Why weight loss medications aren’t enough

There are certainly a lot of positive studies coming out about weight loss medications in development. For example in a phase II trial, retatrutide, a triple combination therapy lead to an AVERAGE of almost 25% weight loss in people who were able to tolerate the side effects at the highest dosage. This is fantastic news - we are at the level of weight loss seen with some types of bariatric surgery!

As excited as I am about these medications leveling the playing field for patients who struggle with their genetics and environment and giving them a chance to lose weight and keep it off, I am very concerned about muscle loss.

Based upon the DEXA scan results of patients in the Weight and Lifestyle Management Program at Cleveland Clinic Canada, we have found that people can lose anywhere from 0% to >40% of their weight from muscle mass. That’s a lot of variability!

Our preliminary data points towards several factors protecting against muscle loss:

1) Following up with a certified bariatric educator regularly.
2) Obtaining adequate protein intake.
3) Increasing activity and exercise levels.

Those that are able to implement these three steps are able to maintain more muscle mass than those who are not, regardless of whether or not they use a weight loss medication.

In our program, those taking anti-obesity agents such as liraglutide, semaglutide and buproprion/naltrexone do lose greater amounts of weight on average than those not taking medications. As more agents become available in the near future, we will need to continue to make sure we best guide patients on how to retain as much muscle mass as possible.

Learn more about retatrutide here: https://www.nejm.org/doi/full/10.1056/NEJMoa2301972