The Ozempic Era - Part Two
Preventing muscle loss during and after treatment.
In this article:
Negative Effects of Reduced Muscle Mass
The Weight Loss Treatment Muscle Loss Cycle
The Effect of Extreme Calorie Restriction on Muscle Mass
How to Promote Muscle Gain/Retention During Treatment
Preface
When I wrote the first article in this series, I did it for one reason; to help people undergoing prescription weight loss treatment have their healthiest experiences and most successful outcomes. Malnutrition is a real possibility with these treatments, but it’s completely preventable. Part one tackled that issue.
Now, as I put on my writing hat for part two, my focus is set on another preventable common side effect; muscle loss. It’s my belief that those outside of gym culture don’t view muscle as important as it truly is to one’s present and future health, physical abilities, and quality of life.
Muscle is an extremely valuable resource for the body and we should all prioritize maximally building it while we’re young, maintaining it through our middle ages, and slowing it’s loss as much as we can during our elderly years.
These four statements bluntly put things into perspective:
Muscle retention is easier than muscle growth.
Muscle is most easily built while we’re young. Take advantage of this.
Muscle becomes continually harder to build as we age. Those who didn’t capitalize during their youth find it harder to build muscle during later years.
The more muscle someone has as they enter their elderly years, the more capable and strong they’ll be. These traits are crucial for maximizing quality of life.
To sum up these statements; muscle is precious, it’s most easily obtained while you’re young, and for your best life at all ages, you should do everything you can to keep it.
This is why I feel so strongly about this article and had to write it. Weight loss drugs have great potential to help with fat loss, but if you’re not using strategies to combat muscle loss during treatment, say good-bye to your precious muscle as well.
There are three primary possible fat/muscle outcomes when undergoing weight loss drug treatment:
Lose fat and gain muscle.
Lose fat and maintain muscle.
Lose fat and lose muscle.
It doesn’t take a brainiac to know which is the least desirable. Hint hint, it’s option three. Let me explain why option three and losing muscle should be avoided at all costs.
Negative Effects of Muscle Loss
When laid out in itemized form, it becomes clear how much muscle helps us and adds to our lives.
As you read the following effects of muscle loss, my hope is that you’ll shift your weight loss treatment outlook from ‘I want to lose weight as fast as possible, no matter what’ to ‘I want to lose weight in a healthy manner so I can keep my muscle and feel my best.’
Think about how your life would change if these effects became your reality.
Reduced Strength & Mobility
As muscle is lost, so is strength. Most people take their muscle for granted and just assume they’ll always be able to do everyday actions, such as standing up from a chair and walking around or taking care of themselves throughout the day. You may have enough muscle and strength to do those things now, but there’s no guarantee it’ll always be there. Imagine if you lost that ability, or if the things that used to feel easy gradually became more and more challenging due to muscle loss.
Metabolic Slowing & Weight Gain
We can boil this one down to simple facts:
Muscle is active tissue, meaning it burns more daily calories than fat, which is an inactive tissue. When a person loses a portion of their muscle mass, they inherently reduce their degree of resting and working daily caloric burn.
Burning fewer calories per day increases the challenge of keeping weight off and often results in weight gain over time. Think of it this way; if you’re burning fewer calories per day, you have to eat less to avoid weight gain. On the flip side, burning a larger amount of calories per day allows for more food consumption without weight gain. Which sounds better to you?
Reduced Confidence, Mental Health, and Physical Appearance
When we look in the mirror, liking what we see gives us confidence. The reflection of a strong and muscularly capable person helps us feel good about the work we’ve done to achieve that look. It gives us the knowing that we’re capable of working to accomplish something, which feels great.
Of course, having a healthy athletic reflection brings feelings of positivity, where a reflection lacking in visual signs of strength and health just doesn’t generate those same feelings. It’s not a confidence-booster to look in the mirror and not like what you see. The troubling part is that you can easily fall into a downward spiral as a result.
One of the worst side-effects of an undesired reflection is how it can impact your willingness to step out of your comfort zone and into a gym, a group fitness class, or an outdoor activity.
Losing confidence leads to being afraid of what others will think, which leads to foregoing the steps to change, which leads to nowhere. Outside of a sudden renewal in personal willpower and determination, the reflection tends to worsen and the downward spiral continues.
