Integrating functional strength training into a GLP-1 weight loss plan could mitigate the risk of sarcopenic obesity and bone density loss.  

For many patients with obesity and/or type 2 diabetes, the clinically significant weight loss associated with GLP-1 medications like Ozempic and Wegovy^1,2  is not without challenges. While the GI side effects of GLP-1 medications have garnered substantial attention, there are two other considerations that also warrant attention, namely sarcopenic obesity and bone density. Integrating functional strength training into a GLP-1 weight loss plan could mitigate the risk of sarcopenic obesity and bone density loss.

Sarcopenia and Sarcopenic Obesity

Sarcopenia, first introduced in 1997³, is most commonly associated with age-related skeletal muscle mass loss and a decrease in muscle strength, though consensus on its definition is still needed.⁴ Sarcopenic obesity is characterized by the co-presence of sarcopenia and obesity, as measured by DXA.⁵ Muscle mass and bone density are known to be correlated⁶, but perhaps more interestingly is that exercise is also an integral part of this relationship. Exercise increases muscle mass and improves bone density.

GLP-1 Agonists and Muscle Loss and Bone Density

The empirical evidence on the role of GLP-1 RA medications on loss of muscle mass and bone density is still mixed. For example, the STEP 1 trial found that roughly 40 percent of the total weight lost by participants was from lean mass. The SURMOUNT-1 tirzepatide study found that lean mass decreased by between 10-11 percent. While some proportion of lean mass loss does occur during active, medically-induced weight loss, the exact relations between GLP-1 agonists and muscle loss is still not clear.⁷

A recent randomized, placebo-controlled, double-blind, phase 2 clinical trial examined the effects of once weekly semaglutide 1.0 mg on bone formation in adults with diabetes.⁸ Participants were 64 adults who had an increased risk of fracture based on a T-score < – 1.0 at the total hip or lumbar spine. The outcome measure was changes in plasma (P)-PINP at 52 weeks from baseline. No changes in baseline were observed in baseline between groups. The semaglutide group had higher plasma levels of bone resorption than the control group. The authors note that the increase in bone resorption in the semaglutide group could be explained by the weight loss. The semaglutide group displayed lower lumbar spine and total hip areal bone mineral densities after 52 weeks. Semaglutide did not increase bone formation based on the bone formation marker (P)-PINP.

Maintaining muscle mass and bone density are important because they can mitigate the risk fractures, promote quality of life, and support participation in daily activities.⁶ Functional strength training, exercises that build muscle groups implicated in daily activities like carrying groceries, getting in and out of a vehicle, getting up from a seated position without assistance, climbing stairs, or walking, could help GLP-1 patients (particularly patients 50 or older) mitigate the risks of muscle mass and bone density loss.

Functional Strength Training

Functional strength enhances strength, flexibility, and balance, each of which is implicated in even the most presumptively simple daily activities like walking, climbing stairs, and getting into and out of a vehicle. Functional strength training helps build muscle mass and support bone health. While resistance training and aerobic exercises have been identified as part of a well-rounded weight loss program, functional strength training offers adults another option to build and maintain muscle mass and preserve bone density.⁹  Functional movements involve multiple planes and muscle groups, relying on compound movements and working more muscle groups simultaneously. Functional movements (e.g., squats, lunge, leg raises) can mitigate functional deficiencies later in life while also providing more immediate benefits.

A recent study included 46 adults who were randomly assigned to a functional strength training group (n = 26) or a traditional strength training group (n = 20).⁹ Pre and post intervention assessments of functional movement, balance control, and anthropometry were taken. Each group participated in 24 training sessions, three days per week across eight weeks. Significant improvements in the functional strength training group were observed across BMI, body fat and body mass.

Implications for Clinical Practice

Functional strength training is novel option for integrating exercise in medically-supervised and/or GLP-1 patients’ weight loss program. Functional strength training builds and preserves muscle mass, which helps preserve bone density. Functional strength training offers the added benefit of improving balance while also helping patients perform daily activities, which is especially important for older patients.

Health care providers should consider working collaboratively with patients to implement sustainable lifestyle changes can help them achieve long-term, sustainable weight loss. Part of this treatment program could include Low Calorie (LCD) or Very Low Calorie Diets (VLCD) supported with scientifically formulated meal replacements to ensure nutritional needs are being met.

Source(s):

1 Clinical insight on semaglutide for chronic weight management in adults: Patient selection and special considerations
2 Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over
3 Sarcopenia: origins and clinical relevance
4 Epidemiology of sarcopenia among the elderly in New Mexico
5 Body composition in healthy aging
6 Correlation of muscle mass and bone mineral density in the NHANES US general population, 2017 – 2018
7 Evidence on GLP-1 drugs and muscle loss remains murky
8 Once-weekly semaglutide versus placebo in adults with increased fracture risk: A randomized, double-blind, two center, phase 2 trial
9 Effects of functional strength training on functional movement and balance in middle-aged adults

About the Author: Dr. Dawn M. Sweet has over 20 years of experience in the field of communication. Dr. Sweet has given several invited talks to and workshops for academic and private sector audiences on the role of nonverbal and verbal communication in achieving positive outcomes and mitigating bias. Her research has been published in several top ranked peer-review journals, and it has been featured on NPR’s River to River / All Things Considered, Buzzfeed, and Science Daily. Her research has also been used to inform expert testimony.

About Robard: Robard Corporation’s medical obesity treatment programs and scientifically-designed nutrition products have been utilized by physicians, surgeons and hospitals across the United States to successfully treat patients living with obesity. To learn more about us and how we can help your practice and patients, visit us online at www.Robard.com, email us at info@robard.com, or call (800) 222-9201.