Weight Loss Medications and Muscle Loss: What You Need to Know

Weight loss medications can bring the number on the scale down quickly—but are you losing fat, muscle or both? And why do some people feel weaker or less healthy even while the pounds are coming off?

In this episode of Baptist Health Talk, host Johanna Gomez speaks with clinical pharmacy specialist Erin Dorval and physician assistant Lisa Davis about what GLP-1 medications such as Ozempic and Wegovy are doing inside the body, why muscle preservation matters and how resistance training and nutrition support healthier, more sustainable results.

They discuss:

•  Why rapid weight loss can include significant muscle loss 
•  How GLP-1 medications reduce appetite and quiet “food noise” 
•  Why resistance training should begin at the start of treatment 
•  What “Ozempic face” really is—and what causes it 
•  How protein, hydration and smaller portions may help manage side effects 
•  Why medication dosage does not always need to keep increasing 
•  The risks of rapid weight loss and unmonitored compounded medications 
•  How pharmacists, cardiology teams and other providers can work together 
•  Practical ways to build healthier habits without trying to change everything at once 

The goal is not simply to lose weight. It is to improve strength, function, metabolic health and long-term quality of life.

Host:
Johanna Gomez
Award-Winning Host & Journalist

Guests:
Erin Dorval, PharmD, CPh
Clinical Pharmacy Specialist
Baptist Health

Lisa K. Davis, DMSc, PA-C, CLS
Physician Assistant
Baptist Health Heart & Vascular Care

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Transcript

SPEAKER_03 0:00

Fat takes up much more space in a patient's body than muscle does. And so when we gain muscle, the weight may not change, but your body changes. The pants fit a little bit differently. You walk a little bit differently because it the body just is adjusted. That body composition is changing.

SPEAKER_00 0:18

Welcome to Baptist Health Talk, a podcast on all things healthcare, powered by Baptist Health South Florida, your trusted source for health care prevention and wellness.

SPEAKER_02 0:29

Hello, everyone. From muscle loss to Ozempic face, and the surprising reason why resistance training matters. We are breaking it all down. We are joined by Erin Dorval, Clinical Pharmacy Specialist at Baptist Health, and Lisa Davis, physician assistant at Baptist Health Heart and Vascular Care. Ladies, thank you so much for being here with me today. It is the biggest conversation. I think it's happening at pickup lines, at parties, everywhere you go, and especially all over social media. People are talking about it. If it's good for them, what they should do, which ones should they be on. So I'm gonna start off with three questions. I'm gonna start with the first one so we can just kind of figure out exactly what is happening and to answer all these questions. So the first one is I'm losing weight, but I don't feel healthy.

SPEAKER_01 2:00

Yeah, you know, that's a great question. And thank you so much for having us here today. Um, I think this is such an important topic. There's a lot of myths out there, like uh myths out there. Like you said, a lot of people getting their information from social media, not necessarily reliable resources. And needless to say, there's not a lack of hype or buzz about these therapies. Um and so it's really important to know, I think one of the important concepts to recognize is that um not all weight loss is created equal. And so when we lose weight and if we lose weight rapidly, um, we're losing both fat mass and muscle mass. Okay. And so um ideally what we want to do is lose fat mass and retain our muscle mass. And so if you're just looking at the scale and you see that number going down, it doesn't really tell us what type of weight loss are we having here. And um with these medications, um, and we're gonna talk about the mechanism of how they work, you'll see that number go down, and it could go down pretty quickly. But if we're not taking the appropriate actions to make sure that we are retaining muscle mass by doing resistance training and getting proper nutrition with adequate protein intake, we're losing both, and then we can feel tired, fatigued, and not necessarily feel those benefits that we would expect from the weight loss.

SPEAKER_02 3:24

And that's why people would say, I don't feel healthy. But you brought up a good point when we were talking off-camera earlier. You said this has been around for a very long time.

