[mikenew]

That is absurd. Muscle mass is a huge predictor of mortality and anyone who isn't actively strength training and maintaining higher levels of muscle would see a health benefit by doing so. The idea that an overweight person has "too much muscle" is nonsense.

The side affect of muscle loss from these glp-1 agonist drugs is a serious downside that everyone should be aware of and try to mitigate if they choose to take them.

[freedomben]

> The idea that an overweight person has "too much muscle" is nonsense.

I think you've misunderstood GP. He's not saying they have too much muscle when they're overweight. He's saying that take that exact same amount of muscle, subtract a ton of fat from their upper bodies, then they have "too much muscle" as typically needed for their body mass. I don't agree with their phrasing, but the point isn't "nonsense."

[n4r9]

> then they have "too much muscle" as typically needed for their body mass

It's a leap to suggest that it's "good" to lose this muscle mass. If you're obese then it's good to lose fat. It's even better to do so while maintaining muscle mass.

[hombre_fatal]

Yeah, but whether you do resistance training while losing weight so that you have proportionally extra muscle mass than you had when you were overweight has nothing to do with the GLP-1 drug.

Every time GLP-1 drugs come up, the convo splinters off into topics that have nothing to do with anything unique to the drug. Now we're just talking about general weight loss and that it's good to exercise. Which is a trivial claim.

[IshKebab]

Yeah that's obviously better. They really meant it's "not bad" rather than "good".

When people read "muscle loss" they think "oh it's going to make me weak and feeble".

[cthalupa]

The problem is it is bad. People aren't just losing a proportional amount of muscle to fat mass to keep a good ratio - rapid weight loss is more catabolic towards lean body mass than it is with slower weight loss.

And most obese people are below optimal levels of total lean body mass overall even before this - their leg muscles being larger than an untrained person of the same height and an average weight does not mean that their leg muscles are of optimal size, much less the rest of their body.

Sarcopenia is a real risk for any obese person who is rapidly losing weight and GLP-1s are no exception.

[stavros]

Well, no, but I like how muscular I look (even with the extra weight). I wouldn't want to look skinny and lose the weight lifting gains.

[mikenew]

I understand the point. Mine is that an ordinary untrained person will see health benefits and a statistically longer life from more muscle. An overweight person would have more muscle than their non-overweight counterparts (mostly localized to the legs, not upper body), and that is the one and only positive of being overweight. Willfully throwing that away will harm your health, full stop. The muscle loss problem with these drugs is talked about a lot because it is in fact a problem. Not because the medical field is mistaken in thinking it's a bad thing.

[Retric]

There’s negative cardiovascular effects from excess muscle just as with excess fat.

Normally that’s offset by the health effects of the exercise required to gain and maintain them as well as the lack of medical conditions that prevent exercise etc. But a fat person losing weight should inherently lose muscle mass long term assuming no changes to lifestyle.

[cthalupa]

This is one of those statements that is technically true but not particularly relevant. Obese people are almost never at a level of lean body mass that they would overall be at a good amount of muscle even for a healthy total weight, and rapid weight loss has consistently been shown in studies to reduce more lean body mass than slower weight loss.

Getting to the same level of additional weight from muscles as there is from fat is also incredibly difficult. The average 5'8 person not utilizing AAS would take years of dedicated training, dialed in diet and recovery, etc., to get to 200lb at 15% bodyfat. People get there much faster and much easier putting on fat.

[Retric]

What’s relevant is subjective. I’ll agree it’s far from as important as obesity, but the point is some of this adaptation is good.

As to loss of muscle mass from rapid weight loss, that’s very true but slightly overstated as regaining muscle can occur ~10x as fast as it takes to grow it in the first place. Someone without a significant calorie deficit barring nutritional deficiency or other impediment will regain whatever muscle mass is required for their lifestyle quite quickly. However, people don’t train with weighted vests as among other things it targets the wrong muscle groups.

[cthalupa]

>muscle mass is required for their lifestyle

The problem here is that the overwhelming majority of people that need GLP-1s have lifestyles that are not conducive to health and have less muscle mass than would be healthy to begin with.

Which is what has me so confounded by this claims - these people already have less muscle than they should for optimal health. Losing any is a significant issue. And without lifestyle intervention, they're not going to regain any of that lost muscle.

GLP-1 drugs are phenomenal and a huge win for health outcomes. But that doesn't mean we shouldn't be telling people the truth about their downsides and what they need to do to counteract them.

[obvi8]

I was looking for this comment! Not a doctor, but as I understand it muscle is roughly equivalent to fat as far as your heart’s workload is concerned. I thought I also read that muscle movement helps with blood return.

