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How to keep muscle while losing weight on Ozempic or Mounjaro

A big slice of GLP-1 weight loss is lean mass, not just fat. Two habits protect your strength, and the trial numbers are more nuanced than the headlines.

Updated 17 min read31 sources

The short answer

About 25 to 40% of the weight you lose on Ozempic, Wegovy or Mounjaro (Zepbound in the US) is lean mass rather than fat, a share similar to other ways of losing weight.[2, 11, 12, 29] Lean mass is not all muscle, since it also counts water, glycogen (stored carbs) and organ tissue, but the amount is still worth acting on.[11] The first habit that limits it is lifting weights two to three times a week.[4, 11] The second is eating roughly 1.2 to 1.5 g of protein per kg a day if you are older or at risk,[5, 6] though with kidney disease you should ask your doctor first.[18]

This content is for educational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional before making changes to your diet, exercise routine, or supplement regimen.

How much muscle do you actually lose on Ozempic or Mounjaro?

Roughly a quarter to two fifths of the weight you lose on a GLP-1 drug is lean mass, and the rest is fat.[2, 11, 12, 29] A 2026 review pooling results from 20 trials put the lean share at about 25% on tirzepatide (Mounjaro) and about 35% on semaglutide (Ozempic, Wegovy).[29]

That lean share is not a muscle share, though. The trials measured it with DXA, a body scan that splits you into fat, bone and lean tissue, which is roughly everything else. Besides muscle, that lean tissue includes water, glycogen (your stored carbs) and organ tissue.[2, 11] So lean-loss kilos overstate how much actual muscle you lose. Fat goes faster, which means your body composition can even improve while lean kilos drop. In the STEP 1 semaglutide trial, lean mass as a share of total body weight rose by 3 percentage points.[1]

The trials behind the range also report two different numbers, and it helps to keep them apart. One is how much of your starting lean mass you lose, which was about a tenth over 68 to 72 weeks in the two big trials.[1, 2] The other is what share of the total weight lost was lean, and that is where the trials spread out. The people, doses and scans differ too much to rank the drugs, so read the table as a range rather than a league table.

Trial Drug Lean mass change Lean share of weight lost
STEP 1, 68 weeks.[1, 11] Semaglutide 2.4 mg -9.7% about 40%
SURMOUNT-1, 72 weeks[2] Tirzepatide -10.9% about 25 to 26%
BELIEVE, 72 weeks[7] Semaglutide 2.4 mg -7.4% about 24%
BELIEVE, 72 weeks[7] Bimagrumab + semaglutide -2.9% about 8%

BELIEVE reports the fat share of the weight lost (75.6% and 92.2%); the table shows the remainder[7] The bimagrumab combination is not approved, and the last section covers it.

A share on its own says little until you compare it with people who lose weight without the drug. In SURMOUNT-1, lean tissue made up about a quarter of the weight lost on both tirzepatide and placebo.[2] The drug group simply lost far more weight, so it also lost more lean tissue in kilos (about 5.6 kg against 1.2 kg).[2] The 2026 review of 20 trials found the same pattern more widely.[29] The lean share was broadly similar on these drugs and on lifestyle programmes, and lowest when people added strength training.[29]

So the drugs do not seem to strip lean tissue out of proportion to the weight lost, but the amount is still real. Using the trials' lean-mass data, a 2025 review estimated that muscle loss may have reached 10% or more over 68 to 72 weeks, roughly 20 years of ageing.[11] That estimate rests on lean mass rather than muscle measured directly. It also leaves open whether you get weaker, because muscle mass and strength do not always move together.

Is losing muscle on a GLP-1 actually a problem?

Losing some lean mass is expected when you lose a lot of fat. The fat loss itself brings real metabolic benefits, which our guide on GLP-1 and longevity covers. What matters for your future is how much strength and function you keep, and one number on a DXA report cannot tell you that.