SPEAKER_03 3:34

Absolutely. I mean, GLP1 medications were started in the early 2000s. The only reason we don't hear about them is it was for diabetes indication only. And so more recently, weight loss has come into play as an indication. And there's a bunch more coming down the pipeline as well. But the medication, um, GLP1 standing for glucagon-like peptide, is a hormone in the body that mimics um how we process uh food in terms of um appetite suppression. And so a lot of patients will feel fuller longer because of the medication, kind of slowing the gastric emptying down. It also works in the brain where it kind of tells the body, hey, I'm kind of full right now. Um, and so patients get that satisfied feeling from the medication as well. It kind of also helps with um reducing the urge to eat those high caloric, sugary foods. Um, and so patients tend to not overeat as much as well. It's the food noise, as we call it. That's what it is.

SPEAKER_02 4:35

So one of the other questions that came up a lot is what happens when I stop taking the medication?

SPEAKER_01 4:41

Yeah.

SPEAKER_03 4:42

Go ahead. I was gonna say, I mean, there is no reason you have to. So I do want to put it out there that patients can be on it long term. Um, but if a patient chooses to transition off the medication, the biggest thing is did they make those dietary and um lifestyle modifications, like the resistance training and the protein, um, which will help them not to be able to regain the weight if they didn't make them.

SPEAKER_02 5:06

Okay.

SPEAKER_01 5:06

And eating uh too little, how dangerous is that? Yeah. I mean, and and that's something that we see in in practice, just to get back to that really quickly, when patients get to their goal weight and they're on a higher dose of the therapy and then they haven't made those lifestyle modifications and they have that rapid cessation where they just stop, that's when we tend to see that weight gain. So we cannot under as you know, really underemphasize the importance of those lifestyle modifications for that long-term success. And um, it's really important, as as uh Aaron said, these medications we we feel full more quickly. It settles down that food noise, which oftentimes leads to reduced caloric intake. And if we're not getting proper nutrition, the right foods, um, then that can lead to loss of muscle math, poor function, um, really overall poor function, uh functional health.

SPEAKER_02 6:03

Um in your body. So the big conversation is also around physical activity now that we found. So, what have you noticed with your patients? And and this is a two-part question for both of you. What is really happening in your body?

SPEAKER_01 6:17

Um, you know, I I think a lot of times, you know, it's it's important for us to look at people struggling with with weight management is really chronic disease management. Um, and thankfully, as a medical community, we're really recognizing that. And it's I think it's just important if whenever we're having this conversation to really emphasize it, patients that it's complicated. It's not necessarily their fault. And just walking into a room and saying, you know, start eating right and exercising, walking out and feeling like yeah, exactly. Um but uh, you know, back to your question about the physical training.

SPEAKER_02 6:55

The physical training.

SPEAKER_01 6:56

Is it it is it's really critical. I mean, really, if we want to have long-term success. I mean, when we think about what is the clinical goal of initiating patients on this therapy to improve strength, to improve functioning, to improve metabolic health, and to prov improve health span, not just living longer, but living longer, healthier.

SPEAKER_02 7:18

And it's funny that you say that because I would have said losing weight. That's it. You want to you want to lose weight, but you're saying losing the right weight, right?

SPEAKER_01 7:26

And so, and and we when you look at, and this is can be a delicate word, but if you look at the longevity space, what we're really recognizing is that we just have not emphasized enough overall the importance of resistance and weight training and just overall health span and longevity. And especially if you're in a therapy now, where you're going to be, you know, potentially really reducing your amount of muscle mass. This becomes even more important to incorporate it.

SPEAKER_02 7:58

There's a lot of misunderstanding of what a healthy weight looks like. And I am using air quotes because it really is very uh confusing.

SPEAKER_03 8:08

It is because a lot of us are accustomed to stepping on the scale and going, hmm, am I in my right BMI? You know, am I am I hitting what I should be? Am I normal? And weight is just one piece of the scale. And a lot of times the doctor will look at a patient too and saying your BMI falls into an obesity category. That takes into account weight and height. That's it. It doesn't look at muscle mass. And so fat and muscle, they do weigh the same, but they look different on you. Fat takes up much more space in a patient's body than muscle does. And so when we gain muscle, the weight may not change, but your body changes. The pants fit a little bit differently, you walk a little bit differently because it the body just is adjusted. That body composition is changing.

