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Ozempic Muscle Loss vs. Fat Loss – The Ultimate DOs and DON’Ts!

Ozempic Muscle Loss

Ozempic muscle loss has been debated recently on various social platforms. It is really concerning when a medicine that’s supposed to help you lose weight affects your muscles, which you definitely wouldn’t want to lose.

While worries about muscle loss due to Ozempic might be valid, it’s difficult to determine if you’re losing muscles by measuring your biceps with a measuring tape.

If you are losing weight, you can not avoid some muscle loss along with fat loss. In clinical trials, up to 9% muscle loss has been documented in patients using Ozempic (Semaglutide).

However, the ratio of lean body mass to fat mass has actually increased. This means that some muscle loss is imminent, but the fat loss is responsible for the significant drop in body weight.

Before we jump into the tips for managing Ozempic Muscle Loss Vs Fat Loss, let’s start by exploring data from significant clinical trials that have looked closely at how Ozempic affects muscle and fat loss.


Ozempic Muscle Loss Vs Fat Loss: Data from STEP 1 Trial:

The study included 140 participants (95 in the Semaglutide group and 45 in the placebo group).

76% of the participants in the study were women. The mean BMI of the study participants was 34.8 kg/m² and the mean baseline weight was 98.4 kg.

Body fat was estimated using Dexa scans. Participants had a baseline fat mass as given in the table below:

Body Fat Estimation at BaselineSemaglutidePlacebo
Total Fat Mass43.4%44.6%
Regional Visceral Fat Mass33.8%36.3%
Total Lean Body Mass Proportion53.9%52.7%

Participants were administered Semaglutide in a dose of 2.4 mg weekly or placebo.

After 68 weeks, the following changes in body fat and muscles were noted.

The table below summarizes the body composition after 68 weeks of using Ozempic: 

Body Composition (% of total body mass)

Total Fat Mass-19.3%
Regional Visceral Fat Mass-27.4%
Total Lean Body Mass-9.7%
Lean Body Mass: Fat Mass RatioIncreased
Change in Body Weight (Baseline to Week 68)-15.0%
Lean Body Mass: Fat Mass Ratio Change+0.23
Lean Body Mass: Fat Mass Ratio Change (≥15% weight loss)+0.41
Lean Body Mass: Fat Mass Ratio Change (<15% weight loss)+0.03

As you can see in the table, participants who took Ozempic experienced a noticeable decrease in fat mass.

The total fat mass was reduced by -19.3% and more importantly, visceral fat was reduced by about 27.4% compared to only a 9.7% reduction in lean body mass.

Although there was a reduction of around 10% in lean body mass, the overall ratio of lean body mass to fat mass increased. This suggests that fat loss was more prominent than muscle loss.


Ozempic Muscle Loss Vs Fat Loss and Visceral Adiposity: 

Another prospective study evaluated the effect of Ozempic on body composition in diabetic patients after 3 and 6 months.

Body fat estimation and muscle mass were evaluated using a phase-sensitive bioimpedance analyzer and ultrasound.

The results of the study are summarized in the table below [Ref]:

Ozempic Muscle Loss Vs Fat Loss


After 3 months

After 6 months

Body weight (kg)103.96−7.83−9.89
Body mass index (kg/m2)38.81−3.05−3.36
Waist circumference (cm)123.53−6.32−7.31
Visceral adipose tissue (L)5.74−0.55−0.95
Fat mass index (kg/m2)17.10−2.19−3.04
Fat-free mass index (kg/m2)21.45−0.61−0.74
Skeletal muscle mass (kg)28.16−1.31−1.53
Skeletal muscle index (kg/m2)10.36−0.52−0.51
Hand Grip (kg)32.490.490.76
Muscle Quality Index (MQI) (kg/kg)
US-VAT (cm)6.93−1.45−1.49

In this study, it was found that Semaglutide effectively lowered body weight by around 9.89 kilograms in just 6 months.

Not only that, but it also helped reduce insulin resistance and improved heart-health indicators.

While the reduction in body weight was noticeable through changes in body weight, BMI, and visceral fat, there was a minor decrease in lean body weight or muscle mass as well.

Normally, it’s considered healthy if the loss of lean muscle mass is kept under 40% of the starting point.

Interestingly, two participants in the study experienced lean muscle loss beyond 40%.

However, it’s worth noting that this didn’t significantly affect their grip strength.


Rybelsus Muscle Loss Without Fat Loss in Japanese Patients:

A non-interventional study conducted in Japan evaluated the effects of Oral Semaglutide on body fats and muscle mass.

The study included 25 participants. Body composition was assessed at 12 and 24 weeks via bioelectrical impedance analysis.

ParameterBaseline12 Weeks24 Weeks
Hemoglobin A1c (%)8.77.6 ( 1.1%)7.0 ( 1.7%)
Body Fat (kg)28.326.8 (1.5 kg)25.5 ( 2.8 kg)
Whole-Body Lean Mass (kg)48.147.7 ( 0.4 kg loss)47.6 ( 0.5 kg loss)
Muscle Mass: Body Fat1.701.78 ( 0.08)1.87 ( 0.17)

The researchers noticed a small decrease in muscle mass. Nonetheless, the loss of fat was notably more, causing the ratio of muscle mass to fat mass to go up.

This suggests that Rybelsus might raise the proportion of lean muscle mass by reducing body fat.


Semaglutide Muscle Loss Vs Muscle Loss Caused by Farxiga Vs Invokana Vs Metformin:

A network meta-analysis of 18 different clinical trials evaluated the effect of oral antidiabetic drugs on muscle mass or fat-free mass (FFM).

The study included the following drugs:

The researchers noticed a considerable drop in weight among those using Semaglutide, Dapagliflozin, and Canagliflozin when compared to the placebo.

