The race is on to stop Ozempic muscle loss

As drugs like Ozempic become increasingly popular for weight loss, more and more doctors and patients are looking for ways to counteract the muscle loss that can occur from these drugs – and companies are rushing to meet that demand.

Luxury gyms offer strength training programs specifically marketed to people taking these drugs, promising to help customers “optimize their results.Nutritionists and meal delivery services are coming up with plans to help patients get enough protein. And pharmaceutical companies, including Eli Lilly, which makes Mounjaro and Zepbound, want to develop combination treatments that prevent muscle loss.

“I know people say, 'Oh, we're trying to solve the liability.' It's not,” said Dr. Daniel Skovronsky, chief scientific officer at Eli Lilly. The question, he said, is how to build on the benefits of medication to help patients lose more fat while maintaining or even gaining more muscle mass.

Eli Lilly is teaming up with BioAge Labs to test whether a compound called azelaprag can help people achieve a more optimal balance between muscle and fat, potentially helping people taking Mounjaro or Zepbound lose even more weight. The drug mimics a hormone produced during exercise that can improve muscle metabolism and function.

And last year Eli Lilly acquired the biopharmaceutical company Versanis, which makes a drug that blocks receptors that regulate skeletal muscle and fat mass. “When that happens, the muscles get bigger,” says Dr. Steven Heymsfield, a professor of metabolism and body composition at the Pennington Biomedical Research Center in Louisiana, who has studied the drug bimagrumab.

There also is a process underway testing bimagrumab and semaglutide, the substance in Ozempic and Wegovy, in adults with obesity. Later this year, the drugmaker Regeneron will begin a clinical trial testing semaglutide in combination with an antibody treatment that blocks receptors that regulate muscle growth. And on Tuesday, the Food and Drug Administration greenlighted a clinical trial to investigate whether a compound previously tested as a treatment for muscle loss in older adults could help maintain muscle and lose more fat in people age 60 and older who are taking a weight loss drug.

“These weight loss medications actually cause the development of frailty in older patients in months rather than years,” says Dr. Mitchell Steiner, the CEO of Veru, who conducted the research.

But even if these studies are successful, it would be years before these new drugs are available to patients taking medications for weight loss.

In the meantime, doctors said it's crucial for these patients to find ways to preserve their muscles. Older adults and postmenopausal women are especially at risk of becoming weak or developing osteoporosis if they lose too much muscle mass, says Dr. Scott Hagan, an assistant professor of medicine at the University of Washington who studies obesity. But anyone who loses muscle can experience weakness and fatigue, said Dr. Hagan, and may be at increased risk for falls and injuries.

“Just because we lose weight doesn't always mean we're getting healthier,” says Dr. Michelle Hauser, director of obesity medicine at the Stanford Lifestyle and Weight Management Center.

Doctors tend to recommend two simple solutions to combat muscle loss: eating protein and doing strength training. Companies benefit from both objectives. In January, Abbott introduced a line of protein shakes aimed at people who use drugs, such as Ozempic, and Daily Harvest, a meal delivery service, has rolled out a new “companion food collection” for clients who use medication.

Nutrition-focused startups like Nourish and Berry Street, which connect people with dietitians, have started promoting services specifically for people taking these medications. Nourish's suppliers emphasize protein intake and pay particular attention to the risk of malnutrition for patients taking weight-loss medications, says Dominique Adair, the company's head of clinical quality.

Noom, a telehealth company that started by offering behavioral health coaching for weight loss and has since expanded into prescribing weight loss medications, now has a Muscle Defense program with fitness videos and a protein tracker. The luxury gym chain Equinox has now tailored a personal training program to people who use the drugs. Obé Fitness, an online workout platform, partnered with a virtual care company that prescribes weight loss medications to develop its MuscleGuard training program.

And in Minnesota, the health club LifeTime Fitness is piloting a clinic that not only offers personal training focused on weightlifting, but also offers compounded versions of weight-loss medications — unauthorized alternatives that the Food and Drug Administration has warned against their use.

The national chain plans to expand the program to “major markets” by the end of the year, a representative said.

A specialized program can help a patient maintain muscle, but most don't need to cram protein powder into all their meals or start an intense exercise routine, said Dr. Hagan.

“What I'm trying to emphasize is that we're not trying to turn you into a bodybuilder or anything like that,” he said. “Two sessions per week with light weights can be very effective.”