Your Maintaining Mass While Losing Weight:

The Why, What and How!​

Introduction: Weight loss drugs such as Semaglutide and Tirzepatide have allowed my patients to see more weight loss than in the past.   While the weight loss advantages of these medications is notable, there is a concern about loss of muscle mass (MM).  Let’s talk more about why this is important, how we can track it, and how we can preserve and even build muscle mass throughout the body remodeling these medications cause.

Why Is Muscle Mass Important? ​

Muscle Mass (MM) plays a crucial role in metabolic health, physical functioning, and overall quality of life. ​ You naturally loose about 5% of your MM per year, which can leave you dangerously weak in your more mature years.  This loss of MM is associated with a number of disease conditions and injuries.  Conversely, improvements in muscle mass are associated with better health.  That means our goal in weight loss should be not only weight loss but preservation or even increasing your muscle mass. ​ Preserving and enhancing your MM is worthwhile goal throughout your health journey, and particularly during periods of weight loss. ​

Measuring Muscle Mass: ​

There are several methods measuring MM, including body composition assessment (BCA) and strength assessment. ​ While BCA provides accurate measurements of adiposity, it does not directly measure MM. ​ Hand grip strength measurements have been recommended as a cost-effective and clinically relevant way to assess MM. ​ Additionally, sitting-rising tests or chair stand tests can be used to evaluate lower extremity strength. ​

Preserving Muscle Mass: ​

To preserve MM while taking weight loss drugs, it is crucial to follow these strategies: ​

1. Dietary Protein: ​ Consuming enough protein daily is essential for preserving MM. ​ Several studies and practical observations suggests that a high-protein diet, with intake greater than 1.5 grams of protein per kilogram of body weight per day (g/kg/d), is required for preservation and enhancement of MM. ​ This is often quite a bit more protein than is in your typical diet, so protein supplementation is often needed to reach this target. ​I have written about this in more detail here.  How do you calculate your target? For most patients seeking to lose weight and for those seeking increase MM, you can calculate your daily protein intake goal by multiplying your ideal body weight in kilograms by 1.5.  (Your body weight in kilograms is about half of your body weight in pounds). Ideal body weight can be calculated here.  Using this calculator, I recommend using the ideal body weight value from the Peterson formula.
2. Resistance Training: ​ Muscle exercise aimed at increasing muscle strength is called resistance training.  This type of training (as distinct from endurance training) is a powerful driver of maintaining and building MM.  Several studies indicate that the minimum amount of resistance exercise is twice a week, targeting all major muscle groups. ​ Each session should consist of 8-12 repetitions for each exercise and last for a total of 60 minutes per week. A popular strength program called “body pump” can be found at YMCA and other community exercise facilities and can even be done at home using your phone and a few light weights.  This exercise program works all major muscle groups.  When you are at home or at work and have access to a stairs, I recommend doing single step step-ups, 20 repetitions per leg, repeated in 3 sets, two times per week.  This exercise session can be completed in less time than a standard work break, but don’t forget to take your water bottle for a chance to boost your water intake during the workout.  Importantly, the handrail will provide a source of stability and no special equipment is needed for this exercise.  You will be shocked at how your leg strength increases with this exercise!
3. Monitoring and Assessing Progress: Regular monitoring of body composition and strength is helpful to track changes and adjust the weight loss plan accordingly.  In the Wellivery program, I aim for gradual weight loss so I am far less concerned about measuring changes in your body composition.  You will notice these changes yourself (waist and hip size, for example) and can report them to me.  I am more interested in ​ repeated assessment of muscle strength which reflects the effectiveness of your resistance training. ​ In the Wellivery program, I use the simple 1 minute timed sit-to-stand-test in which you count how many times you can go from sitting to standing in 60 sec.  This test can be done at home and as your legs get stronger, you will see the number of sit-to-stand transitions increase.

Conclusion:

While weight loss drugs offer new possibilities for achieving significant weight loss, it is crucial to prioritize the preservation of muscle mass and strength. Protein consumption and regular resistance training are key strategies to achieve this goal. ​ At Wellivery, these strategies are built into your weight loss plan and regular monitoring of strength is used to track your optimal outcome. ​