SPEAKER_02 8:55

So can you explain to me exactly what is happening in your body that you lose all this weight, right? But you also lose your muscle with it. Is it there has to be a better way to do this?

SPEAKER_03 9:08

Well, I mean, unfortunately, there's not. But yeah, when when patients, especially on GLP one, sticking with the medication, um, because it's making a patient feel fuller longer, they're going into a caloric deficit, which is great. That's gonna help um reduce weight overall. But unfortunately, the body goes, wait a minute, I need enough um energy to survive the day. And so what happens is that not only do we lose fat, we also lose muscle because we need to meet our basic energy um needs for the day. I kind of think of it like a phone battery. Okay. We can't, you know, I can't go on a plane and watch a three-hour movie if I only have a 20% battery. And our body is the same way that it is that they're looking, the body's looking to maintain our energy needs overall. And so if we're not putting enough food in our system because we're feeling fuller longer, then we don't have enough to sustain ourselves. So the body goes, I'm gonna take a little bit more, a little extra from muscle. Um, and then you don't notice it if you're only looking at the number, because the number on the scale goes down. Great, I'm losing the map. It's just so exciting. But it's it's not the healthy weight. It's sometimes what can be called skinny fat because it's more muscle loss than it is fat loss that's happening.

SPEAKER_02 10:23

So does it go kind of hand in hand? Like if you are getting ready to start a GLP one will go V journey, you should automatically know that with that you should be incorporating resistance training. And and how many times a week are we talking about?

SPEAKER_01 10:39

Yeah, I I think it's it's absolutely critical. And this is a conversation I have with patients all the time. Um, and and I'll see it. And this is really what prompted me to want to, you know, get out there and educate and spread awareness is to often see patients coming in. And they got as far as having the therapy prescribed without the educational component about the importance of these lifestyle modifications. So absolutely from the beginning, resistance training and proper nutrition, including proper uh, you know, adequate protein intake. And I think that it's unrealistic to say someone that hasn't done any resistance training, hasn't lifted a weight, suddenly they're gonna come in and we're gonna tell them, okay, three days away, uh three days a week, full body exercise, eight to 12 reps, three sets go. I mean, that's your setting those, you know, your failure right there. And that's not, you know, a personal, personal story. I've, you know, went through a journey. There was a time when I wasn't able to exercise, and I had to get back to it. And I really had to set really realistic goals for myself. Um, it doesn't take long to lose that muscle mass, but you can work slowly and steadily to build up. And so starting saying, I'm gonna start five minutes a week. If you don't have access to a gym and a personal trainer, okay. We, you know, have these wonderful YouTube videos that could be available, resistance exercises for whatever demographic you fall into. Start five minutes. If you can do two reps, one set, that's wonderful. You applaud that and you slowly start to incorporate more and more. You're gonna feel better, you're gonna be energized, and that hopefully can start that snowball effect. But from the beginning is really important.

SPEAKER_02 12:29

Okay, you're already in it. You've taken it, you've lost all this weight, you've already unfortunately lost some muscle already because you have sagging skin or osempic face. We've all heard of it, and we've probably seen so many of our friends or family members.

SPEAKER_03 12:46

What do you do now? Well, I just want to say that osempic face is not a side effect of these medications. So the medication itself does not cause this.

SPEAKER_02 12:55

But we have coined it.

SPEAKER_03 12:57

It has been out there because of the pictures that most of us see on social media. And really what that is is that rapid, significant weight loss. And so what happens is that fat gets lost in the um more in the facial structure, and the body just does not have time to adapt and tighten, and there's loss of collagen, and so there's loss of elasticity. And so the body just is struggling to catch up. And so, just like Lisa said, if you start the medication and on day one, you set a goal of I'm going to start with five minutes of resistance training. I'm going to plan what I'm eating for lunch every day so that I know that it has enough protein. You can get ahead of it and not go into having ozempic face.

