Blindness and Other Myths
I have a friend/patient who has my cell phone number because his wife and I were friends long before he became my weight loss patient. He enjoys texting me links to popular science articles expounding on the potential dangers from GLP1 receptor agonists. He is scared of going blind and losing all his muscle mass. His most recent query about Ozempic face popped up in my phone last Saturday night around 11pm, and I was too tired to respond. So, my friend, this blog is for you…debunking common GLP-1 receptor myths at a decent hour of the day.
NAION
What is NAION?
NAION stands for non arteritic anterior ischemic optic neuropathy
NAION causes damage to the optic nerve, potentially leading to vision loss.
It is characterized by a sudden reduction in blood flow to the optic nerve.
A study published in JAMA Ophthalmology in 2024 revealed that adults at the Massachusetts Eye and Ear Institute who were prescribed semaglutide (i.e. Ozempic or Wegovy) were at a higher risk for developing NAION.[1] While these results prompted hundreds of patients to send hysterical emails to me, the study had several crucial limitations which limited the reliability of the results.
The study was conducted at a single center
The study population consisted only of people attending an ophthalmology clinic (so they already ostensibly had underlying eye disease)
More recent retrospective analyses assessed NAION risk with GLP-1 use in a real-world databases of over 100 million people with or without eye disease.
These studes did not show any significant increase in blindness due to NAION in patients taking drugs in the GLP-1 receptor family.[2], [3] An additional multinational study similarly found there was no increased risk for patients with obesity or T2DM.[4]
The American Academy of Ophthalmology and the North American Neuro-Ophthalmology Society emphasize the need for more data to determine whether there is any relationship between GLP-1 receptor agonists and NAION. However, additional studies are unlikely to be performed given the negative results of these recent retrospective analyses.
Muscle loss
GLP-1s can cause rapid weight loss, and the body may break down muscle for energy during this process. Maintenance of muscle is important during weight loss because muscles have a higher metabolic rate than fat. Consequently, maintenance of lean body mass facilitates faster metabolism and makes it easier to lose and maintain body weight. Studies suggest muscle loss with GLP-1 receptor agonists accounts for 25% to 39% of the total weight lost.[5] However, before tossing your remaining supply of Ozempic, please pay close attention to the following points:
This substantial muscle loss can be largely attributed to the magnitude of weight loss, rather than by an independent effect of GLP-1 receptor agonists. Non-pharmacological caloric restriction studies with smaller magnitudes of weight loss resulted in muscle losses of 10–30%.[6]
Individuals with obesity have a higher muscle mass but poorer muscle quality. The loss of muscle mass associated with GLP-1 receptor agonist treatment may actually be adaptive. While there is clearly a loss of lean mass, there is an improvement in the quality of the skeletal muscle (both improved insulin sensitivity and decreased muscle fat infiltration).[7]
Regular strength training, including weightlifting or other forms of resistance exercise, can help preserve and build muscle mass. Evidence suggests a set of ten to fifteenrepetitions for eight to ten exercises twice a week, with a goal of progressing to three sets of eight to ten repetitions three times a week, will effectively build muscle mass.[8]
Since protein is the building block of muscle, ensure adequate dietary protein to support muscle repair and growth. Aim to include high-quality protein sources in each of your meals. Lean meats, poultry, fish, eggs, and dairy are excellent options, but plant-based proteins like nuts, seeds, and legumes can also contribute to your daily intake. To support muscle retention and growth while on GLP-1s, aim for approximately 1 gram of protein per day per pound of body weight.
Ozempic face
I would like to start by saying that Ozempic face is a colloquial term, not a medically recognized condition. It refers to the facial changes that can occur as a result of taking GLP-1 receptor agonists, specifically Ozempic. Rapid weight loss can cause the skin on the face to lose elasticity and sag, resulting in hollowed cheeks, sagging jowls, wrinkles, and an aged appearance.
There is nothing specific in GLP-1 receptor agonists that targets fat in the facial area. When patients maintain a higher weight for an extended period of time and then lose a large amount of that weight, the decrease in under-the-skin fat (subcutaneous) can lead to excess skin accumulation. As patients get older, the subcutaneous tissue is less adaptable to changes in subcutaneous fat. Similar changes can occur with any form of significant weight loss, including bariatric surgery and calorie-restricted diets.
Several strategies can help mitigate the effects of Ozempic face:
Gradual weight loss: A slower, more controlled weight loss allows the skin time to adjust, thereby minimizing sagging
Dermal fillers: Injectable fillers can restore lost facial volume, creating a more youthful appearance. For this reason, I have recently hired a board certified plastic surgeon, Dr. Arthur Perry, for my practice.
Healthy lifestyle: Regular exercise, a balanced diet, and proper hydration (ideally 64oz of fluid/day) contribute to skin health and elasticity.
Hopefully this helps my friend (you know who you are) sleep better at night.
[1] Hathaway et al. Risk of Nonarteritis Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. JAMA Ophthalmol. 2024 Aug 1; 142 (8) 732-739.
[2] Klonoff et al. Real-World Evidence Assessment of the Risk of Nonarteritic Anterior Ischemic Optic Neuropathy in Patients Prescribed Semaglutide. Journal of Diabetes Science and Technology. July 30, 2024.
[3] Abbas et al. The Effect of Semaglutide and GLP-1 RAs on Risk of Non-Arteritic Anterior Ischemic Optic Neuropathy, American Journal of Ophthalmology. Feb 25, 2025.
[4] Chou et al. Association between Semaglutide and Nonarteritic Anterior Ischemic Optic Neuropathy. Opthalmology. 2024
[5] Conte et al. Is weight loss-induced muscle mass loss clinically relevant? JAMA. 2024; 332:9-10
[6] Chaston et al. Changes in fat-free mass during significant weight loss: a systematic review. Int J Obes. 2007; 31:743-750
[7] Neeland et al. Changes in lean body mass with glucagon-like peptide-1-based therapies and mitigation strategies. Diabetes Obesity Metabolism. 2024: Sept:26 Suppl 4:16-17.
[8] Borde et al. Dose-Response Relationships of Resistance Training in Healthy Old Adults: A Systemic Review and Meta- Analysis. Sports Med. 2015 (Dec;45 (12) 1693-720.