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Is Weight Loss–Induced Muscle Mass Loss Clinically Relevant?
abstract
This abstract is available on the publisher's site.
Access this abstract nowObesity has adverse effects on nearly every organ system. Weight loss is the primary treatment goal of obesity management because it improves or resolves obesity-related complications. The therapeutic effect of weight loss is proportional to the relative decrease in body weight. For example, 5% to 10% weight loss in people with type 2 diabetes improves glycemic control, whereas 15% to 25% weight loss can achieve diabetes remission. The ability to achieve a large amount of weight loss has typically been limited to bariatric surgery. However, the advent of glucagon-like peptide-1 (GLP-1)–based antiobesity medications has established a new era in the pharmacological therapy of obesity, with mean weight loss of 15% to 25% at 1 to 1.5 years.
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Is Weight Loss-Induced Muscle Mass Loss Clinically Relevant?
JAMA 2024 Jun 03;[EPub Ahead of Print], C Conte, KD Hall, S KleinFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
The question raised by this article pertains to whether muscle loss associated with weight loss is clinically relevant in individuals with obesity. Individuals with obesity have a higher total muscle mass (on average) than those of normal weight, but it tends to be of poorer quality.1 The authors note from previous obesity trials that weight loss may improve that quality, and loss of muscle mass constitutes a relatively small proportion and ultimately may not be clinically relevant in terms of outcomes.1 Supporting this perspective, a recent weight-loss trial using the GLP-1 receptor agonist liraglutide showed that exercise helps maintain bone mass but not muscle mass.2 Conversely, in adults, sarcopenia is a strong predictor of mortality, particularly in older adults.3 As we age, we tend to lose muscle mass as part of normal physiological changes, and older adults are at higher risk of sarcopenic obesity, which itself is linked to higher all-cause mortality.4 Sarcopenia is also associated with higher levels of osteoporosis,5 and significant weight loss (>20%) is linked to an increased risk of fragility fractures.6 I agree with the authors on the need for further investigation into novel anabolic agents such as bimagrumab.7 However, regular exercise for the goal of maintaining muscle mass (which should at least in part be weight-bearing) has important benefits not only on body weight, but also on energy expenditure, insulin sensitivity, muscle preservation, and fall and fracture risks, which should not be overlooked.8-11
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