How To Avoid Ozempic Butt

A study published in Nature Medicine made headlines last week for all the right reasons, and a few of the wrong ones.

Researchers found that a new investigational drug called apitegromab, when taken alongside the weight loss medication tirzepatide (sold as Mounjaro), helped people retain significantly more muscle mass during weight loss.

Around 55% more lean mass preserved compared to those who didn't take it.

The BBC covered it. Social media ran with it. And the reaction from most people was some version of: "Great, they're refining the Ozempic journey."

But I want to have a slightly different conversation. Because I think the way this story is being told is missing something important.

First, Let's Understand the Actual Problem

GLP-1 medications (Ozempic, Wegovy, Mounjaro), work by suppressing appetite aggressively.

They make you feel full faster and for longer, which means you eat substantially less, which creates a significant calorie deficit, which leads to weight loss.

That part isn't controversial. These drugs are genuinely effective for weight reduction, and for people with clinical obesity or serious metabolic conditions, they can be life-changing.

But here's the issue that the Nature Medicine study puts into sharp relief.

When you create a large calorie deficit (through any method, not just medication), your body doesn't exclusively burn fat. It also breaks down muscle tissue for energy.

The researchers found that in people taking tirzepatide without the new drug, around 30% of their total weight loss came from lean mass, meaning muscle, not fat.

Thirty percent.

That's not a minor side effect.

Muscle mass is directly linked to your metabolic rate, your insulin sensitivity, your strength, your long-term functional independence, and, as two studies I've covered recently showed, your risk of dying early from cardiovascular disease and neurological conditions.

Losing significant amounts of it isn't just the cosmetic problem of wanting to know how to avoid "Ozempic butt".

It's a genuine health problem.

So the pharmaceutical response has been: let's develop another drug to fix that.

And that drug, apitegromab, works by blocking myostatin, a protein involved in muscle breakdown.

In the trial, people who took it alongside tirzepatide lost only 14.6% of their weight from muscle, compared to 30.2% in the placebo group.

A meaningful difference.

The science is interesting. The drug appears to work. And for certain people, it may well be the right tool.

But I want to ask a more fundamental question.

Why Is the Muscle Loss Happening in the First Place?

The answer is straightforward.

Because a large, aggressive calorie deficit done without adequate protein intake and resistance training, is the environment in which muscle breakdown occurs.

This isn't unique to GLP-1 medications.

It happens with crash diets. It happens with extreme calorie restriction of any kind.

The drug isn't causing the muscle loss directly, the large deficit it creates is.

And here's the thing. We already know how to significantly reduce muscle loss during a calorie deficit. It's not new science. It's not controversial. It's not experimental.

You do three things:

1. Create a moderate calorie deficit, not an aggressive one.

Rapid weight loss accelerates muscle breakdown.

A slower, more controlled deficit, typically 300 to 500 calories below maintenance or ~10%, allows your body to preferentially burn fat while preserving lean mass.

The dramatic deficits created by high-dose GLP-1 medications push many people well beyond this.

2. Prioritise protein intake.

Research consistently shows that 20 to 40 grams of protein per meal supports muscle preservation during weight loss.

Higher overall protein intake, roughly 1.6 to 2.2 grams per kilogram of body weight per day, is the most evidence-based nutritional strategy for holding onto muscle while in a deficit.

Protein is also the most satiating macronutrient, which means it reduces hunger naturally helping make adherence to a calorie deficit slightly easier.

3. Do resistance training consistently.

Strength training sends a direct signal to your body to maintain muscle tissue.

It doesn't need to be extreme. Two to three sessions per week covering the major muscle groups is enough.

The British Journal of Sports Medicine study I covered recently showed that 90 to 120 minutes of resistance training per week was sufficient to significantly reduce mortality risk.

That same training volume is also what protects lean mass during weight loss.

These three things, moderate deficit, higher protein, and resistance training, are what the body needs to lose fat without losing muscle.

They work whether you're on medication or not. And critically, they're what the GLP-1 guidance already recommends alongside the medication.

The problem is that recommendation is often buried in the small print and isn't made explicit.

In fact, I've heard significantly more stories of consultations ending in recommendations of upping the dose for quicker weight loss, than in recommending more protein and resistance training to mitigate against muscle loss.

My Professional Take After 20 Years of Coaching

I want to be clear: I'm not anti-medication.

These drugs exist for a reason, and for people with serious obesity or complex metabolic conditions, the risk-benefit calculation is very different to what I'm about to say.

But a significant proportion of the people now using GLP-1 drugs aren't in that category.

They're slightly overweight. They've tried a few diets. They're frustrated. They're busy and running on fumes. And they've reached for a pharmaceutical solution before genuinely, consistently applying the lifestyle fundamentals that would get them the result they want, without the side effects, without the cost, and without the need for a second drug to manage the first one.

And it's understandable, but I'm not convinced it's done while being fully informed of the big picture.

A course of Ozempic costs hundreds of pounds a month.

A good personal trainer (hi) costs a fraction of that.

And yet I regularly speak to people who have spent money on the jab but haven't spent sustained time on the basics.

The three things I just listed, a moderate deficit, higher protein intake, and resistance training, are not complicated.

They don't require perfection. They require structure and consistency. And the evidence base behind them is far more extensive than a phase 2 trial of 102 people.

Here's the question I'd genuinely encourage anyone considering a weight loss jab to ask themselves honestly:

Have I consistently, for at least twelve weeks, eaten in a moderate calorie deficit with adequate protein and trained with weights two to three times per week?

Not perfectly. Not obsessively. Just consistently.

If the answer is no, that's where I'd start.

Or more specifically, I'd start here.

What This Means Practically

If you are currently on a GLP-1 medication, or considering one, the research is clear about what you should be doing alongside it:

Protein first. Aim for a palm-sized portion of protein at every meal. Meat, fish, eggs, legumes, dairy. Research suggests 20 to 40 grams per meal as a practical target. This is the single most important nutritional lever for muscle preservation.

Lift weights. Two sessions a week is enough to make a meaningful difference. You don't need a gym. Resistance bands, bodyweight exercises, or any form of progressive overload counts.

Don't chase rapid loss. The faster the weight comes off, the higher the proportion that comes from muscle. Slower is better for body composition, even if it's psychologically harder.

Reconsider the dose. If you're slightly overweight and using GLP-1 medication primarily for cosmetic or modest weight loss goals, it's worth having an honest conversation with your prescriber about whether the dose you're on is creating a deficit larger than necessary, and whether a reduced dose combined with lifestyle changes would achieve the same outcome with fewer side effects.

The Bigger Picture (Beyond How To Avoid Ozempic Butt)

What this story really illustrates is a pattern we see repeatedly in medicine: a drug creates a side effect, and the response is a second drug to manage that side effect.

Sometimes that's the right answer. Sometimes it isn't.

For the people who genuinely need GLP-1 medications, apitegromab may eventually prove to be a valuable addition to the toolkit. The science is early but promising.

But for the growing number of people using these drugs without first exhausting the lifestyle fundamentals, the moderate deficit, the protein, the resistance training, the more useful question isn't "which drug should I add?" It's "have I actually done the basics yet?"

Those basics are what I teach inside Start With 6. Not because they're revolutionary, they're not.

Because they work, they're sustainable, and they don't require a prescription.

Sources:

Pratley RE, et al. Apitegromab for lean mass preservation during tirzepatide-induced weight loss: a randomized, double-blind, placebo-controlled phase 2 trial. Nature Medicine, 2026. BBC Health. New drug to stop 'Ozempic butt' muscle loss side effect of obesity jabs. June 2026.