Do GLP-1s Cause Muscle Loss in Women Over 40?

Nikkiey: GLP-1 medications produce real weight loss, but 40% of that weight loss comes from muscle, not fat. And remember, muscle is medicine. Muscle is longevity. It is the most powerful tool your body has for long-term metabolic health. Any approach that does not protect and build it is leaving the most important variable out of the equation.

What's going on, everyone? Hey, you guys. Welcome back to another episode of The WarriorBabe Show with your host, Nikkiey Stott. Today we're just going to get right into it. I'm going to talk about something that I think is arguably one of the most important conversations happening right now in women's health and in the fitness space. And it's a conversation that is not being handled honestly enough, in my opinion, by the people who should be having it.

So in this episode, I want to specifically talk about GLP-1 medications, weight loss injections. I've talked about Ozempic before and gone into my viewpoint and opinion in a previous episode a while back. But I want to bring it back here because I specifically want to hone in on what these medications are doing to your muscle mass. Because this is the piece of the conversation that is being almost completely overlooked or ignored.

And as someone who has been in the fitness space for over a decade now and has worked with over 21,000 women on metabolism, metabolism repair, hormones, body composition, building muscle and long-term health, it's just on my heart. I have a perspective on this that I don't want to keep quiet about anymore. And I want to lean in even more heavily than what I talked about in the previous episode on my opinion around this topic.

And before I go any further, before we really dive into it, I'm not here to guilt or shame anyone. For those of you who have been on, used or are trying to come off these medications, that's not what this episode is about. I truthfully just want to bring education and information to you, for those of you who are either considering it, on it or coming off of it. Because there are women in my community who are in one of those buckets. And I respect your decision. I understand why. And I'm not here to judge the choices that you've made.

But I want to give you information that maybe you weren't aware of, or that your prescribing doctor very likely didn't give you. For anybody, wherever you are in those buckets, whether you're considering them, you're on them or you're coming off of them, I hope you leave this episode a little bit more educated and informed, which will help you make decisions on what you need to do. Because the muscle loss conversation around GLP-1s is not happening loudly enough in this space, and it needs to be. So I want to lean into that with you guys today.

First, I want to talk high level about what these medications were originally meant to do and how they've exploded into this weight loss category. These weight loss injections, these GLP-1s that you're hearing about everywhere, were originally developed for people with type 2 diabetes, to manage type 2 diabetes. And they've somehow become widely prescribed for weight loss.

They work by mimicking a hormone that slows down gastric emptying and dramatically reduces appetite. It creates an effect in our brains on hunger and reward signaling, and it significantly quiets food noise for most people who take them. And because of these things happening, people are eating significantly less. Their desire to eat just quiets. And when you are eating significantly less, you are going to lose weight. Okay? Yes, the scale is going to go down. Your photos are going to look different. You are going to see and feel your clothes fit differently.

And for people who are dealing with obesity and the serious health complications that come with it, like cardiovascular risk, blood sugar dysregulation and metabolic disease, the weight loss these medications produce is real and is significant for the people who need it. I'm not disputing that. I just want to make that known.

What I want to talk about is what's happening underneath that weight loss that nobody is putting a label on. Because yes, the scale is going down. Yes, the photos look different. Yes, clothes fit differently. Yes, you are losing weight. But there's a huge difference between the scale going down and fat being lost. They are not the same thing. And that distinction right there is everything I want to dive into with you guys. Specifically, the muscle loss, and giving you the data and research that my team at WarriorBabe and I are actually reading and looking into as we try to navigate how to help more women who are in this season of life, because it is so loudly happening in the space.

So the information I want every woman on or considering a GLP-1 medication to have, and I need you to hear this because it's not something most prescribing physicians are walking their patients through, is this. There's trial data on specific GLP-1s, and there have been multiple clinical analyses on this. It is consistently showing that a significant portion of the weight loss on these medications is not fat. Meaning the weight you are losing on these medications is not actually fat loss. When you step on the scale and see it going down, it's not all fat. What it is, is lean body mass, also known as muscle.

