The hidden problem of muscle loss x weight-loss drugs

A beautiful gym; telehealth ketamine; body by pancake. This is Link Letter 76!

The hidden problem of muscle loss x weight-loss drugs
Creepy illustrated anatomy guy courtesy of

Last week I wrote about the yassification of Ozempic (a paid Ask A Swole Woman post that I unlocked on Tuesday for all subscribers!). Buried deep in there was a link suggesting that one of the many (many, many, many) problems with Ozempic and its cohort being prescribed willy-nilly is that it causes a significant loss of precious muscle mass. The underrated, little-understood role of lean muscle mass in our lives, but especially in “weight loss,” is one of the concepts that makes me yell like a banshee about why strength training matters. So I thought I’d dig into this a little further.

This reel from Peter Attia, MD, explains the situation pretty well:


Dr. Attia says he has been aware of these drugs for a couple of years, but is wary of prescribing them unless he feels sure the loss of muscle will be offset by the upsides. Also because of the muscle loss, he prescribes his Ozempic-using clients to lift weights and eat a lot of protein, in accordance with their starting weight (1g/lb of bodyweight mafia). He also derides the FDA for continuing, in the year of our lord 2023, to focus on loss of body weight as the metric of success in medical studies focused on the relationship between body size and health, instead of using to body composition (the better standard).[^1]

Here’s the Big Secret to Looking More Like Your Instagram Fitness Crush (The Avocado Post) — Ask A Swole Woman
Some of them are more honest about their lives than others.

Weight loss as a health panacea is vastly overrated. But the even-worse thing about nearly every trendy weight-loss workout or diet is that they fail to protect our lean body mass. This not only makes it harder to maintain the extremely hard-won effects of those diets or workouts, but leaves the weight-loser in a worse place than they were to begin with, with less muscle mass to make their body function or keep their metabolism up, plus a laundry list of other effects. It doesn’t appear that many—or any—doctors are substantively attending to that aspect of Ozempic weight loss; they’re still just looking at the number of pounds on scales and going, “Mm, could be lower.”

Anyway, this will be writers currently espousing Wegovy/Mounjaro/Ozempic/tirazepatide/semaglutide writing about them again in two to five years:

The yassification of Ozempic
No bigger red flag than describing a weight-loss trend as something “everyone” is doing.


~Discord Pick of the Week: “This gym is so classy it should be called a James”—It took entirely too long for the SNL “Beautiful Gym” skit to reach me.


I’ve waited, I’ve prayed, for this day: Gyms are running out of squat racks because SO MANY people are getting into lifting, and they are scrambling to install more free-weight equipment.

I Don’t Want Brain By Seventeen, I Want Body By Pancake, by inestimable friend of the blog Alex Sujong Laughlin.

A great reel from Sohee Lee on the value-neutrality of tools that tracking weight, food, and progress pictures can be, but aren't always; depends most importantly on the person).

Against junk volume (i.e. doing lots and lots of sets as busywork).

Shon Faye on coming to strength training as a trans woman.


Weight Watchers, which declared itself to be about “Wellness that Works” and rebranded as WW back in 2018, is about weight loss again.

Australian influencer Sarah Stephenson of Sarah’s Day, a lifestyle YouTube channel that has 1.5 million subscribers, admitted that she was so unhealthy living the lifestyle she promoted on her channel that she lost her period. Close readers of this newsletter are already familiar with RED-S, or "relative energy deficiency in sport," an assessment for health issues caused by disordered behavior, sort of like a second-generation Female Athlete Triad. The Olympic committee is considering instituting RED-S to help discourage misguidedly extreme dieting or training in the name of performance. Let me just float something out there: "RED-S but for posting online."

Trainers who sell cookie-cutter workout programs as “custom solutions for YOU” are shaking: The state of Texas’s trial against Brittany Dawn started this week.

Tired (figuratively but not literally; if anything, the opposite): Telehealth startups handing out Adderall like Laffy Taffy. Wired (figuratively and literally): Telehealth startups handing out ketamine like Laffy Taffy (or trying to, anyway).

Noted Instagram comment: “I feel like he hitting certain people harder than others.”


I can’t believe Todd Field, director of Tár, invented Big League Chew (pertaining to this newsletter: This is sports). In that moment he should have started telling people his name was Thorvald Fjeld.

The philosopher who believes in living things.

A compelling thread of bug facts.

That’s all for this week! I love you for reading, thank you, let’s go—

[F1] This is not to say that more muscle mass/leaner body composition is always better. For both genders, there is a falloff point where it becomes distinctly unhealthy to be too lean.