A good example of mass and strength moving apart comes from SEMALEAN, which followed about 100 people with severe obesity on semaglutide.[8] Their lean mass fell by about 3 kg by month 7 and then held steady through month 12, yet their handgrip strength rose by about 4 kg.[8] The share with sarcopenic obesity (low muscle and high fat at the same time) dropped from 49% to 33%.[8] They got lighter, lost some lean tissue on paper and got stronger, which is the pattern you want to see.

SEMALEAN had no comparison group, though, so it shows what happened, not what the drug caused.[8] The drop in sarcopenic obesity is also partly built into the definition, which judges muscle relative to body weight, so it improves when weight falls.[8]

Older people with diabetes tell a less comforting story. A 2026 review points to long-term observational studies, which follow people over time rather than test a treatment.[9] In older adults with type 2 diabetes, those studies have linked prolonged semaglutide use to weaker grip and faster sarcopenia, the age-related loss of muscle and strength.[9] The same review stresses that lean-mass loss does not reliably predict what strength will do, so a reassuring scan does not rule out getting weaker.[9]

Those risks are not spread evenly, and three groups have the most reason to watch closely:

  • Older adults, whose muscle reserve is already thinner: strength is worth protecting from 40 on and even more after 65 (our longevity guide for men 40+ puts muscle in that wider picture).
  • Frail people, or anyone at risk of sarcopenia before they start.
  • People losing weight fast, since a bigger, faster loss raises the concern.

Bone belongs on the watch list too, because weight loss on these drugs can cost bone as well as muscle.[19] In the BELIEVE trial, hip bone density fell about 2% on semaglutide 2.4 mg, against about 1% on placebo.[7] Strength training plus a good diet is the advised protection for both.[19]

That training needs a safe start. If you use insulin or a sulfonylurea, a type of diabetes medicine, weight loss plus more exercise can push your blood sugar too low.[19] In that case, and if you have kidney disease,[18] are frail or have osteoporosis, talk to your doctor before you change training or protein. Then start strength training at a level that is safe and tolerable for you,[5] ideally supervised at first.

Strength training: the exercise that protects muscle on a GLP-1

Lifting weights two to three times a week is the best-evidenced way to protect muscle while you lose weight.[4] Most trials used three sessions a week,[4, 10] and guidelines advise strength work for all major muscle groups on at least two days a week.[11] The trials compared lifting with not lifting, so they do not say whether more sessions add more.

The main evidence is a 2025 review that pooled 25 trials in adults aged 18 to 65, comparing strength training during weight loss with dieting alone.[4] Lifting kept more fat-free mass (everything except fat) with moderate certainty, added fat loss with high certainty and made people clearly stronger with low certainty.[4] The effect on fat-free mass was clear in programmes up to about five months but not in longer ones.[4]

Those averages hide a lot of spread, because the trials differed widely.[4] Most were supervised gym programmes and over half enrolled only women, so a single new trial could find a smaller effect on fat-free mass.[4] Trials in older adults on calorie-cut diets point the same way, though. In a review of six such trials, strength training greatly reduced the lean-mass loss that dieting caused.[10] A trial in dieting older adults with obesity adds a comparison with aerobic exercise. Lean mass still dipped a little with lifting, but less than with aerobic exercise alone, and combining the two improved day-to-day function the most.[13]

None of these trials added strength training to semaglutide or tirzepatide, although a trial doing exactly that, with protein, is under way.[31] The closest evidence comes from liraglutide, an older drug in the same class. In one trial that assigned people to groups by chance, those who exercised on top of liraglutide got fitter and climbed stairs faster.[30] The drug alone did not improve fitness, and the exercise mixed cycling intervals with circuit training rather than pure lifting.[30] So the lifting advice is borrowed from diet trials, not proven on these exact drugs.

Borrowed or not, the practical side is simple, and the plan works best when it is boring and repeatable:

  1. Do two to three full-body strength sessions a week.[4, 10, 11]
  2. Hit the big movements: a squat or leg press, a push (like a push-up or press), a pull (like a row) and a hinge (bending at the hips, like a deadlift).
  3. Add a bit of weight or one more rep when a set starts to feel easy. Progression is the active ingredient.
  4. Skip the fancy gym: bands, dumbbells or your own bodyweight all count if you make them hard enough.