Depending on the analysis, some are estimating up to 40% of total weight loss on GLP-1 medication is coming from lean muscle mass rather than fat tissue. Let me go a step further and put that in real numbers so it lands a little better for you guys. If a woman loses 30 pounds on a GLP-1 medication, and it's 40%, up to 12 of those pounds may be muscle, not fat.

And yeah, she's lighter on the scale. Yeah, her before and after photos look different. Yeah, her body composition looks different. But the actual ratio of muscle to fat that determines her metabolism, her strength, her hormone health and her long-term health results may not have improved nearly as much as the weight loss suggests. People think, I lose weight and I'm going to be healthier. But on these medications, you're not just losing fat, you're losing muscle. And in some of these analyses and some of these trials, those things, her metabolism, her strength, her hormone health, her long-term health overall, may have actually measurably gotten worse because she's losing muscle.

And to draw it in more specifically for the women who are part of our community or in WarriorBabe, you've heard me say this before: muscle mass is something women naturally lose with age. When you're in your 30s, you lose roughly 3% to 8% of muscle mass per decade without intentional intervention. That just happens. And that rate accelerates significantly after menopause.

So for women in their 40s and 50s, which is a significant portion of the women currently using these medications, losing additional muscle on top of age-related muscle loss is not a small side effect. It is not something to be ignored. It is a compounding problem with real long-term consequences for your metabolism, your bone density, your health, your hormonal health, your strength, your foundational strength and your functional strength.

Less muscle mass, and you know I've leaned into this in past episodes, means a slower resting metabolic rate. Which means when the medication stops... and I was talking to one of the members of the team, and the doctors are telling people they're going to have to be on these for the rest of their life. Do you know how expensive that is? For most women, it does stop eventually, whether it's by choice, because of the cost, or because of the side effects they're enduring on the medication. Now I'm going off on a rant. But no matter what, you have less muscle, which means a slower metabolic rate, which means when you stop these medications, the body is burning fewer calories at rest than it was before the drug was ever started.

So the appetite comes back, but the calorie-burning capacity has decreased. And that's why the weight returns. And it often returns faster and in greater amounts than it was lost on these medications.

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There's also a study I read showing that within 12 months of stopping a GLP-1 medication, participants had regained an average of two-thirds of the weight they had lost. Two-thirds within a year. It's literally history repeating itself, just in this new form of drug that's out there for women to lose weight. It's like we're doing the 1960s, 70s, 80s and 90s all over again. This is just the new thing happening. The new drug.

I'm just going to say this out loud. The women who come to me, who come to WarriorBabe after stopping these medications, are not just dealing with weight gain. They are dealing with a metabolism that is running slower than it was before they started the drug. They have less muscle than they had before. They have more fatigue. They have more hormonal disruption. And the feeling that they are starting from a worse position than before they began entirely consumes them with defeat before they even try to start the more sustainable path: proper nutrition, proper strength training, X, Y and Z, which is literally just the answer.

Guys, I know everybody wants to lose weight and wants to lose it fast, but do we really have to do it by means of what this drug is doing to our bodies? What I just named, what I see women dealing with when they come to us after being on these medications, is a trap that nobody warned them about. Nobody warns them about losing muscle, about their metabolism being far worse than where they were when they started the drug, or about experiencing more fatigue or hormonal disruption. And that's why I want to talk about this stuff with you guys today.

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So when I was preparing for this episode, I'm sure people are wondering why. For me at least, I'm like, why is this happening? My mind spirals. Like I just said, we are doing what we did years ago. You women who are 40, 50 and 60 years old grew up in that diet culture. It's just on repeat. They do say history repeats itself. So naturally: why does this happen? And why isn't the medical community making this the centerpiece of every GLP-1 conversation?

The muscle loss happens for a reason that is completely consistent with everything we know about nutrition and body composition. It's not mysterious. The medications suppress appetite so dramatically that most people are not eating enough protein to preserve their muscle mass. They're eating significantly less overall. And when your overall intake drops without you intentionally and deliberately prioritizing protein, we know muscle loss is going to follow every time. I've talked about this across multiple episodes. This is what happens when you're not eating enough and you're in a calorie deficit without adequate protein. The body burns muscle alongside fat because it has to find fuel somewhere.

