Neurologists are raising concerns that the rapid weight loss promoted by popular GLP-1 medications such as Ozempic and Wegovy could worsen neurodegenerative diseases like amyotrophic lateral sclerosis, or ALS.

Jinsy Andrews, MD, who directs the ALS Center at NYU Langone Health, explained that weight maintenance is a critical part of care for patients with neuromuscular disorders. Because GLP-1 drugs sharply reduce body weight, she said they can work against what patients with ALS biologically need to preserve muscle and nerve function.

While GLP-1 agonists are known to be effective treatments for diabetes and obesity, Andrews said the clinical approach changes when ALS is involved. The same processes that make these drugs beneficial for many individuals may be harmful for those whose disease relies on maintaining body mass.

These medications have been shown to lower risks for cardiovascular disease, stroke, liver disease, and addiction, and to reduce inflammation tied to obesity and diabetes. However, Andrews cautioned that the benefits observed in general populations do not necessarily apply to those with a neurodegenerative diagnosis.

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For patients with ALS, losing body weight and fat can accelerate physical decline. Andrews said that caloric deficit and metabolic strain can cause the disease to progress more quickly.

Standard ALS care guidelines often recommend maintaining or even gaining weight to help preserve a patient’s strength and motor function. That stands in contrast to the goals of GLP-1 treatment, which centers on significant weight reduction.

“In certain conditions where hypermetabolism is something that negatively affects the disease […] losing weight actually makes the disease worse and move faster,” Andrews told Fox News Digital. She added that for ALS patients, whether or not they have diabetes, GLP-1 drugs may hasten disease progression.

Evidence from a peer-reviewed case study has added weight to those concerns. The report, published in *Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration* in 2025, described a 52-year-old patient with ALS who began taking semaglutide to manage type 2 diabetes.

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Before starting the drug, her physical decline followed a typical trajectory on the standard ALS rating scale. In the three months after beginning semaglutide, the patient lost 25 pounds and then experienced a striking increase in symptom severity.

The decline was described as a tenfold acceleration compared to her previous progression rate. When clinicians discontinued semaglutide, her downhill trajectory stabilized, according to the report.

Andrews said such published documentation, combined with retrospective cohort data of ALS patients who also have diabetes, strengthens the case for greater caution when prescribing GLP-1 receptor agonists.

She urged physicians to be highly aware of each patient’s context before initiating these medications. For those with underlying neurodegenerative diseases, she said, maintaining nutritional stability may be as important as controlling metabolic conditions.

Experts agree that GLP-1 receptor agonists represent an important tool for managing obesity and related illnesses in the general population. Yet, for patients battling degenerative neurological disorders, the overall goal may differ drastically — preserving weight and muscle mass rather than losing them.