From the Guidelines
Ozempic (semaglutide) may contribute to muscle loss when used for weight loss, particularly if adequate protein intake and regular exercise are not maintained. According to a recent study published in 2023 1, semaglutide, the active ingredient in Ozempic, is a GLP-1 analog that can lead to significant weight loss, with a mean weight loss of 10.3-12.4% over 68 weeks. However, this weight loss can sometimes come from muscle tissue, not just fat, if the patient's diet and exercise regimen are not properly managed.
To minimize muscle wasting while using Ozempic, several strategies can be employed:
- Maintaining adequate protein consumption, approximately 1.2-2.0 grams per kilogram of body weight daily, to support muscle mass
- Engaging in regular resistance training at least 2-3 times per week to build and maintain muscle
- Ensuring proper hydration and overall nutrition to support muscle health
- Consulting with a healthcare provider about supplementing with a multivitamin and monitoring for signs of muscle weakness
The mechanism behind potential muscle loss relates to how GLP-1 receptor agonists like Ozempic work, slowing gastric emptying and reducing appetite, which can inadvertently reduce overall nutritional intake, including protein 1. This effect is more pronounced in those using the medication primarily for weight loss rather than diabetes management. It is essential to weigh the benefits of Ozempic for weight loss against the potential risks of muscle wasting and to take proactive steps to mitigate these risks.
Key considerations for patients using Ozempic for weight loss include:
- Monitoring for common side effects such as nausea, vomiting, diarrhea, and constipation, which can impact nutritional intake and muscle health
- Being aware of the potential for increased risk of pancreatitis, acute gallbladder disease, and suicidal ideation and behavior
- Following the recommended dosing and titration schedule to minimize side effects and maximize efficacy
- Regularly reviewing and adjusting the treatment plan with a healthcare provider to ensure safe and effective use of Ozempic for weight loss.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Muscle Wasting and Ozempic (Semaglutide)
- Ozempic, also known as semaglutide, is a glucagon-like peptide-1 receptor agonist (GLP-1RA) used in the treatment of type 2 diabetes.
- Recent studies have investigated the effects of semaglutide on muscle wasting and skeletal muscle atrophy in various conditions, including type 2 diabetes and chronic liver disease 2, 3, 4.
- The evidence suggests that semaglutide may have a protective effect on skeletal muscle, inhibiting muscle atrophy and promoting myogenesis in certain conditions 2, 4.
Effects of Semaglutide on Muscle Structure and Function
- A study published in 2025 found that semaglutide decreased psoas muscle volume by 9.3% over 24 weeks, but did not significantly change psoas muscle fat or physical function in people with HIV and metabolic dysfunction-associated steatotic liver diseases (MASLD) 3.
- Another study published in 2023 found that semaglutide improved obesity-induced muscle atrophy via the SIRT1 pathway, reducing muscle atrophy markers and improving muscle strength in mice 4.
- A 2022 study found that once-weekly semaglutide induced an early improvement in body composition in patients with type 2 diabetes, with significant decreases in visceral adipose tissue and fat mass index 5.
Mechanisms of Semaglutide's Effects on Muscle Wasting
- The mechanisms of semaglutide's effects on muscle wasting are not fully understood, but may involve the inhibition of ubiquitin-proteosome-mediated skeletal muscle proteolysis, promotion of myogenesis, and improvement of insulin sensitivity 2, 4.
- Semaglutide may also have anti-inflammatory effects, which could contribute to its protective effects on skeletal muscle 6.
- Further research is needed to fully understand the effects of semaglutide on muscle wasting and skeletal muscle atrophy in different conditions, and to elucidate the underlying mechanisms 2, 3, 6, 4, 5.