The difference with GLP-1s is that the appetite suppression is so powerful that people often cannot eat more, especially protein, which is already filling to begin with and requires real effort to consume in adequate amounts. There are already people struggling to get in enough protein. And a woman on one of these medications who can barely finish a small meal is not thinking, oh, I need to hit 130 grams of protein. She's just trying to eat something, anything.

And then the strength training piece, which is the other half of muscle preservation and of holding on to the muscle you're losing as you age, falls away too. When you're already eating very little and your energy is already low, your motivation to train becomes low. And nobody is handing you a prescription to also do resistance training and focus on a protein target while you're taking these medications.

So why, from a broader perspective, isn't the medical community making this a bigger conversation? I'm sure many minds go to money. It's a grab. That's just how insurance and the system work. But I think it also comes down to how outcomes are being measured. Weight loss is the metric. And fat loss and muscle loss both show up as weight loss on the scale. So if the number is going down and certain health markers are improving, then from a medical or clinical standpoint, the medication is working.

But what I think is missing here is a huge level of attention, because it's very nuanced: DEXA scans, lean mass tracking, nutritional coaching. If you think about it, most prescribing practices simply do not have that kind of infrastructure to provide in the first place. So that's why it's happening, and that's why nobody in the medical industry is saying anything about it. It's based on, well, if people are losing weight, it must be working. Weight loss is the metric. But they're clumping muscle loss and fat loss together. Makes sense, right?

I told you this episode was going to be very opinion forward and a bit direct, so let me continue to be direct. I am not anti-GLP-1. I am not telling you these medications are evil and they suck, or that most women who use them are taking the easy way out. I feel like that is unfair, and it ignores the genuine complexity of what many women are trying to navigate when it comes to their health. I said earlier that I respect and understand where people are coming from when they are considering or on this drug. And I'm hoping the information I'm sharing with you today comes across as educational.

But I will say this clearly. As someone who has spent years studying and coaching female body composition, GLP-1 medications prescribed without a mandatory nutrition and strength training protocol are, in my opinion, an incomplete intervention. Prescribing a medication that causes significant calorie restriction without simultaneously requiring someone to prioritize protein and resistance training is, in my opinion, setting that woman up for a body composition outcome that is far worse than the scale is ever going to tell her.

You can lose 40 pounds on one of these medications and end up metabolically worse off than when you started. If that weight loss came with significant muscle loss, a slower metabolism and no strength training foundation to support the body you have now, you are far worse off than before you started the medication.

The women most affected by this are the ones already in the most vulnerable position. They already have low muscle mass. They're experiencing hormonal changes from menopause or perimenopause. They have a history of yo-yo dieting that has already compromised their metabolic rate or metabolic health. These are the women who need to be building muscle the most. And the medication without the right support around it makes that harder and more complicated. It doesn't make it easier.

You know where I stand on this, right? My philosophy hasn't changed: muscle is medicine. Muscle is the organ of longevity. That's what Dr. Gabrielle Lyon says. It is the most powerful metabolic tool a woman's body has. It literally determines how efficiently you burn fat, how well you regulate your blood sugar, how strong your bones are and how well you age. Any intervention, whether it's a drug, a diet or otherwise, that does not account for preserving and building muscle is leaving the most important variable out of the equation. And Dr. Gabrielle Lyon says this too: the more muscle mass you have on your body as you age, the more years you add to your life.

And I want you to know, if you've been on a GLP-1 or you've come off of one, this is all fixable. But it requires a completely different strategy than what most women are getting from the people prescribing these things.

So here are the non-negotiables for putting this into play, whether you're on a GLP-1, you recently stopped one or you're considering one. This is what I would recommend, and these are non-negotiables from a body composition and muscle-preserving standpoint.

Non-negotiable number one, and I wonder how many of you are going to get it because I've talked about it so much: protein first, every single day. No exceptions. On a GLP-1, I know your appetite is suppressed. I know eating feels like a chore some days. Protein still has to come first. Before carbs, before fat, before anything else you put on your plate, put on protein. And if that feels hard out of the gate, lean on liquid or soft proteins like Greek yogurt, cottage cheese, protein shakes and bone broth. Protein is the primary defense against muscle loss. There is no workaround.

