Lean Tissue Losses on GLP-1 Medications
Ozempic Shaming
TLDR – all fat loss past 15% of the person’s highest weight is likely to cause some lean tissue (muscle, water) losses. Lifting weights and eating enough protein will reduce lean tissue losses. In small weight losses, it’s possible to gain lean tissue and lose fat at the same time.
Let’s talk about the GLP-1 medications everyone’s debating: Ozempic and Wegovy.
Some people are now shaming others for how they’re losing weight. So toxic.
Also, some are accusing these meds of causing “dangerous” muscle loss.
Here’s the truth:
These medications were originally created for people with type 2 diabetes. They reduce appetite, food obsession, and sometimes even alcohol cravings. They’re powerful, and for many people, they work. Weight loss is often significant— and it usually comes back if the medication is stopped (80% report regain). I assume that’s due to a resurgence in hunger (which is the primary barrier to weight loss by the way) and perhaps psychological effects of no longer having the support of the medication.
Let’s break it down further.
Fat Loss vs. Lean Mass: What Are We Actually Losing?
When someone loses weight, it matters what kind of weight they’re losing.
There are two main types of losses:
Fat Mass
Fat-Free Mass (aka Lean Mass): This includes muscle, water, bones, and organs.
Don’t worry - your body probably isn’t going to lose organ mass or bone mass.
So we look at body fat percentage to get a clearer picture.
For example:
NBA players: 7–12%
Female beach volleyball players: ~14%
The Notorious BIG (was about 375 lbs) would have been about 60%
The how of weight loss determines what we lose.
And guess what? All weight loss greater than 15% of our starting weight — whether with meds or not — results in some lean tissue loss.
Let’s look at two scenarios of HOW we lose weight:
Case One: The Cardio Vegan
A person who is 180 cm tall and 250 lbs decides to lose weight through a calorie-restricted diet, but:
Doesn’t lift weights
Eats very little protein
May or may not use a GLP-1 medication
Loses 50 lbs
Result?
They’ll lose more lean tissue than fat.
Their body fat percentage might not change much—they’ll be smaller, weaker, have a slower metabolism, and probably some bone mass loss.
Bone density losses would be due to lack of mechanical loading (no strength training). And having less mass. Heavy bodies promote bone density.
The bone loss here is not because of a GLP-1 medication—it’s because of the approach.
Case Two: The Strength & Steak Plan
Same starting scenario and caloric deficit, but this time:
They lift weights progressively, 3-4x a week
They eat plenty of protein
They may or may not use a GLP-1 medication
Loses 50 lbs
Result?
They’ll lose more fat than lean tissue
Body fat percentage drops. The body becomes more athletic. Energy improves. Strength goes up. Bone density is likely the same.
See more hypothetical case studies in this instagram post I made
So Does Ozempic “Cause” Muscle Loss?
No.
Rapid weight loss without strength training and protein: That causes muscle loss.
GLP-1 medications make eating less easier.
All medications have risks but GLP-1 medications are helping many people lose a lot of weight! So helpful!
Small Fat losses:
Losing less than 10% of our highest weight, with ideal conditions, most people will not lose any lean tissue! And some might even gain some! Like, losing 10 lbs of fat but gain 12 lbs of lean tissue!
More Numbers
Let’s say someone starts at 250 lbs and works hard—with resistance training, great nutrition, and (maybe) a GLP-1 prescription. They lose 50 lbs.
Here’s a realistic outcome:
Fat lost: ~40 lbs
Lean tissue lost: ~10 lbs (mostly water, some muscle)
Healthspan and lifespan gains: A decade or more
That is a life-changing transformation.
Shaming people for how they got there—whether with medication, coaching, or lifestyle changes—is harmful.
Let’s Stop Doing This:
Making someone’s medical decisions our business
Shaming people for needing or choosing help
Pretending that all weight loss should be “pure” fat
Ignoring the reality that lean losses happen with any significant fat loss
In fact, in one Ozempic trial, the placebo group (those not taking the GLP-1 medication) lost more lean mass than those on the drug!
Final Word: You Deserve Support
Weight loss is hard. Body composition change is hard. And it’s worth doing if it supports your health goals.
So if you're considering help—whether that’s from medication, coaching, or both—make sure your plan includes:
✅ Resistance training
✅ Adequate protein
✅ Realistic expectations
✅ Compassion—for yourself and others
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Stay strong, stay curious, and don’t buy into the toxic noise.
— Kb