Reduced Bone Density & Increased Chronic Conditions
Muscle loss reduces bone density. Over time, especially in older individuals, osteoporosis is more likely to develop in those with less muscle. Also, serious injuries such as broken bones or bone fractures occur more often in those with reduced bone density. As we know, depending on our age, a broken bone can be life-threatening.
Muscle loss is also shown to be linked to increased cases of diabetes, cardiovascular diseases, and a weakened immune system. Clearly, these are serious health problems. Why not work to build and keep your muscle to help avoid them?
Overall Decrease in Quality of Life
While there are more negatives to muscle loss, I mentioned the ones that stand out the most to me. Zooming out and taking all of these negatives into consideration, it’s unbelievably easy to see just how much muscle drives quality of life.
Honestly, I don’t believe the majority of people understand just how important muscle is to living their best life from start to finish.
The Weight Loss Treatment Muscle Loss Cycle
Now that I’ve hit you with the downsides of muscle loss, I want to discuss why it’s so important to talk about muscle loss during weight loss treatment in the first place. Let me explain a theory I have on what the future holds for those who are un-informed in muscle loss prevention and undergoing weight loss drug treatment.
I’m going to level with you; with the popularity of these drugs and the amount of people taking them who are green to nutrition and training, my theory has me worried for them. I’m worried because they’re on a cyclical path ending in serious muscle loss.
The individual starts weight loss treatment.
The individual does not increase their nutritional knowledge.
The individual overly reduces caloric intake, and inherently, protein intake.
The individual does not prioritize resistance training.
The individual loses significant weight(both fat and muscle), is happy with their loss, and stops weight loss treatment.
Since the individual did not learn long-term nutrition or resistance training habits, or improve their nutrition knowledge, they gain the weight back in the form of fat, not muscle.
The individual starts weight loss treatment again and the cycle repeats itself.
Each time this happens, fat is lost, muscle is lost, fat is re-gained, and muscle is not re-gained.
The net result of each cycle is a decrease in total muscle mass.
Of course, one could argue that this cycle doesn’t apply to everyone on weight loss drugs, and they’d be right. Some people will take the time to learn about nutrition, not overly reduce calories during treatment, and keep the fat off post-treatment. Some people will start a resistance training program, stick to it during and after treatment, and avoid muscle loss.
Some people will do these things, but the reality is that most won’t.
I’m writing this article to change that and to get people out of the weight loss treatment muscle loss cycle.
The Effect of Extreme Calorie Restriction on Muscle Mass
Step three of the muscle loss cycle states that the individual will overly reduce calorie intake due to the effectiveness of their prescription weight loss drug.
Every knowledgeable nutrition coach will tell you the same thing when it comes to dieting for fat loss and retaining muscle; do not maintain an oversized calorie deficit.
In other words, steer clear of extreme dieting approaches. This is such a crucial concept that can change how you feel now, in a year from now, or several years down the road.
I think it's good for you to know that I'm not one to take extreme approaches. Actually, I’ve use a foundational fat loss dieting rule for myself, and my clients, for well over a decade:
Eat as much as possible, while making progress toward your goal at an ideal rate.
While this may seem strange at first glance, it really isn't. The reality is that this is a recipe for avoiding the negative side effects of an oversized deficit. This rule keeps you in a conservative deficit, which results in consistent fat loss, but ensures these important ‘quality of life’ outcomes:
Reduces/eliminates muscle loss.
Results in energy for training and to get you through your day.
Prevents constant hunger and malnourishment.
Provides the body with adequate proteins and fats to perform its necessary functions for health, and also allows for carb intake to keep things balanced.
These are seriously important outcomes, which you won’t experience with an oversized calorie deficit. The dilemma with weight loss drugs is how effectively they lead you into an oversized deficit without you even knowing it. In part one of this series, I referred to this as superhuman adherence.
Remember, your body’s natural hunger signals are blunted and you feel satiated to an unnatural degree during treatment. Drastic calorie-cutting becomes too easy, which is dangerous. If you don’t take the wheel and steer your own ship, your body’s valuable muscle and your daily energy levels will degrade.