Walking is good for your heart (our endurance training guide covers that side), and it can soften lean-mass loss a little. In one diet trial, women past menopause lost less lean mass when they added brisk treadmill walks three times a week.[17] Lifting still does more, because it trains muscle and strength directly. In the trial of dieting older adults, the aerobic-only group lost more lean mass than the groups that lifted.[13] So keep the walks, but do not let them replace the lifting.

Protein on a GLP-1: how much, and how to eat it with little appetite

Protein is the food half of the job. If you are older or at risk of losing muscle, aim for roughly 1.2 to 1.5 g of protein per kg of body weight a day.[5, 6] That figure comes from two expert consensus papers, one by the PROT-AGE group.[5] and one by an ESPEN expert group[6] They set 1.0 to 1.2 g/kg for healthy older adults and 1.2 to 1.5 g/kg for people who are ill or at risk.[5, 6] Both were written for older adults and later applied to GLP-1 users. That makes the numbers a sensible starting point rather than a target proven in people on these drugs.

The big exception is your kidneys. If you have kidney disease or reduced kidney function, agree your protein target with your doctor before you raise it.[18] For adults whose eGFR, the kidney filtering score, is below 60 and who are not on dialysis, kidney guidelines suggest about 0.8 g per kg a day.[18] The same guidelines advise against more than 1.3 g per kg whenever kidney disease is at risk of getting worse.[18] The PROT-AGE paper draws its line further down, naming an eGFR below 30 (not on dialysis) as the point where older people may need to limit protein.[5] Within those limits, the kidney guidelines allow a higher target for older adults with frailty or sarcopenia, which your care team sets individually.[18]

Your body weight is the other catch in the math. If you carry a lot of extra weight, calculating with your current weight overshoots. Guidelines use a lower reference weight instead, such as an "ideal" or "adjusted" body weight, though they do not agree on which one.[11, 19] Ask your doctor or a dietitian which weight to use, then let our protein calculator turn grams per kg into a daily protein target in grams. With kidney disease, that daily target is the number to take to your doctor before you act on it.[18]

The daily target works alongside the lifting, not instead of it, since the two are recommended together and do different jobs.[11, 19] A higher-protein diet on its own helps a little. In a review of 24 short trials, people kept about 0.4 kg more fat-free mass than on a standard-protein diet.[14] So protein supports the lifting rather than replacing it.

Once you have a number, hitting the daily total comes first. Spreading it over the day, at about 25 to 30 g of good-quality protein per meal, is a practical way to get there.[6] Whether timing adds a benefit of its own is not settled.[5]

Getting there is the hard part, because GLP-1 drugs work by dampening your appetite.[19] A few bites in, you may already feel full, so protein rarely happens by accident on these drugs and meals need to be built around it on purpose. A few moves help:

  • Eat the protein first, before the carbs and veg, while your appetite still plays along.
  • Nausea often hits in the morning or after long gaps without food, so small, frequent protein portions usually go down better than one big meal.[19]
  • Keep easy options ready: skyr, Magerquark (German low-fat quark), eggs, tuna or a protein shake.
  • If a full meal feels impossible, a 25 g protein snack still counts toward the daily total.

Tracking your muscle: strength and function before the scale

Strength and function tell you whether lifting and protein are working, and the bathroom scale does not. Our rule of thumb is function before the scale, because the scale lumps fat, muscle, water and food into one number. You could lose 8 kg and be fitter, or lose 8 kg and be frailer, and the scale would show the same.

Two cheap tests tell those two cases apart, and both are easy to find in Germany, Austria and Switzerland:

  • Grip strength: a simple squeeze test on a handheld gauge (a dynamometer), available in many practices and gyms, and the measure SEMALEAN used.[8] You can compare your reading by age and sex with our grip strength calculator.
  • Chair-stand test: stand up from a chair and sit back down as many times as you can in 30 seconds, or time five reps. It is free, repeatable at home and a practical stand-in for leg strength and function.