However, the weight loss wasn’t statistically significant with metformin.

Interestingly, in contrast to the mentioned studies, Semaglutide did lead to a significant decrease in fat-free mass (FFM), which is essentially lean muscle mass.

The results of the study are summarized in the table below:

DrugEffect on Fat-Free Mass (FFM)Weight Loss Vs Placebo
SemaglutideDecrease: -1.68 (95% CI: -2.84 to -0.52)Significant
DapagliflozinDecrease: -0.53 (-0.93 to -0.13)Significant
CanagliflozinDecrease: -0.90 (-1.73 to -0.07)Significant
MetforminNo significant decrease in FFM

Looking at the table above, it’s clear that using GLP-1 and SGLT-2 receptor agonists leads to noticeable weight loss.

However, the authors haven’t directly compared the changes in body composition concerning fat loss.

This aspect could actually alter the situation, as the ratio of muscle mass to fat mass increased, even though there was an overall loss of muscle mass.


Understanding Ozempic Muscle Loss Vs Fat Loss: Key Points to Keep in Mind

The idea of Ozempic causing muscle loss isn’t just a story, but we should consider that muscles actually need some work to stay strong – like bodybuilding.

Have you ever seen those folks who lift weights or stay active through exercises, yoga, walking, running, or cycling? They tend to have strong muscles.

In contrast, those who have more sedentary lives often end up with bigger bellies and fewer muscles compared to the amount of fat.

Another big factor is the amount of protein you eat. It’s important to have a balanced diet with about 1 to 2 grams of protein per kilogram of your body weight every day.

This helps prevent your muscles from wasting away and keeps you from developing sarcopenia (muscle loss).

Here’s something else to consider: there’s a belief that tiredness from Ozempic might be linked to losing muscles.

While that could be true sometimes, it’s not always the case. In reality, it might create a kind of loop. Feeling tired could stop you from being active, leading to a more sedentary lifestyle and more muscle loss.

To beat this tiredness, you’ve got to make yourself get up and move. Begin slowly, with just 5 minutes of exercise each day, and then increase it to 10 minutes, 15, and so on. Keep going until you can exercise for 30 minutes without feeling worn out.


Here are some DOs and DONTs to prevent Muscle Loss using Ozempic:

  • Guidelines for Ozempic and Mounjaro Dose Adjustment

Do: Follow the recommended titration plan – Gradually adjust your dose as advised.

Don’t: Jump to a higher dose right away, even if you feel okay with it. Let’s take it step by step.

Do: Aim for a daily intake between 800 to 1200 calories. Your body needs these calories to keep functioning well. Keep track of your calories and try to have a goal of not exceeding a 500-calorie deficit.

Don’t: Don’t go below 800 calories a day or push for more than a 500-calorie deficit. Let’s keep it balanced and sustainable.

  • Staying Active

Do: Make regular exercise and strength training your main priority to preserve your muscles while using Ozempic and Mounjaro. Aim for at least 30 minutes daily.

Don’t: Don’t just lay back and assume Ozempic will do everything. Your effort matters too. But also, don’t overdo it or push your body beyond its limits. Finding the right balance is key.

  • Ozempic: Watching Muscles and Fat

Do: If you’re curious, you can use a scale to see how your weight changes over time. No need for special tests.

Don’t: Avoid using less reliable methods like measuring arm span or using complex formulas to track muscle mass.

Don’t skip the testing to figure out muscle or fat loss. If you’re losing weight and feeling good, that’s the main aim. Keep it simple and healthy!

  • Keeping an Eye on Your Hormones

Do: If you’re genuinely losing muscles or are on medications like corticosteroids or thyroxine, it might be wise to check your thyroid and cortisol levels.

Don’t: Avoid regular monitoring of drug levels, insulin, or testosterone levels. Let’s focus on the essentials.

  • Tracking Your Blood Sugar

Do: Keep an eye on your blood glucose levels and A1C regularly. Uncontrolled blood sugar might be causing muscle loss.

Don’t: Avoid taking too much medication to lower your blood sugar. Also, steer clear of unapproved meds or trying other weight loss drugs like phentermine, topiramate, or naltrexone without medical guidance. Safety first!

  • Seek Support

Do: Reach out to reliable sources like your endocrinologist for guidance and help.

Don’t: Don’t depend on personal opinions from friends or online weight loss experts. Trust the experts!

Here is a summary in a tabulated form of the DOs and DONTs to avoid Ozempic-induced Muscle Loss:

Ozempic Muscle Loss

Dos ✔

Don’t ❌

Dose Adjustment (Ozempic/Mounjaro)Follow the recommended titration planJump to a higher dose right away
Healthy Eating PlanAim for 800-1200 daily caloriesGo below 800 calories or exceed the 500-calorie deficit
Staying ActivePrioritize regular exercise and strength trainingAssume Ozempic does all the work
Watching Muscles and Fat (Ozempic)Use a scale to track weight changesRely on less reliable methods or skip testing
Keeping an Eye on HormonesCheck thyroid and cortisol levels if neededSkip monitoring of drug, insulin, or testosterone
Tracking Blood SugarMonitor blood glucose and A1C regularlyOverdose medication or take unapproved drugs
Seeking SupportGet guidance from an endocrinologist or expertsRely on personal opinions from friends or online gurus



What do you think?

Written by Dr. Ahmed

I am Dr. Ahmed (MBBS; FCPS Medicine), an Internist and a practicing physician. I am in the medical field for over fifteen years working in one of the busiest hospitals and writing medical posts for over 5 years.

I love my family, my profession, my blog, nature, hiking, and simple life. Read more about me, my family, and my qualifications

Here is a link to My Facebook Page. You can also contact me by email at or at My Twitter Account
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