How to avoid Ozempic butt is a common concern for individuals prescribed semaglutide (Ozempic or Wegovy) for type 2 diabetes or weight management. This colloquial term describes gluteal volume loss and sagging that can occur during rapid weight reduction with GLP-1 receptor agonists. Whilst not an officially recognised adverse effect, these body composition changes reflect the loss of both subcutaneous fat and muscle mass in the buttocks. Understanding the mechanisms behind this phenomenon and implementing evidence-based strategies—including targeted resistance training, adequate protein intake, and gradual weight loss—can help preserve gluteal muscle and contour whilst achieving therapeutic weight reduction goals under medical supervision.

What Is Ozempic Butt and Why Does It Occur?

'Ozempic butt' is a colloquial term describing the loss of volume and sagging appearance in the gluteal region that some individuals experience during rapid weight loss associated with GLP-1 receptor agonist medications such as semaglutide. In the UK, semaglutide is marketed as Ozempic for type 2 diabetes treatment and as Wegovy for weight management in eligible patients with obesity (as per NICE TA875).

This phenomenon is not an officially recognised medical condition or listed adverse effect in the Summary of Product Characteristics, but reflects a broader concern about body composition changes during pharmacologically induced weight reduction.

GLP-1 receptor agonists work by mimicking the glucagon-like peptide-1 hormone, which enhances insulin secretion, suppresses glucagon release, slows gastric emptying, and reduces appetite through central nervous system pathways. This mechanism typically results in a caloric deficit and subsequent weight loss. However, rapid weight reduction can lead to loss of both adipose tissue and lean muscle mass, including in the gluteal muscles (gluteus maximus, medius, and minimus). Research suggests that without resistance training, approximately 20-30% of weight lost may come from lean tissue rather than fat.

The buttocks comprise both subcutaneous fat and underlying muscle. When weight loss occurs quickly without adequate protein intake or resistance exercise, the body may catabolise muscle tissue for energy, leading to reduced gluteal volume and a flatter, less toned appearance. Additionally, the loss of subcutaneous fat—which provides shape and contour—combined with potential skin laxity in individuals with significant weight loss, contributes to the sagging effect. Age, genetics, baseline muscle mass, rate of weight loss, and lifestyle factors all influence the degree to which these changes occur. Older adults and those with pre-existing sarcopenia or frailty are at higher risk of muscle loss during weight reduction.

Strategies to Prevent Muscle and Fat Loss During Weight Loss

Preserving lean body mass whilst achieving therapeutic weight reduction requires a multifaceted approach that balances caloric deficit with muscle-sparing interventions. The primary goal is to ensure that weight loss derives predominantly from adipose tissue rather than muscle, thereby maintaining functional strength and body contour, including in the gluteal region.

Gradual, controlled weight loss is fundamental. The NHS recommends aiming for a sustainable rate of around 0.5–1 kg per week, which allows the body to adapt metabolically and reduces the likelihood of excessive muscle catabolism. NICE guidance (CG189) suggests targeting a 5-10% weight loss over 3-6 months, typically achieved through a daily calorie deficit of about 600 kcal. Patients prescribed semaglutide should work closely with their healthcare team to monitor weight loss trajectory and adjust dietary intake accordingly.

Very low-energy diets (below 800 kcal daily) should only be followed under clinical supervision and for limited periods. Low-energy diets (800-1,200 kcal) may be appropriate for some individuals but should be nutritionally complete and medically supervised.

Adequate protein intake is important for muscle preservation. Evidence suggests that individuals undergoing weight loss may benefit from consuming 1.2–1.6 grams of protein per kilogram of adjusted body weight daily, distributed across meals to optimise muscle protein synthesis. Those with kidney disease should discuss protein intake with their healthcare provider. High-quality protein sources include lean meats, fish, eggs, dairy products, legumes, and plant-based alternatives.

Regular physical activity, particularly resistance training, provides the mechanical stimulus necessary to maintain and build muscle tissue. The combination of progressive resistance exercise with adequate protein intake creates an anabolic environment that counteracts the catabolic effects of caloric restriction. Additionally, staying well-hydrated and ensuring sufficient micronutrient intake—particularly vitamin D (10 micrograms/day recommended in autumn/winter for UK residents), calcium, and B vitamins—supports overall metabolic health and muscle function during weight loss.

Exercise and Resistance Training to Maintain Gluteal Volume

Targeted resistance training is a key strategy for preserving and enhancing gluteal muscle mass during weight loss with GLP-1 receptor agonists. Evidence suggests that the gluteal muscles respond well to progressive overload, and a structured exercise programme can help mitigate volume loss in this region.

Key exercises for gluteal development include:

• Hip thrusts and glute bridges – These movements specifically target the gluteus maximus through hip extension against resistance

• Squats and lunges – Compound movements that engage all three gluteal muscles whilst also strengthening the quadriceps and hamstrings

• Step-ups and Bulgarian split squats – Unilateral exercises that address muscle imbalances and provide targeted gluteal activation

• Deadlifts (conventional and Romanian) – Posterior chain exercises that strengthen the gluteals, hamstrings, and lower back

• Lateral band walks and clamshells – Isolation exercises for the gluteus medius, important for hip stability and overall gluteal shape

For optimal results, resistance training should be performed 2–3 times weekly, allowing 48 hours between sessions targeting the same muscle groups for recovery. Progressive overload—gradually increasing weight, repetitions, or training volume—is essential for continued muscle adaptation. Beginners should start with bodyweight exercises or light resistance and progress under guidance from a qualified fitness professional or physiotherapist.