Body-composition scales that use bioimpedance (BIA) are cheap too: they send a tiny current through you to estimate muscle and fat. Their formulas are known to be unreliable in people with obesity, which is why the SEMALEAN researchers left their BIA data out of the analysis.[8] Use a BIA scale as a rough hint at most, not to tell muscle loss from fat loss.

DXA is the established clinical scan for body composition, splitting you into fat, lean tissue and bone.[8] It estimates lean tissue rather than measuring muscle itself, and in Germany, Austria and Switzerland it is usually self-pay and harder to book. A baseline scan plus one follow-up gives you a clean before-and-after, but you do not need one to monitor well.

Whichever tests you pick, watch the trend over months rather than single snapshots. Choose one strength test and one function test, then retest every couple of months. That habit matters most for older adults with type 2 diabetes, in whom long-term semaglutide use has been linked to weaker grip.[9] If your grip and chair-stand hold steady or improve while the weight drops, you are keeping your strength and function. It does not prove that muscle mass held, since in SEMALEAN grip rose while lean mass fell.[8]

Muscle-sparing drugs: what is coming and what you can get today

No weight-loss drug that spares muscle is available yet. One combination kept far more lean mass on DXA in phase 2, the mid-stage trials that come before the large ones needed for approval.[7] It still lost some lean mass, though, and it is not approved.[7]

Drugs in the pipeline

That combination adds bimagrumab to semaglutide. Bimagrumab is an antibody that releases one of the body's brakes on muscle growth, and the BELIEVE trial tested it with semaglutide in 507 people.[7] By week 72, high-dose bimagrumab plus semaglutide took off about 22% of body weight, against about 16% on semaglutide alone.[7] Lean mass fell by less than half as much on the combination, so far more of the loss came from fat.[7] The table in the first section has the numbers. The week-72 results come from an extension in which people knew what they were taking, since the main readout came at week 48.[7]

Two results cut the other way. At week 48, grip strength on the high-dose combination rose only about as much as on placebo.[7] The combination with the lower 1.0 mg semaglutide dose was the only one to beat placebo on grip.[7] More people also stopped treatment because of side effects on the combinations (5 to 13%) than on placebo (4%).[7] Muscle spasms, diarrhoea and acne were common, and bimagrumab is given as an infusion every 12 weeks.[7] It is investigational, not approved and not standard care.

A second antibody, apitegromab, blocks myostatin, another brake on muscle growth. In a 24-week phase 2 trial of about 100 people on tirzepatide, it kept about 1.9 kg more lean mass than placebo at similar weight loss.[28] Side effects were similar to placebo.[28] It is also investigational and not approved, so both drugs are a future option at best, not something to ask for next month.

Access and costs in Germany, Austria and Switzerland

The drugs you can get today are all prescription-only, and for weight loss most people pay for them themselves. In Germany, the law (§ 34 Abs. 1 SGB V) excludes drugs for weight loss from statutory health insurance.[26] So the GKV, the statutory insurance, will not pay for Wegovy (semaglutide) or Mounjaro (tirzepatide) when they are prescribed for weight loss.[26] You need a Privatrezept (private prescription) and pay the pharmacy price. If you have private insurance, ask your insurer in writing before you start. Self-pay prices as of October 2026:

  • Wegovy pen: about EUR 173 to 278 per four weeks up to the 2.4 mg maintenance dose, and EUR 383.80 for the 7.2 mg dose (four single-dose pens, four weeks).[22, 24]
  • Wegovy pill: EUR 172.73 to 277.60 for 30 tablets, depending on dose.[23, 24]
  • Mounjaro: about EUR 206 to 482 a month depending on dose, per a pharmacy guide as of March 2026; ask your pharmacy for the current price of your pack.[25]

The Wegovy pill has been sold in German pharmacies since 1 September 2026.[24] We have seen no body-composition data for the pill yet, but it contains the same active ingredient, so the same lifting and protein advice applies.

