Creatine for glucagon-like peptide-1-associated muscle loss.

Glucagon-like peptide-1 (GLP-1)-based therapies have transformed obesity treatment, yet reductions in lean tissue may accompany pharmacological weight loss. We hypothesize that rapid weight loss and associated reductions in energy and protein intake, mechanical loading, and potentially physical activity may create conditions of increased skeletal-muscle bioenergetic vulnerability. Creatine supplementation represents a biologically plausible adjunct that could support muscle energetics and function in this setting. However, this proposal is hypothesis-generating, and no randomized clinical trial has directly evaluated creatine supplementation during GLP-1-based pharmacological weight loss. Future trials should determine whether creatine, as part of a multimodal muscle-preservation strategy, can help preserve muscle quality and functional capacity during treatment.