Cardiovascular exercise remains important for overall health and caloric expenditure but should be balanced with resistance training rather than performed exclusively. Excessive cardio without strength training may accelerate muscle loss.

The UK Chief Medical Officers' Physical Activity Guidelines recommend at least 150 minutes of moderate-intensity activity or 75 minutes of vigorous activity weekly, plus muscle-strengthening activities on at least 2 days per week. Patients with mobility limitations, cardiovascular conditions, or musculoskeletal concerns should consult their GP or a physiotherapist before commencing a new exercise programme to ensure safety and appropriateness.

Nutritional Approaches to Support Muscle Preservation

Optimising nutritional intake is paramount for maintaining muscle mass and gluteal volume during pharmacologically assisted weight loss. The appetite-suppressing effects of semaglutide can make adequate nutrition challenging, necessitating deliberate dietary planning.

Protein distribution and quality are important considerations. Research suggests that distributing protein intake across 3–4 meals (approximately 20–30 grams per meal) may help maximise muscle protein synthesis throughout the day. Protein-rich foods include chicken, beef, fish, eggs, dairy products, legumes, and plant proteins. For individuals following plant-based diets, combining complementary protein sources (legumes with grains) helps ensure adequate amino acid profiles. Those with kidney disease should discuss protein requirements with their GP or a registered dietitian.

Essential fatty acids should not be neglected despite fat's higher caloric density. Omega-3 fatty acids from oily fish (salmon, mackerel, sardines) may support overall health, though evidence specifically for muscle recovery during weight loss is still emerging. Moderate fat intake also aids absorption of fat-soluble vitamins and supports hormonal function.

Micronutrient adequacy becomes increasingly important during caloric restriction. Key nutrients include:

• Vitamin D – Essential for muscle function and calcium absorption; the NHS recommends UK residents consider taking 10 micrograms (400 IU) daily during autumn and winter months

• Calcium – Supports muscle contraction and bone health

• Magnesium – Involved in muscle protein synthesis and energy metabolism

• B vitamins – Critical for energy production and protein metabolism

Patients experiencing significant appetite suppression should consider nutrient-dense, protein-rich foods such as Greek yoghurt, cottage cheese, eggs, and protein smoothies. Working with a registered dietitian can help develop personalised meal plans that meet nutritional requirements whilst accommodating reduced appetite. There is no official link between specific supplements and prevention of 'Ozempic butt', though adequate protein and micronutrient intake through diet or supplementation supports overall body composition.

When to Seek Medical or Specialist Advice

Whilst changes in body composition during weight loss are expected, certain circumstances warrant professional medical evaluation or specialist referral to ensure safe and effective management.

Contact your GP or prescribing clinician if you experience:

• Excessive or rapid weight loss exceeding 1.5 kg per week consistently, which may indicate inadequate caloric intake or other metabolic concerns

• Significant muscle weakness or functional impairment affecting daily activities, mobility, or balance

• Persistent fatigue, dizziness, or signs of malnutrition such as hair loss, brittle nails, or poor wound healing

• Gastrointestinal symptoms (severe nausea, vomiting, or diarrhoea) that prevent adequate nutritional intake or could lead to dehydration

• Psychological distress related to body image changes or disordered eating patterns

Seek urgent medical attention via NHS 111 or A&E for:

• Severe, persistent abdominal pain (especially radiating to the back), which could indicate pancreatitis

• Yellowing of skin/eyes or severe right upper quadrant pain, which may suggest gallbladder problems (gallstones are more common during rapid weight loss)

• Signs of severe dehydration (extreme thirst, dizziness, confusion, dark urine)

• Severe hypoglycaemia symptoms (particularly if taking insulin or sulfonylureas)

• Sudden vision changes (especially important for patients with diabetes and pre-existing retinopathy)

Specialist referrals may be appropriate in several scenarios. A registered dietitian can provide evidence-based nutritional guidance tailored to individual needs, particularly for those struggling to meet protein requirements or managing comorbidities such as diabetes or renal disease. Physiotherapists can design safe, effective resistance training programmes for individuals with mobility limitations, chronic conditions, or those new to structured exercise.

For individuals experiencing significant skin laxity or body contour concerns following substantial weight loss, consultation with a plastic surgeon may be considered, though such interventions are typically reserved until weight has stabilised for at least 6–12 months. Availability of body contouring procedures on the NHS varies by local commissioning criteria; many patients will require private consultation.

Regular monitoring during GLP-1 receptor agonist therapy should include assessment of weight loss trajectory, body composition where possible, nutritional adequacy, and functional capacity. Open communication with your healthcare team enables timely adjustments to treatment plans, dietary strategies, or exercise programmes to optimise both therapeutic outcomes and body composition. Patients should never discontinue prescribed medications without medical supervision, as abrupt cessation may result in weight regain and metabolic destabilisation.

If you suspect you've experienced a side effect from semaglutide or any medication, report it through the MHRA Yellow Card Scheme (yellowcard.mhra.gov.uk or the Yellow Card app).

Frequently Asked Questions