To put it bluntly, through prolonged under-eating, you’ll be lighter on the scale, but you’ll also be weak, soft, and feel like shit.
By following my rule above, you’ll still be lighter on the scale, but it won’t come with those other three nasty downsides. It’s the best approach…easily.
So, how do you avoid entering the realm of extreme dieting? The answer has to do with knowledge, awareness, and paying attention to your progress. You need to know that all weight loss isn’t healthy weight loss. Perhaps your friend calls you up and exclaims that they’ve lost 30lbs in the past month. That’s a big number, which seems incredible, but it’s really not healthy.
When it comes to weight loss, more is not always better and faster isn’t always better, either.
Let’s dig into this and get into some real numbers on what constitutes an ‘ideal rate’ of weight loss with a section from The Ozempic Era - Part One:
Understanding What Healthy Weight Loss Looks Like
When it comes to weight loss, losing too much, too fast, is not ideal. Rapid weight loss is generally not quality weight loss.
Of course, this lesson leads to the questions:
How fast is too fast?
What constitutes rapid weight loss?
I’m going to give you the sauce around rate of loss, and while I know it feels great to see rapid weight loss when shrinking down is your main goal, I’m begging you…
…please please please place more value on quality than quantity.
The consensus among science-based experts, as well as my own recommendations based on 15 years of client data, is to track weight loss on a ‘per week’ basis.
Also, set your weekly goal using a percentage of your body weight. Using a percentage will personalize your goal, which just makes sense. On top of personalization, it will keep your expectations reasonable and healthy, especially as you continue to lose weight.
When determining the optimal percentage of body weight to lose per week, I’m factoring in four key variables:
Avoiding malnourishment through under-eating
Promoting fat loss, not muscle loss
Maintaining motivation and enjoyment during the process
Having energy for daily life and added activities
In order to achieve these four keys, for most people, the target falls between losing 0.5 and 1.0% of their body weight per week.
This range finds a happy medium between seeing enough movement on the scale to be continually motivated, enthused, and energetic, but also not losing so quickly as to cause concern for muscle loss and malnourishment.
Now, I know you’ll hear people say to simply pick a number to lose, like 1 or 2lbs per week. This is certainly common advice, but it’s generic. I’m not into generic, as it’s just not on the same level as specific advice, for you, an individual. Also, aiming for a set number like 2lbs per week has no built-in adjustment as you make progress and weigh less.
Perhaps you start off at 250lbs and losing 2lbs per week isn’t that difficult, rapid, or unhealthy. In fact, it falls within the 0.5-1.0% range. But, what happens months down the road when you’ve whittled your weight down to 175lbs? Is 2lbs per week still ideal? Well, if we calculate the expert consensus range, it’s 0.87 to 1.75lbs per week. All of the sudden, that 2lb per week generic recommendation starts leading to problems. Here are some of those problems:
It’s harder to maintain, leading to feelings of failure and demotivation.
If you do maintain it, energy levels suffer, leading to a lowered quality of life.
Decreased energy means decreased activity, leading to muscle loss.
The likelihood of malnourishment increases.
Also, it’s important to note that as the number on the scale continues to drop, striving for that same weekly goal of loss only exacerbates the above problems. Using a percentage-based goal of loss removes this issue.
Now comes the part where you use the knowledge you just gained, assess how much weekly weight you’ve been losing during your weight loss treatment, advocate for your own health, muscle, and quality of life, and proceed accordingly.
Are your weekly loss numbers consistently within that 0.5-1.0% of bodyweight range? If they are, continue without concern.
Are you consistently losing less than 0.5% or more than 1.0% of your bodyweight per week?
If you are, consider meeting with your doctor to discuss modifying and individualizing your weight loss drug dosage. This is advocating for yourself.
Do you have a concern about your current rate of loss? Reach out to me and let’s talk about it.
How to Promote Muscle Gain/Retention During Treatment
At this point, we’ve covered the importance of building and keeping muscle, the negative effects of muscle loss, the Weight Loss Treatment Muscle Loss Cycle Theory, the effect of extreme calorie restriction on muscle mass, and what constitutes a healthy rate of weight loss. These are all very important topics, but one still remains; what actions can we take to avoid muscle loss during treatment? It boils down to these three keys:
Exercise in the form of resistance training.
