There’s a moment I see occurring more and more often.
A woman steps on the scales, sees a number on the scales – a number she’s been working toward for months, and feels flat. She expected that once she felt lighter, she would automatically have more energy. Instead, she feels tired, her legs feel weak on the stairs, and her body looks spongier than it did at a higher weight.
She’s done everything she was told to do. So she can’t understand why reaching her goal feels this way.
What she’s feeling has a clear explanation, and it comes back to the tissue I wrote about last week: muscle.
You’ll recognise this if you’ve been here before
Some women reach a smaller number by cutting back on food. Others get there with a GLP-1 medication such as Ozempic, Wegovy or Mounjaro, which turns appetite down so far that many women eat much less than they realise.
The route is different. But what I see afterwards is remarkably similar.
Arms and legs that look less toned. Skin that seems looser. Energy that hasn’t lifted the way she hoped. A strength that’s slipped away without her noticing until something as simple as carrying the shopping feels harder.
Then there’s the other version of this story…..She lost the weight, held it for a while, then watched the weight creep back. Each time this happens, the weight seems to settle more around the waistline, and each attempt to lose it again feels harder than the last.
Both experiences point to the same thing. When you lose weight, you lose more than fat.
What comes off when the weight comes off
Your body has no way of taking weight off from fat alone. When you eat less than you need, it draws on fat stores, but it also draws on muscle mass too.
Dieting studies have shown this for decades.
When people cut calories without strength training, about a fifth to almost a third of the weight they lose is lean tissue, including muscle.
The effect of GLP-1 medications brings the same trade-off. In the main semaglutide trial, a sizeable share of the weight lost came from lean tissue. Some of that was water and organ tissue rather than muscle. Ultimately, fat came off faster than lean muscle tissue, so overall body composition improved. Which is great! Yet any muscle loss affects our metabolic rate.
In midlife, it matters more than at any other age. As I explained last week, in perimenopause your muscle is already less responsive to the signal to grow. Muscle lost during weight loss is harder to rebuild now than it would have been at 30. That’s why the woman on the scales feels weaker than she expected.
Why the weight comes back, and why it comes back differently
This is the part I most want to impress on you.
Muscle is the tissue that burns energy while you’re resting. When you lose muscle, your body’s metabolic rate or resting energy use drops with it.
At the same time, after weight loss, your body turns up hunger signals and turns down fullness signals to protect itself. This is an ancient survival response.
So ultimately you end up needing less food to serve your metabolic rate yet while feeling hungrier. That’s a hard combination to live with for long.
With GLP-1 medications, the medication holds that hunger response at bay. When the medication is stopped, appetite usually returns, and research shows most people regain a large share of the weight within a year.
What concerns me most as a clinician is that the weight that comes back tends to return more as fat than as muscle. Rebuilding muscle takes a deliberate signal, whereas fat simply needs extra fuel.
So a woman can finish a cycle of losing and regaining at the same weight she started at, carrying less muscle and more fat than before. Her metabolism is slower, her blood sugar is less stable, and the next attempt becomes harder. Over several rounds of yo-yo weight loss, that adds up.
What this means for the years ahead
Everything I wrote about last week applies here. Less muscle means less help managing your blood sugar, a weaker signal keeping your bones strong, less support for your memory and mood and a smaller reserve to draw on in your seventies and eighties.
Weight loss that comes at the expense of muscle can leave you lighter and, at the same time, less resilient. I want every woman to see that trade-off before she starts.
Four things that protect your muscle while you lose weight
Losing weight can be the right decision for your health. If a GLP-1 medication has been prescribed for you, that’s a conversation between you and your doctor, and it can be a useful tool. My focus is making sure the weight you lose is mostly fat, so you come out the other side stronger. I think about it in four parts.
- The pace. The faster weight comes off, the harder it is to hold on to muscle. A steadier pace gives your body the chance to protect what you want to keep.
- The supply. When you’re eating less, every meal has to work harder. Protein matters more than ever, and so does whether your digestion can break it down and absorb it. Many women on GLP-1s eat so little that they fall well short without realising it.
- The signal. Your muscle needs a clear reason to stay. Strength-based exercise tells your body this tissue is in use and worth keeping, even while you’re eating less.
- The plan for afterwards. Most women plan how to lose weight. Very few plan for what happens once they stop, whether that’s the end of a diet or coming off a medication. Supporting your blood sugar, appetite, stress and sleep before you reach that point makes a big difference to whether the weight stays off.
How I work through this with you
I’m a naturopath, biochemist and microbiologist with nearly 30 years in clinical practice. I see weight as one part of a bigger picture that includes your digestion, blood sugar, stress, sleep, and hormones.
Whether you’re dieting, using a GLP-1 or coming off one, I can work alongside the care you already have.
If you’ve reached your goal weight and feel weaker for it, if you’re watching the weight come back, or if you’re about to start and want to protect your strength along the way, I’d love to help. We’ll look at what’s happening underneath and build a plan that leaves you lighter and stronger at the same time.
Teressa,
Naturopath | Clinical Nutritionist | Biochemist
Gold Coast Naturopath, Gold Coast Health, Naturopath Australia, Gold Coast Wellness, Holistic Health, Naturopathic Medicine, Functional Health, Midlife, Personalised Healthcare, Muscle Loss in Midlife
