24/05/2024
Has the “muscle loss” issue on obesity medication taken up more space than it deserves?
As anyone working in Obesity Medicine knows, concurrent loss of muscle mass is a physiological response to weight loss.
After all, why should the body invest in maintaining muscle mass that it no longer needs to move a lighter body around?
Indeed, muscle mass is a poor correlate for actual muscle function or mobility. Svelte marathon runners, for example, have far less muscle mass than anyone carrying around 200 pounds - yet, we don’t hear them complaining of sarcopenia!
So, while the problem of disproportionate muscle loss, certainly warrants consideration, especially in the frail elderly, or perhaps in South Asians (where sarcopenic obesity is rampant), this topic is unlikely to be of major relevance for the vast majority of people losing weight on obesity medication.
And, with an adequate amount of protein intake and moderate weight-bearing physical activity, this should rarely be an issue of clinical relevance.
Indeed, as far as function and mobility is concerned, it is muscle strength and endurance that matters, not some arbitrary body composition cut offs. It is for this reason, that I have long advocated for functional measures like grip strength to be included in assessments.
It may also be worthwhile noting, that in my years of caring for individuals, who have lost substantial amounts of weight following bariatric surgery, sarcopenia, resulting in functional limitations, has been rather rare, and generally limited to those individuals who had significant problems maintaining adequate protein intake.
I see no reason to suspect that this issue should now be a greater problem or deserve more attention in individuals losing similar amounts of weight on obesity medication.