An improved, new generation of weight-loss drugs may be just over the horizon, hopefully signalling an end to the typical “deflated balloon” look of Ozempic users, particularly prevalent among women, predicts Oliver Bateman in Pirate Wires.
Ozempic burns muscle plus fat, creating legions of people who look like empty sacks, he writes, but it appears as if pharma has finally found a way to make people look “as if they lift”.
In 2004, a German toddler shocked neurologists at Berlin’s Charité Hospital. At four-and-a-half-years-old, the boy could hold 3.5kg dumbbells with his arms extended. His quads bulged like tree trunks. He was roughly twice as strong as other kids his age.
This wasn’t some toddler CrossFit cult, nor was he dosed with steroids. He’d been born with a genetic mutation that shut off his body’s production of myostatin, a protein that inhibits muscle growth (it literally means “muscle remain”).
His mother, a former sprinter, carried one copy of the mutation, and several of his relatives were known for their unusual strength, including a construction worker who could unload heavy curbstones by hand. Like Belgian Blue cattle and “Mighty Mice” before them (cattle and mice breeds genetically engineered to be freakishly muscular), this toddler’s family was naturally hypertrophic.
Twenty years later, that discovery is colliding with a new medical phenomenon.
Ozempic is giving people tofu bodies
Millions are injecting GLP-1 drugs like Ozempic to shed kilos, but they’re discovering an ugly truth: the drugs turn long-time users into deflated balloons.
Semaglutide (the active ingredient in Ozempic) strips away muscle alongside fat. In a 2021 trial, ~40% of weight lost on the drug was lean muscle, not fat. Patients on tirzepatide (an Ozempic competitor) fared slightly better in a 2022 trial, with lean muscle dropping by around 25%.
Ozempic users tend to be sedentary (they’re naturally fat, remember) which compounds the muscle-loss problem. They’re not hitting the gym or eating protein-rich diets to preserve muscle – so they lose much more of it.
The result? They end up “skinny-fat”: thin but weak, with a slower metabolism and higher risk of regaining weight (as fat). Lean muscle stabilises blood sugar, boosts immunity, keeps bones strong, and maintains metabolic rate.
Women are most at risk of health complications from becoming skinny-fat because muscle loss compounds age-related bone density issues.
When these women stop taking Ozempic, they regain mostly fat (not the muscle they’ve lost). It’s a vicious cycle.
The ‘Swole Pill’
Since the discovery of myostatin inhibitors in the 90s, scientists have been digging around for a use case. At first, they thought these drugs could treat muscular dystrophy, but that didn’t work. Now they’ve found their killer app: preventing the “muscle tax” that makes Ozempic users look so weak.
Two recent trials demonstrate the concept:
In June, Regeneron proved that semaglutide alone strips 34.5% of weight loss from muscle. But add their myostatin inhibitor, trevogrumab? Patients lost nearly 14kg in total and only 680g were muscle (versus 3.5kg on semaglutide without the myostatin inhibitor).
Scholar Rock, a decade-old biotech company founded by Harvard Medical School researchers, reached a similar conclusion a week later. Its drug apitegromab (a myostatin-blocking antibody) preserved 54.9% of lean mass when combined with tirzepatide. Instead of losing weight as 70% fat and 30% muscle, patients on the tirzepatide-apitegromab combo lost 85% fat and 15% muscle.
In other words, patients taking these cutting-edge drugs didn’t just lose more weight. They finally lost the right weight.
These trials are extra-reliable because they exploit a delicious irony: the same lazy, muscle-wasting population that makes Ozempic so problematic represents an ideal testing ground for myostatin inhibitors. These people, who won’t lift a weight or track a macro, are experiencing the worst-case scenario for body composition, and their abnormally high muscle loss makes the benefits of these drugs crystal clear in trials.
Now that pharma has clocked the potential, it’s a gold rush.
Scholar Rock could receive FDA approval within months and become the first to market. Its stock exploded 300% when data from the trial summarised above dropped.
Competing pharma companies Biohaven and Roche are also in advanced clinical trials. Eli Lilly paid $1.925bn for a drug that blocks muscle-limiting receptors, and last year AstraZeneca dropped $80m on something similar.
When pharma starts writing billion-dollar cheques, you know they smell profit. Long-time pharma-journalism insiders tell me this is the sort of pharmaceutical boom that strikes actual (as opposed to fool’s) gold.
We are probably very close to the next wave of weight-loss drugs. They will not only make you skinny, but jacked. And the potential applications of myostatin inhibitors extend far beyond fat people. FDA-approved myostatin inhibitors that could revolutionise muscle preservation and growth for everyone: athletes, ageing adults, or everyday men and women who simply want more mass. Your body, your choice.
Ozempic proved dramatic weight loss was possible. Now the race is about quality, which entails not just losing kilos but using pharmaceuticals to sculpt your body mass as you see fit.
The winners – Scholar Rock, Regeneron, or up-and-comers – won’t just capture market share. They’ll define the next decade of metabolic medicine.
Nobody should have to pay hundreds of dollars a month plus a 35% muscle tax just to look like an empty sack of potatoes when they could look like they actually lift.
A “Swole Pill” generally refers to a pre-workout supplement designed to enhance athletic performance, muscle growth, and energy levels. These supplements often contain a combination of ingredients aimed at increasing blood flow, improving endurance, and boosting mental focus during workouts. “Swole” is a slang term referring to a muscular physique, and “Swole Pill” is used to market supplements that help achieve that look.
Pirates Wire article – We may have found the Swole Pill (Open access)
See more from MedicalBrief archives:
Why I think weight loss drugs are not the answer – US obesity expert
Patients felled by weight-loss drugs’ side effects
Ozempic, Wegovy rivals step up the pace in obesity drug gold rush