Consume adequate daily protein.
Consume a daily calorie amount that causes fat loss and minimizes muscle loss.
I believe most people relate resistance training and adequate protein intake to muscle, but I don’t think the average person understands how much total calorie consumption plays a role in muscle retention during fat loss.
This is why I wrote The Ozempic Era - Part One, it helps drive the point home; losing fat is good, losing muscle is not, and under-eating is not a good plan.
Resistance Training
Resistance training comes in many forms; free weights, machines, and bodyweight exercises are the most common and accessible for most. The world of resistance training is much, much, much too vast and deep to dive into in this article. There are literally thousands of programs to follow and different theories and methods to explore.
Since this is my article and I have a program focused specifically on gaining muscle, I’m going to link you to it and tell you why I put so much time into creating it. The program is called GST-SIZE. I understand that if you’re taking part in weight loss treatment, a program with the word size in the name doesn’t sound too enticing. However, when weight loss is the goal, it’s actually the most important time to exercise in a way that keeps muscle growth as the top priority.
When losing weight, the risk of muscle loss is at its highest, so training for muscle growth to lower that risk makes the most sense.
Start the full GST-SIZE program here or start reading about it below:
Here’s my statement on why I created it:
“They say it takes 10,000 hours of experience to become an expert at something. My name is Ryan, I’m past that mark, and I’m here to share my knowledge with you.
Why? It’s my vendetta against trash training programs and wasted time in the gym. As a beginner, I lost years of efficient muscle growth to those two things, and I hate that. My mission is to make sure you don’t do the same…and it’s personal.”
On top of GST-SIZE, I have other articles focused on resistance training:
Alright, next key topic…
Consume Adequate Daily Protein
Pairing adequate protein intake with resistance training is massively important for avoiding muscle loss. A giant portion of our bodies is composed of proteins.
Proteins make up more than just our muscles, so we need make sure we’re eating enough of it to stay healthy and functional.
When we’re focused on building a great body and maintaining muscle mass during weight loss treatment, muscle is a priority. Muscle looks the best, feels the best, is useful for life, is metabolically active, and we need adequate protein to build new muscle and maintain current levels.
Do your best to meet your goal protein intake each day. Overreaching and consuming over your goal amount is fine, but try to avoid landing under it.
General protein recommendations for optimizing muscle growth range from .75 to 1.25 grams per pound of lean body mass.
On top of the amount, when we consume our protein makes a difference as well. Stimulating muscle protein synthesis through ingestion of complete protein sources is key.
To keep things effective and simple, try to follow a rule of having at least three high-protein meals per day and space them evenly throughout the day.
Do you need help with all of this? Would you like me to work for you as your nutrition coach? If so, please fill out the following form for a free assessment.
For additional reading on protein and strategies to help you eat enough, read the following articles:
Onward to the third and final key concept…
Consume a total daily calorie amount that causes fat loss and minimizes muscle loss.
So far my Ozempic Era series has two parts, and by nature, those parts do have some overlap. Nutrition and resistance training both play crucial roles in any healthy prescription weight loss treatment. Talking about one without the other is very difficult, if not impossible.
I’m bringing this up because the discussion on consuming a daily calorie amount that causes fat loss and minimizes muscle loss is one I’ve already written about in The Ozempic Era - Part One. I’m simply going to direct you back to that article to cover this topic.
The Recap
This second Ozempic Era article hit you with the facts on so many important aspects of being your best self during and after treatment. From importance of building and keeping muscle, the negative effects of muscle loss, the Weight Loss Treatment Muscle Loss Cycle Theory, the effect of extreme calorie restriction on muscle mass, what constitutes a healthy rate of weight loss, resistance training, adequate protein intake, and finding that sweet spot for total calorie intake, it’s been a ride and I’m happy you took it with me.
Before I go, feel free to reach out to me with any nutrition/training-related question you might have. I want to help you and I love answering questions.
Thank you so much for reading.
I learned so much about the importance of muscle retention today. The example you gave about getting up from the chair will stick with me. And nice graphics too btw. It puts the cycle into perspective. Awesome work!