[genewitch]

Muscle movement is also necessary for the limbic system to function.

[Retric]

Limbic system is unrelated to muscle movement.

Movement is required for the lymphatic system to function, excess muscle volume doesn’t help.

[hombre_fatal]

Your complaint doesn't make sense to me. The negative health impact of being obese isn't equalized by having a little more muscle mass.

Also, if this is your stance, then GLP-1 is a red herring because you have the same issue with weight loss in general. Weight loss, without increasing resistance training, leads to muscle loss.

[JohnMakin]

Yea what you're replying to is just pure fat-logic that isn't really backed by science. You will lose muscle from calorie restriction - that isn't really in doubt by anyone. However, when cutting weight, you can do a routine that maintains/builds muscle as you cut, to reduce the effect. A body with more lean muscle mass will be able to keep weight off for longer - this has been known, settled, and accepted in weight loss and fitness science for decades now. I've never heard anyone, anywhere posit that muscle loss is good - and would love to see a source, so I can laugh at it.

One insidious thing with these GLP1 drugs, is that they also seemingly affect muscles like the heart. I would not be willing to take one unless the risk of me carrying my weight far outweighed (no pun intended) the risk of the side effects. However, a lot of people seem to be treating it as some kind of miracle fad diet drug, which is concerning.

It also has other side effects like reduced elasticity on skin, etc. I suspect we'll see longer term issues in the next decade from these drugs, and I'm glad alternatives are being explored.

[crazygringo]

> Yea what you're replying to is just pure fat-logic

I can't even imagine what that's supposed to mean.

> However, when cutting weight, you can do a routine that maintains/builds muscle as you cut, to reduce the effect.

I literally talked about staying physically active.

The point is, you're going to have however much muscle your workouts and physical activity build/maintain. And you're going to lose whatever extra muscle isn't needed in your workouts. And that's fine, because you probably want well-balanced strength rather than legs that can carry around 300 lbs all day long.

None of this has anything to do with weight loss, except that simply walking around and daily movement becomes less of a workout as you lose weight because you're moving less mass. But it's not the weight loss directly that makes you lose muscle (assuming you're eating protein), it's the reduced physical strain because you weigh less so you're not needing those muscles. Do you get the distinction?

You don't need to work out even more to "reduce the effect" as you say. There's no effect. There's just working out to have whatever muscles you want. Weight loss will never lead to losing the level of muscle you need for your workout.

[sn9]

The reason you want to keep all your muscle on a cut is because that means a higher proportion of the weight that you do lose will be fat tissue.

This is the strictly superior outcome.

[crazygringo]

If you're "cutting" as part of bulking and cutting, then obviously.

But if you're going from obese to healthy, then your goal isn't to retain all your leg muscle, that's absurd. Your goal is to get to a healthy weight with overall balanced healthy muscle -- not disproportionately large legs.

Nothing is "strictly superior". What is best depends on what your goals are. Bodybuilding and not being obese any more involve wildly different measures of success.

[cthalupa]

If we didn't see tons of people reaching their "target weight" on GLP-1 drugs while having unhealthily low levels of lean body mass, you might have a point.

But that is what we do see. I'd argue that they're still in a better place than they were before, and we know that muscle that has been lost recently grows back very quickly when exposed to stimulus and adequate protein and rest, so I absolutely am a full believer in GLP-1 medications.

But if everyone on GLP-1 meds were keeping up with their protein and resistance training, even leg day, there would be very very few that had huge legs. That one portion of their body might be, on average, more muscular than a totally untrained individual, but it's not like being fat is the equivalent of a low bf% bodybuilder when it comes to lower body muscle mass. A formerly 300lb person dropping down to 180 with average genetics is almost certainly going to have smaller legs than someone who has been lifting for a year at the same height/weight.

[sn9]

No this is absurd.

The goal for anyone obese is to lose as much fat as sustainably possible.

For any given rate of weight loss, losing a higher proportion of body fat is always better.

This notion of "balanced" healthy muscle is one you've made up that no one else thinks of. I've been on fitness forums for well over a decade and have literally never seen a single case of this.

[crazygringo]

> The goal for anyone obese is to lose as much fat as sustainably possible.

Correct.

> For any given rate of weight loss, losing a higher proportion of body fat is always better.

That is in direct contradiction to your previous sentence. No, losing the higher absolute amount of body fat is better. While being sustainable healthy.

> I've been on fitness forums for well over a decade and have literally never seen a single case of this.