SPEAKER_02 13:40

I just want to go ahead and say this because I feel sometimes it's so easy to say these things. It is hard to do resistance training. I feel like it's so much easier to just go for a walk than to lose some weights. That's my own personal bit. But I want to make sure that everyone that's watching or that's listening right now, that they're aware of that we know we're saying this, but it's hard. So I guess like setting a plan, be like working, you know, just kind of ahead a little bit to know what you're dealing with, it's definitely easier because losing weight quickly is great, but does it mean that it's working perfectly?

SPEAKER_03 14:10

Oh, absolutely. I mean, I I think you're you're nailing it when you're saying that you have to be intentional. And it is very hard. And so one of my um areas that I like to make sure the people are doing is when they're on it, that they're working with a healthcare provider. Not because we need to maintain a lot of, you know, oversight on some things, but it's there more as accountability and kind of like a coach where we're saying, hey, great with the success and the weight loss, but then don't forget to do these other things that are just as important. Starting small, knowing when to increase the amount of weights when you can do it, knowing when you need to have more protein or more other nutrients in the body as well. So okay.

SPEAKER_02 14:51

So there was another question. Medications do all the work, everything else is optional and you are laughing.

SPEAKER_03 14:58

I'm sorry. As a pharmacist, we hear this a lot that it's like once you get a medication, it's like that set it and forget it mentality. And this medication is definitely not one of those. Um, it needs oversight. Um, you do want to make sure that you are avoiding or minimizing the side effects that can happen with it. And that all comes down to are you having somebody else in your team, whether that's the pharmacist and they're your provider, um, and you know, maybe support groups, all of them working together to help with this, with nutrition advice, with uh resistance training and the management of the medication. It's not intended to really, I'm gonna start this dose, the next one I go up, they go up, I go up. Right. A lot of times if a patient is sustainable and losing weight little by little each week, they stay on the same strength of medication. They can stay on that for months at a time. There's nothing that says you have to keep progressing to the top dose of things. And I think that's what a lot of patients feel like the medication is intended to do.

SPEAKER_02 15:59

Have you seen a lot of difference in the outcomes of patients when they do strength training and incorporate in those who don't?

SPEAKER_01 16:07

Absolutely. Especially when we look at really long-term sustainability and success. Um, and and again, we have to just really emphasize overall all health. Um, but um what we what we tend to see is the patients that don't incorporate those lifestyle modifications, the resistance training, um, and adequate protein intake, the nutritional um component to it, they'll have success, they'll do well, they'll talk about coming off of the medication, they'll stop the medication, they've and then that's when we see that they tend to just regain the weight. And um, and then they feel even, you know, the the the mental, you know, component to this as well of seeing that sort of yo-yo. Um, and and it's really important when we look at that part of this uh journey as well, we know the benefits of exercise and resistance training for, again, overall health and wellness.

SPEAKER_02 17:04

So, this is to both of you. Um, have you seen risk and dangers when it comes to losing weight so fast?

SPEAKER_01 17:11

I mean, we can see what and and understand that this isn't necessarily what we're discussing today, isn't necessarily unique to just GLP1 therapy. Anything where you see rapid weight loss, you're gonna have loss of muscle mass. Um you're gonna have all of these other potential negatives. So, really, anything that you're doing where you're you're looking at uh, you know, the potential for weight loss is really important that you corporate these things. So, because there's so much attention in the media and in social media about losing uh muscle mass with GLP ones, it's really with any weight loss. Um, so not unique to this. But we do see where you can have increased fatigue, sometimes with really rapid weight loss. There is potential for potential gallbladder issues. Um, and so I always tell my patients, listen, chances are you didn't gain this weight over one, two, three months. There's no reason to think that the goal here is to lose it in one, two, three months.

SPEAKER_02 18:11

I know, but you know when you get your mind fixated on something, you're like, I want to do this and now this is my goal. Right. But you want it off, you want to take that off.

SPEAKER_01 18:19

Celebrating all of those goals along the way of this long-term lifelong journey. Um, and that's what we really need to focus on.

SPEAKER_02 18:27

Okay, so give me a tip for all those watching as experts. How can people start planning ahead? Because there are side effects that come with taking these medications. How do we plan ahead?

