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  • The best smart scales for 2025

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    A smart scale does more than show your weight. It tracks metrics like body fat, muscle mass and water percentage, then syncs that data to your phone so you can see changes over time. If you want to take control of your health, the best smart scale gives you clear insights and helps you stay consistent with your goals.

    Some models focus on accuracy, while others support multiple user profiles or connect with apps you already use. With so many options available, choosing the best smart scale comes down to the features that matter most for your routine. This guide highlights our top picks to make that decision easier.

    Table of contents

    Smart scale safety

    There are valid reasons to weigh yourself but your self-worth shouldn’t be defined by what number shows up between your feet. If you’re looking to alter your body shape, that figure could go up as your waistline goes down since muscle weighs more than fat.

    Some scales go further by providing additional metrics like visceral fat levels, giving you a more comprehensive picture of your health. Dr. Anne Swift, Director of Public Health teaching at the University of Cambridge, said “weighing yourself too often can result in [you] becoming fixated on small fluctuations day-to-day rather than the overall trend over time.” Swift added “it’s sometimes better to focus on how clothes fit, or how you feel, rather than your weight.”

    A meta-analysis from 2016 found there may be some negative psychological impact from self weighing. A 2018 study, however, said there may be a positive correlation between regular weigh-ins and accelerated weight loss. It can be a minefield and I’d urge you to take real care of yourself and remember success won’t happen overnight.

    Best smart scales for 2025

    Fitbit

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes | Length: 11.8 inches | Width: 11.8 inches | Number of profiles: Multiple

    There are plenty of good budget scales out there, with Xiaomi and Fitbit offering very different products for very little money. Fitbit’s scale has far fewer features but has better build quality and is faster and more reliable than its even-cheaper rival. Crucially, it also leverages the Fitbit app, which is refined and easy-to-use, offering clean and easy to understand visualizations of your weight measurements.

    Xiaomi, meanwhile, offers your weight and body composition data,but much of that is only seen inside the app. From a data perspective, Xiaomi has the edge but its companion app is terrible. The lag time for each weigh-in, too, leaves a lot to be desired with the Xiaomi, even if I had no qualms about its accuracy.

    One of my nan’s favorite sayings was “you can either have a first class walk or a third class ride.” Fitbit’s scale is the very definition of a first class walk, polished, snappy with a great app but otherwise pretty limited. Xiaomi, meanwhile, charges less and offers more for your money but both the hardware and software lack any sort of polish. It’s up to you, but this is one of those rare occasions where I’d prefer the first class walk to the third class ride.

    Pros

    • Good build quality
    • Easy to use
    • Convenient integration with Fitbit app
    Cons

    • Fewer features than competitors

    $50 at Amazon

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    eufy

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes, syncs with Apple Health, Google Fit, or Fitbit | Length: 12.8 inches | Width: 12.8 inches | Number of profiles: Unlimited

    This slot was previously occupied by Eufy’s last smart scale, the P2 Pro, so it’s little surprise its successor replaces it here. The company’s strategy remains the same: Throw as many features into the P3 smart scale as possible to ensure competitors are beaten on specs alone. It’s easy enough to use, and offers a whole host of data to better help you understand your body composition.

    The P3 will measure your weight, body fat, muscle mass, heart rate, water, bone mass and your protein levels. It promises to calculate your basal metabolic rate, the number of calories you need to maintain a constant weight. There’s a gorgeous and clear-to-read color screen that lays out all your stats after you’ve weighed in, including trend graphs annotated with emojis.

    A downside of this all-but-the-kitchen-sink approach is the lack of polish, cohesion and user friendliness. For instance, if multiple people in your home have similar weights, then you may need to tap the right quadrant of the scale to switch profile. That’s quite easy, or would be, if the selection window didn’t zoom by faster than the time it takes to lift your toes up and down.

    It’s also a little unforgiving, nagging you at every weigh in with an orange angry emoji if you gain weight, even if the overall trend is positive. The inverse is also true — during testing, my kids somehow managed to get their joint weight registered under my name. But despite losing half of my body weight overnight, it did nothing but make my 3D avatar look gaunt.

