Multimodal strategy to protect lean mass in people using semaglutide for obesity – case report

Introduction: Semaglutide, a glucagon-like peptide-1 analogue (aGLP-1), has emerged as a pivotal therapy for managing obesity by significantly reducing caloric intake through central nervous system modulation. Beyond appetite control, it demonstrates efficacy in diminishing visceral fat and improving metabolic markers. However, concerns arise regarding its potential to induce lean mass loss, highlighting the need for adjunctive strategies. Objective: This study aims to assess the effects of a multimodal intervention combining semaglutide therapy with nutritional supplementation and resistance training on body composition, particularly lean mass preservation. Case Description: A 38-year-old male with obesity underwent semaglutide treatment alongside a structured protocol integrating a ready-to-drink nutritional supplement, resistance exercise, and dietary intervention. Over six months, changes in weight and body composition were evaluated using DXA, bioimpedance, and plicometry. The patient experienced a significant weight loss of 14.6 kg, with body fat reduction of 8.5 kg, 9.7 kg, and 10.4 kg, depending on the measurement method. Notably, lean mass loss was minimized, supporting the efficacy of adjunctive strategies in mitigating muscle depletion during weight loss. Final considerations: These findings underscore the need for mitigation strategies to be started together with any aGLP-1 when treating a person with obesity including but not limited to diet, exercise and a metabolic-friendly ready to drink nutritional supplement - a non-pharmacological strategy frequently forgotten by endocrinologists. Graphical Abstract