When trying to lose weight, it’s natural to want to see quick results. So when the number on the scales drops rapidly, it seems like we’re on the right track.

But as with many things related to weight loss, there’s a flip side: rapid weight loss can result in a significant loss of muscle mass, as well as fat.

So how you can tell if you’re losing too much muscle and what can you do to prevent it?

Why does muscle mass matter?

Muscle is an important factor in determining our metabolic rate: how much energy we burn at rest. This is determined by how much muscle and fat we have. Muscle is more metabolically active than fat, meaning it burns more calories.

When we diet to lose weight, we create a calorie deficit, where our bodies don’t get enough energy from the food we eat to meet our energy needs. Our bodies start breaking down our fat and muscle tissue for fuel.

A decrease in calorie-burning muscle mass slows our metabolism. This quickly slows the rate at which we lose weight and impacts our ability to maintain our weight long term.

How to tell you’re losing too much muscle

Unfortunately, measuring changes in muscle mass is not easy.

The most accurate tool is an enhanced form of X-ray called a dual-energy X-ray absorptiometry (DXA) scan. The scan is primarily used in medicine and research to capture data on weight, body fat, muscle mass and bone density.

But while DEXA is becoming more readily available at weight-loss clinics and gyms, it’s not cheap.

There are also many “smart” scales available for at home use that promise to provide an accurate reading of muscle mass percentage.

However, the accuracy of these scales is questionable. Researchers found the scales tested massively over- or under-estimated fat and muscle mass.

Fortunately, there are three free but scientifically backed signs you may be losing too much muscle mass when you’re dieting.

1. You’re losing much more weight than expected each week

Losing a lot of weight rapidly is one of the early signs that your diet is too extreme and you’re losing too much muscle.

Rapid weight loss (of more than 1 kilogram per week) results in greater muscle mass loss than slow weight loss.

Slow weight loss better preserves muscle mass and often has the added benefit of greater fat mass loss.

One study compared people in the obese weight category who followed either a very low-calorie diet (500 calories per day) for five weeks or a low-calorie diet (1,250 calories per day) for 12 weeks. While both groups lost similar amounts of weight, participants following the very low-calorie diet (500 calories per day) for five weeks lost significantly more muscle mass.

2. You’re feeling tired and things feel more difficult

It sounds obvious, but feeling tired, sluggish and finding it hard to complete physical activities, such as working out or doing jobs around the house, is another strong signal you’re losing muscle.

Research shows a decrease in muscle mass may negatively impact your body’s physical performance.

3. You’re feeling moody

Mood swings and feeling anxious, stressed or depressed may also be signs you’re losing muscle mass.

Research on muscle loss due to ageing suggests low levels of muscle mass can negatively impact mental health and mood. This seems to stem from the relationship between low muscle mass and proteins called neurotrophins, which help regulate mood and feelings of wellbeing.

So how you can do to maintain muscle during weight loss?

Fortunately, there are also three actions you can take to maintain muscle mass when you’re following a calorie-restricted diet to lose weight.

1. Incorporate strength training into your exercise plan

While a broad exercise program is important to support overall weight loss, strength-building exercises are a surefire way to help prevent the loss of muscle mass. A meta-analysis of studies of older people with obesity found resistance training was able to prevent almost 100% of muscle loss from calorie restriction.

Relying on diet alone to lose weight will reduce muscle along with body fat, slowing your metabolism. So it’s essential to make sure you’ve incorporated sufficient and appropriate exercise into your weight-loss plan to hold onto your muscle mass stores.

But you don’t need to hit the gym. Exercises using body weight – such as push-ups, pull-ups, planks and air squats – are just as effective as lifting weights and using strength-building equipment.

Encouragingly, moderate-volume resistance training (three sets of ten repetitions for eight exercises) can be as effective as high-volume training (five sets of ten repetitions for eight exercises) for maintaining muscle when you’re following a calorie-restricted diet.

2. Eat more protein

Foods high in protein play an essential role in building and maintaining muscle mass, but research also shows these foods help prevent muscle loss when you’re following a calorie-restricted diet.

But this doesn’t mean just eating foods with protein. Meals need to be balanced and include a source of protein, wholegrain carb and healthy fat to meet our dietary needs. For example, eggs on wholegrain toast with avocado.

3. Slow your weight loss plan down

When we change our diet to lose weight, we take our body out of its comfort zone and trigger its survival response. It then counteracts weight loss, triggering several physiological responses to defend our body weight and “survive” starvation.

Our body’s survival mechanisms want us to regain lost weight to ensure we survive the next period of famine (dieting). Research shows that more than half of the weight lost by participants is regained within two years, and more than 80% of lost weight is regained within five years.

However, a slow and steady, stepped approach to weight loss, prevents our bodies from activating defence mechanisms to defend our weight when we try to lose weight.

Ultimately, losing weight long-term comes down to making gradual changes to your lifestyle to ensure you form habits that last a lifetime.

At the Boden Group, Charles Perkins Centre, we are studying the science of obesity and running clinical trials for weight loss. You can register here to express your interest.