SPEAKER_03 18:38

Well, all medications have side effects. And a lot of it is a, let's start at the smallest dose. I think some patients too want to rush and, you know, let me get the top dose that I know is gonna get me the most weight. Um, but making sure we make um adjustments to dietary needs at the same time. So a lot of times the nausea and vomiting that happens with this medication is we have the patient has not changed how they've eaten. Um, so by reducing portion sizes, by having less fatty foods at the same time, that all that food is staying in the gut longer, which is a good thing. It's slowing down the absorption. We're allowing the body to have, you know, less blood sugar spikes, things like that. But the more that it sits there, the more that has a tendency to come back up as well. So we want to make sure that we're having planning what we're eating. And on the other end is you want to make sure you plan to have whole foods, good nutrition choices so that we're not, you know, sacrificing the weight loss for nutrition deficiencies. Um, so the biggest thing with it in managing side effects is are they getting enough to eat throughout the day to make sure that they're maintaining enough to meet their energy needs? Are they getting enough protein to make sure we're preserving muscle mass? I was just gonna ask them that to it.

SPEAKER_02 19:55

All we ever hear about is protein, especially women later in our midlife, I should say. We need to eat protein all the time. And that's all we hear about. But do you have to be on like more protein if you are on these weight loss medications? Or mindful, I should say.

SPEAKER_03 20:12

I think that's a better word. I don't necessarily think that there's any more that we need to. I think the GLP ones have brought it into conversation in terms of how much we just need to. I think overall, women in general probably haven't had as much protein throughout the um the day that we need to. And it's just brought into the conversation to be intentional with eating.

SPEAKER_01 20:34

Okay, so prioritizing it. Um, it's so if you're gonna have, I tell patients right away you're gonna start on these medications, cut your portions 30 to 50 percent. Okay. Yeah, but you're gonna feel full. You shouldn't feel like you're depriving yourself. You're gonna feel satisfied, you're gonna feel full. Well, like Aaron said, if you're slowing down gastric empty and you overeat, it has to go somewhere and it's not gonna be the way you want it to be. So cut your portions 30 to 50 percent, and then maybe prioritize because you're gonna feel full more quickly. Prioritize the protein first. You know, start eating that. Um, the other side effects that uh commonly we'll see is potentially constipation. So making sure that we're getting enough water intake, staying hydrated is extremely important. Moving around, walking while we're talking about the emphasis of resistance training coming from the cardiology space. We still want to tell people yes, moving the embodied and doing some cardio is important as well. And then if if constipation is really an issue, there's certain things like stool softeners that you could use. Talk to your healthcare provider about it. Um, but those are things that we can do to help to mitigate those.

SPEAKER_02 21:43

Just throw up the heart. So I'm going to ask you how does pharmacy and heart work together? And how should this be the team that people need?

SPEAKER_01 21:52

Um, I tell you, I'm I'm very fortunate in my space, and I work in the preventive cardiology space and uh prevention clinics. Clinics, and we really approach this with a care, team-based care approach. So within our space, we have physicians, APPs like physician assistants, pharmacists, nurse navigators, care coaches, and really patients have the benefit of having all of those resources available to them. So if I identify a patient who meets indication and is a candidate for these therapies, we'll start the therapy, do the education. But then automatically with that comes a referral to our wonderful pharmacist. And she will follow up with the patient when it may be the appropriate time to consider titrating, to assess for any side effects, give them instructions about what they can do to lower the risk of having those side effects. Make sure that they are getting a proper amount of resistance exercise, that they're eating properly. Find that right time to titrate the medication and really guide them through this journey. So close monitoring is really important. Too often we approach patients, and in healthcare now, you really see the sort of siloed care where this care team model collaborating with the full care team is really, really important for the patient and really giving them the best opportunity to have success with these medications.

SPEAKER_03 23:23

Yeah, I just want to echo what she's saying in terms of the collaborative nature. I mean, we've been so used to having siloed care for so long, but it really does help. I think referring patients to pharmacy after the diagnosis has been made really alleviates some of the pressure on the provider to have to do all of it at once. Allow the pharmacist there to help manage some of the side effects, um, insurance coverage, um, different formulations. I mean, now they have both pens and they have needles and vials. And so making the pharmacist can make sure that the patient is getting the correct dose that they need. But then on the other hand, when we start to see them on a monthly basis, we can say, hey, you need to get back to your healthcare provider for lab work to be checked out. And so it's a good team effort to go back and forth. It's not one or the other.