You may be on the wrong forums then. Most forums don't think all your days should be leg days.

[JohnMakin]

> I can't even imagine what that's supposed to mean.

Where are you getting your information from?

[cma]

Don't you also need a bigger heart when you gain weight and not need as big of one at less weight? Liposuction and amputations can also result in muscle loss in the heart from it having less work to do.

[badosu]

You don't want to have too much hypertrophy in the heart for sure. My understanding though is that it's very hard (almost impossible?) for it to be a problem without exogenous hormones, or some other condition that allows you to accrue an abnormal amount of muscle mass (e.g. myostatin defficiency).

Edit: I mean someone with a healthy fat percentage body composition. Of course having to pump blood to a 300lb-140kg body is problematic for the heart, be it a mostly fat or mostly muscle body composition. My point is it's just much easier to be fat enough for it to be a problem than muscular enough without exogenous hormones or an abnormal condition.

[cthalupa]

Yeah, LVH is the big deal there in both cases.

Telmisartan, an ARB generally used for BP management, can actually reverse LVH to a significant degree over time, though. Popular for bodybuilders on large quantities of AAS for that reason.

[Izkata]

> One insidious thing with these GLP1 drugs, is that they also seemingly affect muscles like the heart.

Okay so I don't know where I picked this up - it was a decade or more ago - but I always thought the problem was losing weight too fast is what causes bad muscle loss such as from the heart, or from leg/other muscles beyond what's no longer needed from the weight loss. Something like, you're starving yourself so your body starts drawing energy not just from your fat but from anywhere it can.

[cthalupa]

The idea that people on GLP-1s shouldn't be trying to preserve (or indeed build) as much muscle mass as they can is absurd. It is more important than ever to perform resistance training and make sure you are getting adequate protein.

But this isn't anything special about GLP-1s - the same is true for any sort of rapid weight loss approach, be it diet, GLP-1, lap band, whatever.

And we see improved cardiovascular outcomes independent of weight loss for people on GLP-1 drugs in widespread clinical trials, vs. one mechanistic in vitro study showing loss of heart muscle cells.

[s1artibartfast]

There is a huge conflation of cause and effect with respect to muscle mass and longevity.

Low muscle mass is associated a broad swath of illnesses, low activity, and generally poor health.

Muscle mass's power as a predictor is not the same as it's utility as an intervention.

[naasking]

As long as you're not using exogenous hormones, muscle mass can only be achieved with exercise that builds or preserves muscle. I'd say that's a pretty good predictor against frailty, which is strongly associated with mortality among the elderly.

[inglor_cz]

True, but frailty in the old age has a reason that cannot fully be mitigated with exercise: depletion of stem cells. The same mechanism will make our blood vessels thin and prone to bursting etc.

[s1artibartfast]

Exactly my point! you have a chain of 3 associations right there. One is nearly tautological and another has backwards causality. Correlation =/= causation.

Something being a good a good predicative indicator does not mean it is an effective intervention.

[naasking]

There is no backwards causality in the implication that building or preserving muscle that would otherwise be lost can prevent or delay frailty, nor is it backwards to imply that frailty can lead to death (from falls, disease, etc.). I really don't understand what you're trying to say.

[sn9]

"Muscle" isn't an intervention.

"Building muscle" is an intervention and has extremely well-documented mechanisms that have a causal role in improving health.

[cthalupa]

Muscle actually is an intervention for one of the biggest risk factors in metabolic syndrome - insulin resistance.

Muscles use glycogen. They use more glycogen when you're doing the sort of thing that builds muscle, so of course it's even better there, but someone who just genetically puts on more muscle at the same level of activity as someone who puts on less will still use more blood sugar for their muscles, and thus be less likely to increase their insulin resistance.

[sn9]

Ok how do you "intervene" with muscle? Do you surgically transplant it?

It's a thing that exists. Genetic differences are not interventions. Those are also simply things that exist.

An intervention is a change in treatment or behavior that induces a change with effects we want.

Differences between individuals are not interventions.

The intervention of interest is building muscle through strength training.

[inglor_cz]

"The idea that an overweight person has "too much muscle" is nonsense."

Our bodies like to have a balance of everything.

"Muscle mass is a huge predictor of mortality"

In biology, most such predictors work only up to a point. Massively muscular people don't live to be 120. Bodies don't work in a straightforward fashion, and there are other effects to consider. For example, activation of the mTOR pathway, associated with tissue growth, is associated with shorter lifespan, and mTOR inhibitors like rapamycin seem to be modestly prolonging lives of many species.