Changes in lean body mass with glucagon‐like peptide ‐1‐based therapies and mitigation strategies

Weight loss from glucagon-like peptide-1 receptor agonists (GLP-1RAs) approaches levels similar to those achieved with surgery.

• Reductions in lean mass during GLP-1RA treatment may vary significantly, with some studies reporting decreases between 40% and 60% of total weight lost, while others show reductions of approximately 15% or less.
• The observed heterogeneity in lean mass changes may be influenced by factors such as patient population, specific drug characteristics, and existing health conditions.
• Lean mass measurements encompass not only muscle but also organs, bone, fluids, and fat water, complicating the interpretation of muscle health.
• Skeletal muscle changes during GLP-1RA treatments appear to be adaptive, with reductions in muscle volume aligned with expected outcomes related to aging and disease status.
• Improved insulin sensitivity and reduced fat infiltration in muscle may enhance muscle quality, potentially decreasing the risk of strength and functional loss.
• Older age and disease severity could impact the suitability of GLP-1RA therapies for individuals due to the risk of sarcopenia.

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