SPEAKER_02 24:18

You mentioned resources. We have resources, patients, but unfortunately, sometimes we have resources outside of medical professionals, and you can have access to these medications without even speaking to a doctor. How much of a no-no is that? I'll let you, as the experts, answer that.

SPEAKER_01 24:37

Yeah, and we tread cautiously here because, you know, this could be a whole conversation. But um, and you know, the problem is that if you're going to a clinic and getting a compounded information, uh compounded formulation, honestly, you're not sure what dose of the medication, what medication you're getting, any other sort of fillers, what else is in there. And um, and and we could see really some serious potential complications come from that. So the best thing to do is to go to your healthcare provider, make sure that you're getting um the medication that's prescribed. These medications don't come in generic forms yet, unfortunately. Um so if you're getting some generic formulation, we don't know where you're getting that from, you know what what. So, and and they've they've actually, the FDA has come out and said and cautioned against people getting compounded um formulations because of that reason. So I think the cost is probably the biggest issue for people though.

SPEAKER_03 25:42

Absolutely. And that's what I was going to um start to say was that compounded medications came about when there was a shortage of the um wholesale or the manufacturer being able to provide. I mean, it was a huge explosion of these medications coming onto the market. Um, but in terms of compounding, I get that there is a financial burden sometimes on patients. I've done enough work with insurance to try to make sure it comes about, but it is can be pretty pricey. So, what I tell patients a lot, if they choose to use a compounded pharmacy, make sure that they ask those questions. Right. Is it just the medication that's in here or has it been mixed with something else? It is an injectable. So once it goes in, that's it. It's not coming back out. And the other piece is making sure that their provider knows. And so a lot of times when they're doing their medication history in the office for their annual visit, are you telling them, the patient, everything that you're on, that you're on a compound of medication just in case there is some type of complication that the physician or other um practitioner knows what's going on?

SPEAKER_02 26:45

Okay, before I let you ladies go, key takeaways that you want us to really just hone in on?

SPEAKER_01 26:52

I think, you know, for me, one of the key take takeaways is that not all weight loss is created equal. Um and so it's important for patients to really understand that it's not just about looking at that number on the scale and really understanding what weight loss means for you, for your health. With these medications, again, we see a lot of additional benefits. We see improvement in their glucose, in insulin resistance, blood pressure, lipid profiles. Um, there are a lot of positives. There's a lot of different indications for these medications. And when used appropriately with incorporating these lifestyle modifications, we see that they can really improve patients' long-term health, but it's not a magic bullet. It's not just about you give the shot once a week and job is done. It's really important for that long-term success that we do that. I know we keep repeating it, but resistance training, adequate protein intake, and that's the best sort of formula that we have for long-term success.

SPEAKER_02 27:57

You've been nodding your head the entire time.

SPEAKER_03 27:59

Yeah, I mean, that I mean, everything that Lisa says is, you know, one of my key takeaways on it, that it's not a quick solution. It's not a set it and forget it. I think the only piece that I'll add is it's intentional planning that that individuals need to do. It's hard work to get resistance training and meal planning or trying to ensure you get enough nutrition in. And so give yourself grace, you know, a little bit at a time. It doesn't have to be, you know, a huge bite of stuff every day, but it's, you know, little, little changes. Is it five minutes of resistance training? Did I get, you know, at least 20 grams of protein in today and then making the adjustments along the way? But intentionality is key.

SPEAKER_02 28:41

Yeah, it definitely definitely is hard, but we will give ourselves some grace when we go through this. Ladies, thank you so much for sharing all of your information with us. It was truly informative and I learned a lot. And remember, viewers, be sure to hit that subscribe button on our channel to keep up with the latest health and wellness information and tips from our experts. You can also find Baptist Health Talk on Apple Podcasts, Spotify, or wherever you listen to podcasts. So you can tune in anytime, anywhere. Thanks for watching and be safe.

SPEAKER_00 29:12

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