On weight loss drugs, my patient had cramps and fatigue: Here are 5 ways to deal with muscle loss

Indian Express

4 days ago

Mr Kumar, 42, had been taking the weight loss drug semaglutide for some time because his blood sugar level had been spiralling out of control while his body weight stood stubbornly at 98 kg, a weight cliff from which he couldn't get off. No amount of exercise and diet was helping him. But although his weight started dipping, he exhibited signs of muscle loss. He had cramps, lost balance, muscle twitches, all signs that his core muscle mass was beginning to get wasted.
Muscle loss is common among those on GLP-1 receptor agonists — like semaglutide or liraglutide — which mimic gut hormones to regulate blood sugar and hunger pangs, thereby reducing calorie intake and body weight. But along with fat loss, some individuals also lose lean body mass, which includes muscle. That's something we need to watch carefully.
Why is muscle loss a problem? Isn't any weight loss good?
Not necessarily. Muscle is crucial for your metabolism, strength, balance and overall health. Losing too much muscle can reduce your energy levels, increase fatigue and even raise your risk of falls or injuries later in life. Also, muscle helps burn calories, so losing it could actually slow down your metabolism and make long-term weight maintenance harder.
Is this more serious for Indians?
Many Indians naturally have lower muscle mass due to genetic and lifestyle factors. This is sometimes called the 'thin-fat' body type. Even if we look slim, we may carry more fat and less muscle, especially around the abdominal area. So, preserving muscle becomes even more important during weight loss.
How can you make sure you lose only fat, not muscle?
There are three main steps to follow:
Prioritise Protein: Ensure you're eating enough protein — around 1.2 to 1.6 grams per kg of ideal body weight. Include high-quality sources like eggs, dairy, dals, legumes, paneer, tofu, chicken or fish. Try to have a source of protein in every meal.
Incorporate Strength Training: At least two to three times a week, do some form of resistance training—this could be lifting weights, using resistance bands or doing bodyweight exercises like squats and push-ups. This helps signal your body to retain and build muscle even while losing weight.
Regular Monitoring: If possible, do a body composition analysis every few months to check if your muscle mass is being preserved. If muscle loss is seen, your exercise and diet plan can be adjusted accordingly.
Balanced diet: While you need a calorie deficit to lose weight, avoid drastic calorie restriction, as this can lead to muscle loss. Focus on a balanced diet with adequate protein, carbohydrates, and healthy fats to support overall health and muscle maintenance.
Get adequate sleep: Sleep regulates your hunger hormones, metabolism and is the best way for muscle synthesis.
Relying only on the medicine is not enough
The medication helps reduce hunger and supports weight loss, especially when lifestyle changes are difficult. But to make the weight loss healthy and sustainable, you need to combine it with good nutrition and exercise. The goal is not just to lose kilos—but to gain health, strength, and confidence in the process.
(Dr Mohan is Chairman, Dr Mohan's Diabetes Specialities Centre, Chennai)