Ozempic is a different case, because it is approved in the EU only for type 2 diabetes.[21] The legal exclusion covers weight loss, not diabetes treatment, so it does not apply when Ozempic or Mounjaro is prescribed for type 2 diabetes.[26] Using Ozempic just to lose weight is off-label, meaning outside its approved use, and not covered.[21, 26] The semaglutide results in this guide's table come from the Wegovy dose of 2.4 mg.[1, 7] Whichever drug you use, buy it on a prescription at a pharmacy: falsified Ozempic pens have already turned up in Germany.[22, 27]

In Switzerland, basic insurance (OKP) does pay for Wegovy and, since 1 January 2026, also for Mounjaro for weight loss, including in people without diabetes.[20] The conditions for Mounjaro are strict,[20]:

  • a BMI of 35 or more, or 28 or more with prediabetes, type 2 diabetes, high blood pressure or high blood lipids
  • prior approval by your insurer
  • a documented diet with a 500 kcal daily deficit
  • prescription and check-ups only by an endocrinology specialist or an obesity centre
  • at least 5% weight loss after 16 weeks (7% if your BMI is 35 or more) and 10% (or 12%) after 10 months, or cover stops
  • three years at most in total, counting any earlier Wegovy or Saxenda

Wegovy is reimbursed too[20] but under conditions of its own that we could not verify, so do not assume they match Mounjaro's. Mounjaro's listing is temporary, until 31 December 2027,[20] so check the current Spezialitätenliste, the Swiss list of covered drugs, with your doctor (as of October 2026). In Austria, ask your health insurer before you start; we could not confirm a general rule for covering the weight-loss use.

Full prices, doses and insurance rules are in our weight-loss jab cost guide. Prices depend on dose and change often, so check a pharmacy quote or the current Lauer-Taxe, the official German drug price list, before you budget on one number.

Frequently asked questions

How do I prevent muscle loss on Ozempic or Mounjaro?

Lift weights two to three times a week with full-body sessions, which is what the trials used and what guidelines advise.[4, 10, 11] Eat roughly 1.2 to 1.5 g of protein per kg a day if you are older or at risk,[5, 6] spread over meals of about 25 to 30 g.[6] If you have kidney disease, ask your doctor before raising protein.[18] Then retest your grip strength and a chair-stand every few months instead of trusting the scale.

How much of the weight you lose on Ozempic is muscle?

Roughly 25 to 40% of the weight lost on GLP-1 drugs is lean mass, and a 2026 review pooling 20 trials put it at about 35% on semaglutide, the drug in Ozempic and Wegovy.[11, 29] In the STEP 1 trial, about 40% of the weight lost was lean tissue.[1, 11] Lean mass on a DXA body scan also counts water, glycogen (stored carbs) and organ tissue, so the actual muscle loss is smaller than that figure suggests.[11]

Is muscle loss a side effect of Ozempic or Mounjaro?

It mostly comes with the weight loss itself: the drugs do not seem to strip lean tissue out of proportion to the weight lost. In SURMOUNT-1, lean tissue made up about a quarter of the weight lost on both tirzepatide and placebo, and a 2026 review of 20 trials found a broadly similar lean share with lifestyle programmes.[2, 29] The amount is still real, because these drugs take off a lot of weight. A review estimated that muscle loss in the big trials may have reached 10% or more over 68 to 72 weeks, though the trials measured lean mass rather than muscle.[11]

Will I get sarcopenia (muscle wasting) from taking a GLP-1?

Not automatically, but older adults should watch for it. Observational studies in older adults with type 2 diabetes have linked prolonged semaglutide use to weaker grip and faster sarcopenia.[9] In SEMALEAN, sarcopenic obesity fell from 49% to 33%, but that study had no control group and its definition scales muscle to body weight.[8] Strength training is the best-evidenced protection, and enough protein backs it up.[4, 14]

Do I need to lift weights on Mounjaro or Wegovy?

