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372 points Eumenes | 1 comments | | HN request time: 0.413s | source
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crazygringo ◴[] No.42203302[source]
I'm always so baffled by warnings about losing muscle when losing weight.

Of course you do! If your body is tens of pounds lighter, then you don't need the extra muscle to lug it around. This paper is about reduction in heart muscle, and of course your heart doesn't need to be as strong because there's less blood to pump and less tissue to fuel.

When you gain weight, you also increase the muscles needed to carry that weight around. If you see someone obese at the gym doing the leg press, you may be astonished at how strong their legs are. When you lose weight, you don't need that muscle anymore.

Our bodies are really good at providing exactly the amount of muscle we need for our daily activities (provided we eat properly, i.e. sufficient protein), so it's entirely natural that our muscles decrease as we lose weight, the same way they increased when we gain weight. Muscles are expensive to keep around when we don't need them.

Obviously, if you exercise, then you'll keep the muscles you need for exercising.

But this notion that weight loss can somehow be a negative because you'll lose muscle too, I don't know where it came from. Yes you can lose muscle, but you never would have had that muscle in the first place if you hadn't been overweight -- so it's not something to worry about.

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lee ◴[] No.42203958[source]
From the article: "...explains this rate of muscle decline is significantly higher than what is typically observed with calorie-reduced diets or normal aging and could lead to a host of long-term health issues..."

The warning isn't that you're losing muscle during weight-loss with these drugs. It's that the ratio of muscle vs fat loss is much greater with the drugs compared to traditional weight loss methods.

It's been well studied that if you exercise and eat enough protein while losing weight, you can retain more muscle.

Losing a lot of lean mass is incredibly detrimental to your longevity and quality of life.

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crazygringo ◴[] No.42204741[source]
If I'm reading the study [1] correctly, that conclusion is not warranted.

It appears that they fed the control group and treatment group of mice lots of food to get them fat, then gave them identical normal diets, and gave the treatment group semaglutide.

The semaglutide group lost significantly more weight (fig A.ii) than the control group, and also lost heart muscle.

So it does not seem that they compared to an equivalent amount of weight loss in mice, which is what I'd think you'd need to do to come to the conclusion from the article (actually, not just an equivalent amount of weight loss, but also at the same rate).

[1] https://www.sciencedirect.com/science/article/pii/S2452302X2...

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AuryGlenz ◴[] No.42205036[source]
I guess perhaps the better conclusion would be that maybe dosages should be adjusted so that people don’t lose weight too quickly?
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1. explodingman ◴[] No.42217225[source]
In its trials, Ozempic was combined with intervention/guidance from nutritionists and fitness advisors, and doctors are supposed to reproduce this by referring patients. You can't do that with mice.

I think if I were taking Ozempic I would ask my doctor to halve the rate of progression to higher doses to make the whole process easier to manage, not just managing muscle loss but also the whole of life impact. The official protocol is very "crash diet" in style.

Anyone thinking of taking Ozempic should be aware that many people abandon the drug within the first two years, due to too much nausea, diarrhoea and cost.