Recent research highlights the promising benefits of glucagon-like peptide 1 (GLP-1) analogs, in managing obesity, glycemic control, and reducing the risk of cardiovascular events, while also improving kidney function. Long-term studies, such as the SURMOUNT-1 trial, demonstrate the efficacy of GLP-1 in sustaining weight loss and delaying the progression to type 2 diabetes, particularly in individuals with obesity and prediabetes. However, concerns have emerged regarding the impact of GLP-1-induced weight loss on lean mass, with studies indicating significant reductions in fat-free mass, including skeletal muscle. Muscle loss is particularly concerning for older adults, who are already at an increased risk of sarcopenia, functional decline, and frailty due to age-related modifications. Additionally, weight regain, primarily as adipose tissue, after GLP-1 treatment raises concerns about sarcopenic obesity, a condition that independently predicts morbidity and mortality in older people. Strategies such as high-protein diets, resistance training, and muscle-anabolic agents are currently under investigation to mitigate muscle loss during GLP-1 therapy. Further research is needed to better understand the long-term effects of incretin-based therapies on body composition and to establish effective prevention strategies.
- Domenico Azzolino
- Tiziano Lucchi
