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From 2 episodes

How do I know if I'm losing fat or muscle on a GLP-1?

Answered by Nikkiey Stott and her guests · Updated

The short answer

The scale can't tell you, so track other markers. Nikkiey says to watch your strength numbers, take consistent progress photos and measure your waist, hips, arms and thighs about once a month. If strength drops or measurements stall while the scale falls, you may be losing muscle. DEXA or InBody scans show lean versus fat mass.

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  1. Nikkiey on why the scale can't tell you if you're losing fat or muscle on a GLP-1

    Plays from 14:03 · Ep. 403: How to Look Toned on a GLP-1, Not Just Smaller

  2. Why Nikkiey says DEXA or InBody scans before, during and after a GLP-1 are non-negotiable

    Plays from 23:30 · Ep. 358: Do GLP-1s Cause Muscle Loss in Women Over 40?

  3. How monthly waist, hip, arm and thigh measurements reveal muscle loss

    Plays from 15:41 · Ep. 403: How to Look Toned on a GLP-1, Not Just Smaller

  4. Nikkiey on estimates that up to 40% of GLP-1 weight loss may be muscle

    Plays from 6:16 · Ep. 358: Do GLP-1s Cause Muscle Loss in Women Over 40?

The full answer

This matters more than most women realize. On Ep. 358, Nikkiey points to clinical analyses estimating that up to 40% of the weight lost on GLP-1 medications can come from lean muscle mass rather than fat. In real numbers, a woman who loses 30 pounds could be losing up to 12 pounds of muscle. On Ep. 403 she adds that the scale is almost guaranteed to go down on these medications, but it can't tell you whether you're losing fat, muscle or both. Without that information, you have no way of knowing whether your strategy is working.

On Ep. 403, Nikkiey lays out what to track instead:

  • Strength: if what you can lift holds or climbs while you lose weight, you're preserving muscle. If it drops along with the scale, muscle is being lost and your approach needs adjusting.
  • Photos: same light, same spot, in the morning before you eat and after you use the bathroom. You're the only one who has to see them.
  • Measurements: waist, hips, arms and thighs, about once a month. If they shrink as the scale drops, your body composition is improving. If they stay the same while the scale drops, you may be losing muscle.

For a clearer picture, Nikkiey calls body composition testing a non-negotiable on Ep. 358. She suggests pushing for DEXA scans or InBody measurements that show lean mass versus fat mass at baseline, throughout your time on the medication and after you stop. Your prescribing doctor is a good person to ask about arranging these.

If the signs point to muscle loss, that's not a failure on your part. It's information that the plan needs to change. On the same episodes, Nikkiey stresses strength training, since she says cardio doesn't send muscle the signal it needs, and making protein the first thing you eat in your first meal.

From Nikkiey Stott and WarriorBabe's coaching. For education, not medical advice: talk to your doctor about your own health.

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    Do GLP-1 medications cause muscle loss?

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