Non-negotiable number two, and I wonder if you're going to get this one too: strength training, consistently. You don't need to be in the gym three hours a day, five or six days a week. Three to four focused sessions per week of compound, progressive strength training is the minimum to meaningfully preserve muscle mass during the weight loss these medications produce. Literally, walking away from being prescribed these, you should have a proper nutrition protocol and a proper strength training protocol to follow.

And cardio does not... listen to me. I'm saying strength training. Pick up the dumbbells, pick up the barbells. I'm not saying cardio. Cardio does not preserve muscle. Cardio has real value, don't get me wrong, for cardiovascular health and stress management. But it does not send your muscle the signal it needs to maintain and to grow. Only resistance training, only strength training, does that. So you need to prioritize it.

Non-negotiable number three: track your body composition, not just your weight. Push for DEXA scans or InBody measurements that show your lean mass versus your fat mass at baseline, throughout your time on the medication and after. That is a non-negotiable. So: prioritize your protein, strength train, and track your body composition, not just your weight.

Number four is have a plan for what comes after. This is a conversation almost nobody is having about these medications, and I feel like it's probably the most important one. What happens when you stop? Because most women do stop eventually. They stop by choice. They stop because of cost. They stop because of side effects. Because the prescription ends. Even though some doctors are saying you have to be on this forever, which is crazy.

And if you have not built a nutritional foundation and a body composition that can sustain itself without appetite suppression, the weight is going to come right back. As I said, two-thirds of the weight loss returns within 12 months for the women who didn't maintain a behavioral change on these medications. The women who keep the results while using the medication built the habits. They prioritized protein. They had a strength training foundation. They had metabolic health that was supported along the way. Okay? But that's a very small percentage of individuals. You need to be prepared with a plan for what to do when you're done: a strong nutritional foundation and a strength training protocol to follow.

So, to sum up everything we covered today: GLP-1 medications produce real weight loss, but 40% of that weight loss comes from muscle, not fat. That's crazy, you guys. Just let that sink in, please. And remember, muscle loss slows down your metabolism. It can leave you worse off than where you were when you started, because now your metabolic health has been disrupted, you may have blood sugar dysregulation, and you're burning fewer calories than you were before. When the medication stops, your appetite returns, and now the body is burning fewer calories than it was before. That's why the weight comes right back.

But I want you to know it's fixable. You just need the right strategy. You need protein first, every day. Strength training, consistently. Body composition data, DEXA scans, InBody scans, not just scale weight. And remember, muscle is medicine. Muscle is longevity. It is the most powerful tool your body has for long-term metabolic health. Any approach that does not protect and build it is leaving the most important variable out of the equation.

So I hope you are walking away from this episode with more awareness of this drug and more knowledge of what it's doing, and that you're considering whether it's the right path for you, knowing that if you have to lose weight, there is a much better way to go about it foundationally than jumping on a medication that could leave you worse off than where you started.

Guys, I'm just going to add this in here. There are women inside our community who are on this right now and coming off of it, and they're being supported by our coaches with the right nutrition and strength training protocol. There are women who are considering going on it who are having these real dialogues inside our community. There are women navigating exactly this. And they're doing the work, they're asking the hard questions, and they're building the foundation that actually lasts.

So if you want to surround yourself with more of this information and be part of a community of women who lean on each other, who hold each other accountable and get the right insight on the decisions they're making, our community is completely free. It's full of women in your exact season of life. It's my biased opinion, but it's also one of the most real spaces on the internet for this type of conversation. I'm going to put the link in the show notes. Click it and join our community for free.

And I just ask that you share this episode with a woman who is on one of these medications or is considering it, because I promise you she needs to hear this. I love you guys, and I hope you were able to take away some stuff from this episode. Muscle is the most important thing. Remember that as you continue to age. Okay, I'll see you guys in the next episode. Peace out.

Hey, really quick before you go, I have one small favor to ask. If this episode brought you value or sparked something in you, take just a moment to hit that review button. Your rating and review make all the difference in helping more women discover the tools they need to transform their fitness and their confidence. It takes less than a minute, but it can change the path of someone else's journey. Thank you so much for leaving that review. I appreciate you so much.