meals to stimulate muscle protein synthesis
• Prioritise leucine-rich sources like meat, eggs, tofu, cottage cheese, Greek yogurt, or whey protein
• If your appetite is low, consider broths, protein, or amino acid supplements to avoid missing your targets.

“Even if your appetite is low, protein isn’t optional—it’s your body’s muscle insurance policy.”

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2. Lift Weights (Or At Least Stimulate Your Muscles Regularly)

You have to use your muscle or you can lose it. If you’re not strength training during a calorie deficit, you’re likely losing lean mass.

If you aren’t able to lift weights, you can still:

• Use resistance bands or bodyweight exercises 2- 4 times per week
• Incorporate Pilates with time-under-tension holds (excellent for joint-friendly muscle work)
• Focus on compound movements: squats, lunges, push-ups, rows
• Focus on eccentric loading (slow lowering phase) for muscle stimulus

“If you’re not up for the gym, time-under-tension exercises like Pilates and slow eccentric lifting can stimulate muscle without overtaxing the nervous system.”

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3. Go Slow to Go Far

Rapid weight loss is a stressor on the body – and muscle loss is a common consequence. A safe and effective rate of loss is around 0.5 – 1% of your body weight per week. Make sure to:

• Support with enough sleep, electrolytes, and whole foods
• Avoid prolonged fasting or extreme calorie deficits

This gives your body time to adapt, preserves lean mass, and reduces stress on the thyroid and adrenals.

“Rapid weight loss is catabolic by nature. Give your body time to adapt – it takes time to build, and preserve muscle.”

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4. Creatine: The Unsung Hero

Creatine monohydrate is one of the most studied supplements in the health industry.

• 5g/day of creatine monohydrate can support muscle retention and strength
• Enhances brain and cognitive function
• Particularly helpful if you’re not training as intensely or eating much red meat
• Safe and well-studied—even for women

5g daily is a safe and effective dose for most people.

“Creatine is one of the most researched supplements for preserving lean mass – and yet one of the most underused by women. It’s not just for bodybuilders; it’s for anyone wanting to protect strength, brain function, and metabolic health – especially during weight loss.”

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5. Sleep and Recovery Matter More Than You Think

Sleep is where your body repairs and regenerates – especially muscle. Sleep deprivation raises cortisol, which is catabolic to muscle tissue.

Tips:

• Aim for 7–9 hours of sleep per night
• Balance intense training with restorative movement
• Support circadian rhythms with morning light, low evening screen time, blue-light blocking apps and salt lamps in your home
• Add magnesium for sleep quality if needed

“Sleep is where your body recovers, rebuilds muscle, balances hormones, and lowers inflammation. No supplement replaces it.”

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6. Monitor Body Composition, Not Just Weight & Track What you’re Losing

If you’re not tracking what’s being lost, you’re flying blind. Tools to consider:

• DEXA scan (gold standard) or body composition scales
• Pay attention to strength, energy, and performance – not just weight
• Photos and tape measurements, – photos and waist/hip measurements can show fat loss even if weight stays stable

Focus on body recomposition: reducing fat while maintaining (or even increasing) lean mass.

“If you’re not measuring body composition, you’re flying blind. The type of body tissue you’re losing matters more than how much.”

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Final Thoughts: Your Muscle Is Your Metabolic Currency

I want to be clear that I don’t think Ozempic is bad – but we have to acknowledge its power to do good and bad, if not managed correctly. Without a plan, it can undermine the very health you’re trying to reclaim.

Ozempic can be a helpful tool – but it’s only one part of the puzzle. If your goal is true health, not just weight loss, then muscle preservation is a vital part of your plan.

Whether you’re using GLP-1 medication or simply in a strict caloric deficit, protecting your muscle means protecting your:

• Metabolism
• Hormones
• Resilience
• Lifespan

“Fat loss is only one piece of the health puzzle. Your muscle is your metabolic currency – don’t spend it lightly.”

Weight loss without strength is just shrinkage. Let’s aim higher than that, let’s be a culture that focus on being strong, not skinny.

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Do you need support with metabolic health, body recomposition, or personalised nutrition and training while using Ozempic, or during weight loss?
Explore my 1-1 health coaching here.