GLP-1 medications such as Ozempic, Wegovy and Mounjaro are being widely described as wonder drugs for obesity, Type 2 diabetes and cardiovascular risk. For many people, they offer real and meaningful benefits.
But as their use increases in older adults, an important question is being overlooked:
What happens to muscle – and what does that mean for cognitive decline and healthy ageing?
Clinical trials show that 35–45% of weight lost on GLP-1 drugs comes from lean mass, including muscle and bone. From a functional medicine perspective, this is not a minor side effect – it is a central concern.
Muscle is not simply “extra weight”. It is a metabolic and signalling organ that plays a vital role in blood sugar control, inflammation, immune balance and brain health. When muscle contracts, it releases myokines that directly support cognitive function, brain plasticity and insulin sensitivity in the brain.
There is growing evidence that loss of muscle (sarcopenia) is independently associated with faster cognitive decline, increased dementia risk and loss of functional independence. This may help explain why, despite improvements in glucose and cardiovascular markers, GLP-1 trials have not shown protection against dementia.
In later life, frailty is often a greater threat than fat. Rapid or poorly supported weight loss can increase the risk of falls, fractures, hospital admissions and loss of independence – particularly when appetite suppression leads to inadequate protein and nutrient intake.
Another concern is what happens when people stop these drugs. High discontinuation rates mean weight often returns, but muscle does not always recover. Repeated cycles of weight loss and regain create metabolic instability and may accelerate functional decline over time.
This is not an argument against GLP-1 medications. It is a call to use them more intelligently.
From a functional medicine lens, we should be asking:
- How do we protect muscle and bone while using these drugs?
- Are older adults being supported with adequate protein, digestion and resistance training?
- Should lower or maintenance dosing be considered?
- And are we measuring strength, function and cognition – not just weight?
Obesity is a disease and deserves proper treatment. But so does sarcopenia. So does cognitive decline.
If our focus is weight loss alone, we risk missing the bigger picture.
The real goal is not simply to live lighter – but to live stronger, sharper and more resilient for longer.