    If you’re prepared to accept the lack of polish to get ahold of the raw features, then Eufy’s latest scale is a solid option. You’re not likely to find anything that’s as similarly affordable and useful in this price range, especially given Eufy’s propensity for deep discounts.

    Pros

    • Easy to use
    • A lot of data
    • Very affordable
    Cons

    • Lackluster app
    • Lack of polish and joined-up thinking

    $100 at Amazon

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    Garmin

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes | Length: 12.6 inches | Width: 12.2 inches | Number of profiles: 16

    I’m partial to Garmin’s Index S2, but it’s the sort of scale that needs to be used by people who know what they’re doing. Everything about the hardware is spot-on, and the only fly in its ointment is the low refresh rate on its color screen. I can’t say how upsetting it is to see the screen refresh in such a laggy, unpolished manner, especially when you’re spending this much money. But that is my only complaint, with accurate and detailed readings, including your body water percentage. If you’re looking to set goals to alter your body shape, this isn’t the scale for you — it’s the scale you buy once you calculate your BMR on a daily basis.

    Pros

    • Good build quality
    • Good integration with Garmin mobile app
    • Provides a lot of data

    $200 at Amazon

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    Withings

    Display type: LCD | Wi-Fi connectivity: Yes | App connectivity: Yes, syncs with Apple Health and Google Fit | Length: 12.7 inches | Width: 12.7 inches | Number of profiles: 8

    If you’re looking for a machine catering to your every whim, then Withings’ Body Comp is the way forward. It’s a luxury scale in every sense of the word, and you should appreciate the level of polish and technology on show here. Withings health app remains best in class, and I love how effortless the whole thing is to use on a daily basis. It’s a lot more expensive than the rest since it does so much more, like checking your nerve and arterial health. The retail price is a bit steep, but it’s one of those moments where you get exactly what you pay for.

    Pros

    • Good build quality
    • Excellent software support with Withings app
    • In-depth health tracking, including data on nerve and artery heatlh
    Cons

    • Runs on disposable batteries

    $230 at Target

    What to look for in a smart scale

    Weight

    A scale that measures weight is probably the top requirement, right? Whether you’re after a basic weight scale or a full-featured body fat scale, bear in mind, with all these measurements, the readings won’t be as accurate as a calibrated clinical scale. It’s better to focus on the overall trend, up or down over time, rather than a single measurement in isolation. Scales offering high-precision measurements can help, especially if you’re looking at the data to inform a specific health or fitness goal.

    Connectivity

    Before you buy your scale, work out how you’re planning on weighing yourself and when, as it is an issue. Some lower-end smart bathroom scales connect via Bluetooth and have no internal storage, so if you don’t have your phone to hand, it won’t record your weight. If your scale has Wi-Fi, then your scale can post the data to a server, letting you access them from any compatible device. Also, you should be mindful that some smart scales aren’t built with security in mind, so there’s a small risk to your privacy should your scale be compromised.

    Bone density

    The stronger your bones are, the less risk you have of breaks and osteoporosis — common concerns as you get older. Clinical bone density tests use low-power x-rays and some scales can offer you an at-home approximation. These bone mass tests pass a small electrical current through your feet, measuring the resistance as it completes its journey. The resistance offered by bones, fat and muscle are all different, letting your scale identify the difference. A body composition monitor often includes this feature, too, providing a detailed breakdown of bone density, fat and muscle mass.

    Body fat percentage and muscle mass

    Fat and muscle are necessary parts of our makeup, but too much of either can be problematic. Much like bone density, a body composition measurement feature can monitor your body fat and muscle mass percentages using Bioelectrical Impedance Analysis (BIA). This measurement tests how well your body resists an electrical signal passing through your body. (It’s a rough rule of thumb you should have a 30/70 percent split between fat and muscle, but please consult a medical professional for figures specific to your own body and medical needs.) For those with specific athletic goals, smart scales offer an athlete mode to better tailor readings for accuracy. If body fat monitoring is a priority, look for a model marketed as a body fat scale.

