GLP-1 agonists have reshaped how clinicians approach weight loss, but the conversation doesn’t stop at the number on the scale.
As more patients experience rapid weight reduction, questions around muscle preservation, bone health, and what happens after treatment are becoming increasingly important in everyday practice.
On Healthcasts, clinicians weighed in on when to involve physical therapy or nutrition support, how closely to monitor bone density, and whether muscle strength returns after stopping GLP-1 therapy. Their responses have a common theme: sustainable outcomes require planning beyond weight loss alone.
Have you previously treated patients with muscle loss from GLP-1 RAs? Log in or sign up to share your approach and view the consensus summary.
Post:
As we all see in clinical practice, more patients are requesting GLP-1 medications for DM and weight loss. A lot of seniors over 65 yrs with DM and obesity are using them too. In addition to weight loss, I have seen that patients lose a lot of muscle mass with the GLP-1 medications . In addition to increasing protein in the diet and increasing exercise, what preventative measures can be taken to prevent muscle loss?
Key takeaways about treating muscle loss from GLP-1 RAs:
Family Practice
"1. A patient's insurance may or may not cover PT, depending on the diagnosis; just muscle strengthening would probably not be covered.
2. If a patient already has osteopenia or osteoporosis, the patient should be receiving treatment, so it is appropriate to get DEXA scans annually to reassess improvement or further regression
3. Some muscle strength may return, but only with proper resistance training and nutrition."
Endocrinology/Diabetes
"1. Evaluation by physical therapy for gait strengthening and resistance training is important, especially in obese patients who may have disuse muscle atrophy/ low lean muscle mass prior to treatment. Nutrition education for adequate protein intake is essential.
2. Screening DEXA scans can be done every 2-3 years—an annual test is done if the patient is being treated for osteopenia/ osteoporosis.
3. Discontinuing treatment will allow for weight gain, but not necessarily an increase in muscle mass, especially in patients who have limited mobility/ activity."
Family Practice
"1. If they are not actively engaging in some sort of physical activity/exercise, then a physical therapist would be very reasonable. Everyone who is on a GLP-1 should probably see, or at least speak with, a dietician about their nutrition anyway.
2. I would follow the guidelines unless I have reason to suspect loss of bone mass.
3. Like many things, it depends on the individual. Some gain muscle mass, especially if they follow a correct diet, but others do not."
Family Practice
"1. If the muscle loss results in decreased strength/ambulation, yes. Over the past 1-2 years, I have stopped suggesting or endorsing rapid weight loss. I’ve never encouraged it, but with GLP-1 use, especially in those with DM, I discuss the ability to significantly reduce/eliminate DM meds as our goal. Once this is achieved, I don’t endorse continued titration.
2. I encourage screening BMD in all post menopausal women regardless of GLP-1 use.
3. If they continue high-protein weight-bearing exercise, some muscle mass may return. I actively encourage all patients to include yoga: maintain balance/strength/flexibility, and it can be done no matter the weather!"
Internal Medicine
"1. Yes, that should be done, but I personally don't have any patients suffering from sarcopenia. Weight or resistance home exercises should be recommended for all patients receiving GLP1/GIP medications
2. It is advisable to get a baseline DEXA for monitoring.
3. Usually not, weight regain is usually fat. Weight-bearing and resistance exercises should be initiated while they receive these medications."
How do you help patients protect their muscles and bone health during GLP-1 therapy? Visit the full post on Healthcasts to share your approach and read other perspectives from the community.