Yes. It is the best-evidenced way to protect muscle while you lose weight, though the trials were in people dieting without a GLP-1.[4] A review pooling 25 trials found lifting kept more fat-free mass, added fat loss and made people clearly stronger.[4] Two to three full-body sessions a week is what the trials used, and walking helps your heart but does not replace lifting.[4, 10, 13]

Can you build muscle on Mounjaro?

Direct data are thin: in the big tirzepatide trial, lean mass fell rather than rose,[2] and no trial has shown people building muscle mass on it. Keeping muscle and getting stronger is realistic: lifting during weight loss keeps more fat-free mass and makes people stronger,[4] and in a semaglutide study grip rose by about 4 kg while lean mass fell.[8]

How much protein should I eat while on a GLP-1?

Aim for roughly 1.2 to 1.5 g per kg of body weight a day if you are older or at risk, based on the PROT-AGE and ESPEN papers.[5, 6] If you carry a lot of extra weight, ask which reference weight to use rather than your current weight.[11, 19] Portions of about 25 to 30 g per meal make the total easier to reach,[6] and if you have kidney disease, ask your doctor before raising protein.[18]

Do protein shakes help on a GLP-1?

Yes, as a tool, not a must. With your appetite turned down, a shake is often the easiest way to get 25 to 30 g of protein into one sitting,[6] and skyr, quark or eggs work just as well. The protein itself helps a little: higher-protein diets kept about 0.4 kg more fat-free mass in short-term weight-loss trials.[14]

Is there a weight-loss drug that doesn't cause muscle loss?

Not yet. In a phase 2 trial, bimagrumab plus semaglutide reached about 22% weight loss with about 92% of it from fat, and lean mass fell only about 2.9%.[7] It is not approved, grip strength on the high-dose combination rose no more than on placebo, and it brought its own side effects, so it is a future option at best.[7]

Does losing muscle on semaglutide make me weaker?

Not necessarily in the short term. In SEMALEAN, handgrip rose by about 4 kg while lean mass fell, though that study had no comparison group.[8] In older adults with type 2 diabetes, observational studies have linked longer-term use to weaker grip,[9] so tracking strength matters more as you age.

How can I check if I'm losing muscle instead of fat?

Track strength and function with a grip test and a 30-second chair-stand, which are cheap or free and easy to repeat. A bioimpedance scale is a rough hint at most, because its formulas are unreliable at higher body weight,[8] and a DXA body scan, which splits you into fat, lean tissue and bone, is the best tool you can realistically book, though usually self-pay. If grip and chair-stand hold while the weight drops, you are keeping strength and function; that does not prove muscle mass held, since in SEMALEAN grip rose while lean mass fell.[8]

Is walking enough to keep muscle on a GLP-1?

Probably not on its own. In one diet trial in postmenopausal women, brisk treadmill walking three times a week meant less lean mass lost than dieting alone.[17] But in a trial of dieting older adults, the aerobic-only group lost more lean mass than the groups that lifted.[13] Keep walking for your heart and add two to three strength sessions a week.[4, 11]

Is it safe to eat more protein on Ozempic or Mounjaro if I have kidney problems?

Not without your doctor. For adults with chronic kidney disease whose eGFR, a kidney filtering score, is below 60 and who are not on dialysis, kidney guidelines suggest about 0.8 g of protein per kg a day.[18] They advise against more than 1.3 g per kg when the disease is at risk of getting worse.[18] That can clash with the 1.2 to 1.5 g/kg often advised for muscle, though the same guidelines allow a higher target for older adults with frailty or sarcopenia.[5, 18]

Does Swiss health insurance pay for Wegovy or Mounjaro?

Yes, under strict conditions: Swiss basic insurance (OKP) pays for Wegovy and, since 1 January 2026, also for Mounjaro for weight loss.[20] For Mounjaro, your BMI must be 35 or more (or 28 or more with conditions such as prediabetes or high blood pressure), and a specialist or obesity centre must prescribe it.[20] You must also reach set weight-loss targets, cover stops after three years at most, and the listing runs until 31 December 2027.[20] Wegovy has conditions of its own, so check the current status with your doctor (as of October 2026).

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