    BMI

    A lot of scales offer a BMI calculation, and it’s easy to do since you just plot height and weight on a set graph line. Body Mass Index is, however, a problematic measurement that its critics say is both overly simplistic and often greatly misleading. Unfortunately, it’s also one of the most common clinical body metrics and medical professionals will use it to make judgements about your care.

    Pulse Wave Velocity

    French health-tech company Withings has offered Pulse Wave Velocity (PWV) on its flagship scale for some time, although regulatory concerns meant it was withdrawn for a period. It’s a measurement of arterial stiffness, which acts as a marker both of cardiovascular risk and other health conditions. For those looking for an even deeper understanding of their health, some scales now offer a body scan, which provides more advanced metrics such as segmental body composition and vascular health insights.

    Wearables and integration

    Pairing your smart scale with wearables like fitness trackers or smartwatches can further enhance your health-tracking ecosystem. Many smart scales sync directly with platforms like Fitbit or Apple Health, making it easier to track trends and analyze your data in one place.

    Display

    Less a specification and more a note: Smart bathroom scales have displays ranging from pre-printed LCDs or digital dot matrix layouts through to color display screens. On the high end, your scale display can show you trending charts for your weight and other vital statistics, and can even tell you the day’s weather. If you are short-sighted, and plan on weighing yourself first thing in the morning, before you’ve found your glasses or contacts, opt for a big, clear, high-contrast display.

    App and subscriptions

    You’ll spend most of your time looking at your health data through its companion scales app, and it’s vital you get a good one. This includes a clear, clean layout with powerful tools to visualize your progress and analyze your data to look for places you can improve. Given that you often don’t need to buy anything before trying the app, it’s worth testing one or two to see if you vibe with it. It’s also important you check app compatibility before making your purchase. Some health apps will only work with iOS or Android — not both. Apple Watch connectivity can also be a bonus for tracking workouts and health metrics seamlessly. Several companies also offer premium subscriptions, unlocking other features – including insights and coaching – to go along with your hardware.

    Data portability

    Using the same scale or app platform for years at a time means you’ll build up a massive trove of personal data. And it is (or should be), your right to take that data to another provider if you choose to move platforms in the future. Data portability is, however, a minefield, with different platforms offering wildly different options, making it easy (or hard) to go elsewhere.

    All of the devices in this round-up will allow you to export your data to a .CSV file, which you can then do with as you wish. Importing this information is trickier, with Withings and Garmin allowing it, and Omron, Xiaomi, Eufy and Fitbit not making it that easy. (Apps that engage with Apple Health, meanwhile, can output all of your health data in a .XML file.)

    Power

    It’s not a huge issue but one worth bearing in mind that each scale will either run disposable batteries (most commonly 4xAAA) or with its own, built-in battery pack. Either choice adds an environmental and financial cost to your scale’s life — either with regular purchases of fresh cells or the potential for the whole unit to become waste when the battery pack fails.

    How we tested and which smart scales we tested

    For this guide, I tested six scales from major manufacturers:

    Mi (Xiaomi) Body Composition Scale 2

    Our cheapest model, Xiaomi / Mi’s Body Composition Scale 2 is as bare-bones as you can get, and it shows. It often takes a long while to lock on to get your body weight, and when it does you’ll have to delve into the Zepp Life-branded scales app in order to look at your extra data. But you can’t fault it for the basics, offering limited (but accurate) weight measurements and body composition for less than the price of a McDonald’s for four.

    Fitbit Aira Air

    Fitbit, now part of Google, is the household name for fitness trackers and smartwatches in the US, right? If not, then it must be at least halfway synonymous with it. The Aria Air is the company’s stripped-to-the-bare bones scale, offering your weight and a few other health metrics, but you can trust that Fitbit got the basics right. Not to mention that most of the reason for buying a Fitbit product is to leverage its fitness app anyway.

    Anker Eufy Smart Scale P2 Pro

    Eufy’s Smart Scale P2 Pro has plenty of things to commend it – the price, the overall look and feel (it’s a snazzy piece of kit) and what it offers. It offers a whole host of in-depth functionality, including Body Fat, Muscle Mass, Water Weight, Body Fat Mass and Bone Mass measurements, as well as calculating things like your Heart Rate and Basal Metabolic Rate (the amount of calories you need to eat a day to not change weight at all) all from inside its app. In fact, buried beneath the friendly graphic, the scale offers a big pile of stats and data that should, I think, give you more than a little coaching on how to improve your overall health.

