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Glucagon-like peptide-1 receptor agonists and gastrointestinal adverse events: a systematic review and meta-analysis [published online June 9, 2025]

When MPP+ enters cells, it inhibits mitochondrial complex I enzyme and NADHubiquinone oxidoreductase, causing ROS formation and mitochondrial electron leakage (47)

These authors concluded that the proportion of LBM relative to total body mass increased with semaglutide. Similarly, in the SURMOUNT-1 trial which studied tirzepatide, researchers found that participants treated with tirzepatide had a percent reduction in fat mass approximately 3 times greater than the reduction in lean mass, resulting in an overall improvement in body composition. More recently, a viewpoint in JAMA re-grounded the conversation: weight loss in persons with obesity primarily reduces body fat, but also decreases fat free mass (FFM)

In some cases, a hepatologist or gastroenterologist may be involved