Preservation of Muscle Mass over a Lifetime

Introduction:

Americans often think folks in the South, including Nashville and all of Tennessee can be a little heavy, on the obese side. Obesity (being overweight) is a problem that is plaguing many in America, however. Worse than weight, however, is the fact that Americans often ignore that muscle mass silently declines over the decades. In later life this decline can lead to weakness, frailty, falls, and loss of independence.

The new weight loss medications (GLP-1 agonists such as semaglutide and tirzepatide) can produce muscle loss.

Your size, weight, and health are not straightforward. They are about body composition. Simply taking semaglutide and tirzepatide outside of a thoughtful medical treatment plan carries risk.

I am William Conway, MD. I am a general internist who practices Concierge Medicine, or private medicine, in Nashville. I was elected to fellowship in The American College of Physicians for my work in diabetes. Over my career, I have learned that preserving muscle mass is as important as reducing fat.

Executive Summary

Your body composition is critical:

  1. Too much fat is harmful
  2. Too little muscle is equally dangerous
  3. Weight is not straightforward
  4. Muscle mass peaks at age 40, and then begins to decline
  5. Exercise and protein protect muscle
  6. Medications can shift body composition

How Muscle and Weight Change across Time

Average Weight over a Lifetime

Medicine is dominated by variability. You are unique, and your diagnosis and treatment should be individualized.

Still, there is an average weight trajectory over a lifetime. Weight gradually increases to age sixty. Then weight begins to decline in the following decades. Weight loss in later life often represents loss of muscle mass, not just fat.

 

Average Muscle Mass Across Life

Protecting Muscle with Lifestyle

Effect of Exercise on Muscle Mass

Exercise is often considered the “best medicine for aging.” Strength training is an essential component of exercise. Strength training in exercise maintains muscle mass, delaying the decline in muscle mass commonly seen in aging.

Effect of Protein and Calorie Deprivation over a Year

Adequate protein and calorie intake is essential to preserve muscle mass over a lifetime. Diets which cut calories too aggressively often result in muscle breakdown as well as fat loss.

Special Risks

 Potential Adverse Effect of Psychiatric Medication on Weight 

Second generation antipsychotics have a well-known side effect of producing rapid, large gains in weight. While they are often essential for mental health, patients taking these medicines require additional support from their internist.

 

Aging and Inactivity

Decades of inactivity in Nashville accelerates muscle loss. Even short periods of inactivity such as hospitalization can cause muscle loss. Restoration of strength is possible, but becomes more difficult with age.

Conclusion

At Nashville Concierge Medicines, your size is important. Preservation of your muscle mass is discussed with you, with the development of an individualized action plan. Preservation of muscle mass is equally important to weight loss.

 

Call to Action

CTA: Call Nashville Concierge Medicines at 615-708-0390 to begin your personalized plan for your weight with Dr. William Conway.

References:

  1. Colleluori G, Villareal DT. Aging, obesity, sarcopenia and the effect of diet and exercise intervention. Exp Gerontol. 2021 Nov;155:111561. doi:10.1016/j.exger.2021.111561. Epub 2021 Sep 23. PMID:34562568.
  2. Bilski J, Pierzchalski P, Szczepanik M, Bonior J, Zoladz JA. Multifactorial mechanism of sarcopenia and sarcopenic obesity: role of physical exercise, microbiota and myokines. Cells. 2022 Jan 4;11(1):160. doi:10.3390/cells11010160. PMID:35011721.
  3. Choi KM. Sarcopenia and sarcopenic obesity. Korean J Intern Med. 2016 Nov;31(6):1054-1060. doi:10.3904/kjim.2016.193. Epub 2016 Nov 1. PMID:27809450.
  4. Polyzos SA, Vachliotis ID, Mantzoros CS. Sarcopenia, sarcopenic obesity and nonalcoholic fatty liver disease. Metabolism. 2023 Oct;147:155676. doi:10.1016/j.metabol.2023.155676. Epub 2023 Aug 4. PMID:37544590.
  5. Zamboni M, Rubele S, Rossi AP. Sarcopenia and obesity. Curr Opin Clin Nutr Metab Care. 2019 Jan;22(1):13-19. doi:10.1097/MCO.0000000000000519. PMID:30461451.
  6. Damluji AA, Alfaraidhy M, AlHajri N, Rohant NN, Kumar M, Al Malouf C, et al. Sarcopenia and cardiovascular diseases. Circulation. 2023 May 16;147(20):1534-1553. doi:10.1161/CIRCULATIONAHA.123.064071. Epub 2023 May 15. PMID:37186680.
  7. Gortan Cappellari G, Zanetti M, Donini LM, Barazzoni R. Detecting sarcopenia in obesity: emerging new approaches. Curr Opin Clin Nutr Metab Care. 2024 Sep 1;27(5):402-409. doi:10.1097/MCO.0000000000001062. Epub 2024 Jul 18. PMID:39022899.
  8. Wei S, Nguyen TT, Zhang Y, Ryu D, Gariani K. Sarcopenic obesity: epidemiology, pathophysiology, cardiovascular disease, mortality, and management. Front Endocrinol (Lausanne). 2023 Jun 30;14:1185221. doi:10.3389/fendo.2023.1185221. eCollection 2023. PMID:37455897.
  9. Cruz-Jentoft AJ, Baeyens JP, Bauer JM, Boirie Y, Cederholm T, Landi F, et al.; European Working Group on Sarcopenia in Older People. Sarcopenia: European consensus on definition and diagnosis. Age Ageing. 2010 Jul;39(4):412-23. doi:10.1093/ageing/afq034. Epub 2010 Apr 13. PMID:20392703.
  10. Batsis JA, Villareal DT. Sarcopenic obesity in older adults: aetiology, epidemiology and treatment strategies. Nat Rev Endocrinol. 2018 Sep;14(9):513-537. doi:10.1038/s41574-018-0062-9. PMID:30065268.