Nick Fuller, Charles Perkins Centre Research Program Leader, University of Sydney

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Semaglutide (sold as Ozempic, Wegovy and Rybelsus) was initially developed to treat diabetes. It works by stimulating the production of insulin to keep blood sugar levels in check.

This type of drug is increasingly being prescribed for weight loss, despite the fact it was initially approved for another purpose. Recently, there has been growing interest in another possible use: to treat addiction.

Anecdotal reports from patients taking semaglutide for weight loss suggest it reduces their appetite and craving for food, but surprisingly, it also may reduce their desire to drink alcohol, smoke cigarettes or take other drugs.

But does the research evidence back this up?

Animal studies show positive results

Semaglutide works on glucagon-like peptide-1 receptors and is known as a “GLP-1 agonist”.

Animal studies in rodents and monkeys have been overwhelmingly positive. Studies suggest GLP-1 agonists can reduce drug consumption and the rewarding value of drugs, including alcohol, nicotine, cocaine and opioids.

Out team has reviewed the evidence and found more than 30 different pre-clinical studies have been conducted. The majority show positive results in reducing drug and alcohol consumption or cravings. More than half of these studies focus specifically on alcohol use.

However, translating research evidence from animal models to people living with addiction is challenging. Although these results are promising, it’s still too early to tell if it will be safe and effective in humans with alcohol use disorder, nicotine addiction or another drug dependence.

What about research in humans?

Research findings are mixed in human studies.

Only one large randomised controlled trial has been conducted so far on alcohol. This study of 127 people found no difference between exenatide (a GLP-1 agonist) and placebo (a sham treatment) in reducing alcohol use or heavy drinking over 26 weeks.

In fact, everyone in the study reduced their drinking, both people on active medication and in the placebo group.

However, the authors conducted further analyses to examine changes in drinking in relation to weight. They found there was a reduction in drinking for people who had both alcohol use problems and obesity.

For people who started at a normal weight (BMI less than 30), despite initial reductions in drinking, they observed a rebound increase in levels of heavy drinking after four weeks of medication, with an overall increase in heavy drinking days relative to those who took the placebo.

There were no differences between groups for other measures of drinking, such as cravings.

In another 12-week trial, researchers found the GLP-1 agonist dulaglutide did not help to reduce smoking.

However, people receiving GLP-1 agonist dulaglutide drank 29% less alcohol than those on the placebo. Over 90% of people in this study also had obesity.

Smaller studies have looked at GLP-1 agonists short-term for cocaine and opioids, with mixed results.

There are currently many other clinical studies of GLP-1 agonists and alcohol and other addictive disorders underway.

While we await findings from bigger studies, it’s difficult to interpret the conflicting results. These differences in treatment response may come from individual differences that affect addiction, including physical and mental health problems.

Larger studies in broader populations of people will tell us more about whether GLP-1 agonists will work for addiction, and if so, for whom.

How might these drugs work for addiction?

The exact way GLP-1 agonists act are not yet well understood, however in addition to reducing consumption (of food or drugs), they also may reduce cravings.

Animal studies show GLP-1 agonists reduce craving for cocaine and opioids.

This may involve a key are of the brain reward circuit, the ventral striatum, with experimenters showing if they directly administer GLP-1 agonists into this region, rats show reduced “craving” for oxycodone or cocaine, possibly through reducing drug-induced dopamine release.

Using human brain imaging, experimenters can elicit craving by showing images (cues) associated with alcohol. The GLP-1 agonist exenatide reduced brain activity in response to an alcohol cue. Researchers saw reduced brain activity in the ventral striatum and septal areas of the brain, which connect to regions that regulate emotion, like the amygdala.

In studies in humans, it remains unclear whether GLP-1 agonists act directly to reduce cravings for alcohol or other drugs. This needs to be directly assessed in future research, alongside any reductions in use.

Are these drugs safe to use for addiction?

Overall, GLP-1 agonists have been shown to be relatively safe in healthy adults, and in people with diabetes or obesity. However side effects do include nausea, digestive troubles and headaches.

And while some people are OK with losing weight as a side effect, others aren’t. If someone is already underweight, for example, this drug might not be suitable for them.

In addition, very few studies have been conducted in people with addictive disorders. Yet some side effects may be more of an issue in people with addiction. Recent research, for instance, points to a rare risk of pancreatitis associated with GLP-1 agonists, and people with alcohol use problems already have a higher risk of this disorder.

Other drugs treatments are currently available

Although emerging research on GLP-1 agonists for addiction is an exciting development, much more research needs to be done to know the risks and benefits of these GLP-1 agonists for people living with addiction.

In the meantime, existing effective medications for addiction remain under-prescribed. Only about 3% of Australians with alcohol dependence, for example, are prescribed medication treatments such as like naltrexone, acamprosate or disulfiram. We need to ensure current medication treatments are accessible and health providers know how to prescribe them.

Continued innovation in addiction treatment is also essential. Our team is leading research towards other individualised and effective medications for alcohol dependence, while others are investigating treatments for nicotine addiction and other drug dependence.

Read the other articles in The Conversation’s Ozempic series here.

Shalini Arunogiri, Addiction Psychiatrist, Associate Professor, Monash University; Leigh Walker, , Florey Institute of Neuroscience and Mental Health, and Roberta Anversa, , The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.