    It’s worth noting that Anker – Eufy’s parent company – was identified as having misled users, and the media, about the security of its products a few years back. Its Eufy-branded security cameras, which the company says does not broadcast video outside of your local network, was found to be allowing third parties to access streams online. Consequently, while we have praised the Eufy Smart Scale for its own features, we cannot recommend it without a big caveat.

    Omron BCM-500 Body Composition and Scale with Bluetooth

    Given its role in making actual medical devices, you know what you’re getting with an Omron product. A solid, reliable, sturdy, strong (checks the dictionary for more synonyms) dependable piece of kit. There’s no romance or excitement on show, but you can trust that however joyless it may be, it’ll do the job in question and will be user-friendly. The hardware is limited, the app is limited, but it certainly (checks synonyms again) is steady.

    Joking aside, Omron’s Connect app is as bare-bones as you can get, since it acts as an interface for so many of its products. Scroll over to the Weight page, and you’ll get your weight and BMI reading, and if you’ve set a fitness goal, you can see how far you’ve got to go to reach it. You can also switch to seeing a trend graph which, again, offers the most basic visualization of your workouts and progress.

    Garmin Index S2

    Garmin’s got a pretty massive fitness ecosystem of its own, so if you’re already part of that world, its smart scale is a no-brainer. On one hand, the scale is one of the easiest to use, and most luxurious of the bunch, with its color screen and sleek design. I’m also a big fan of the wealth of data and different metrics the scale throws at you – you can see a full color graph charting your weight measurements and goal progress, and the various metrics it tracks in good detail. If there’s a downside, it’s that Garmin’s setup won’t hold your hand, since it’s for serious fitness people, not newbies.

    Withings Body Comp

    At the highest end, Withings’ flagship Body Comp is luxurious, and luxuriously priced, a figure I’d consider to be “too much” to spend on a bathroom scale. For your money, however, you’ll get a fairly comprehensive rundown of body composition metrics including your weight, body fat percentage, vascular age, pulse wave velocity and electrodermal activity. Its monochrome dot matrix display may not be as swish as the Garmin’s, but it refreshes pretty quickly and feels very in-keeping with the hardware’s overall sleek look.

    Withings Body Scan

    If you want to flaunt your cash, you don’t buy a car, you buy a supercar, or a hypercar if you’re flush enough. What then, do we call Withings’ $400 Body Scan if not a super-smart scale, or a hyper-smart scale? As well as doing everything the Body Comp does, plus running a six-lead ECG, segmented body composition, and will even check for neuropathy in your feet. It is the best scale I’ve ever used, it is also the most expensive, and I suspect it’s too much device for almost everyone who’d consider buying one.

    Smart scales FAQs

    What’s the difference between a smart scale and a regular scale?

    A regular scale is pretty straightforward — it tells you how much you weigh, and that’s usually it. A smart scale, on the other hand, does much more. Not only does it give you your weight measurements, but it can also track things like your body fat percentage, muscle mass, and even your BMI. Some smart scales even monitor more advanced metrics like bone density, depending on the model.

    What’s even better is that smart scales sync with scales apps on your phone using Wi-Fi or Bluetooth, so you can see all your health data in one place. This lets you monitor trends over time, like if your muscle mass is increasing or your body fat percentage decreasing.

    How do smart scales work with more than one person using it?

    When more than one person in a household uses the smart scale, it usually recognizes each person by their weight range and other body measurements (like body fat percentage). Most smart scales allow you to set up individual profiles in the companion app, and once your profile is linked, the scale can automatically figure out who’s standing on it.

    Let’s say you and a family member have fairly different weights — the scale will easily know who’s who based on that. But if you and someone else have similar weights, it might ask you to confirm the profile on your phone after the weigh-in. Some scales even let you assign a profile manually in the scales app if it’s not sure.

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    Daniel Cooper

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  • Coffee may help with muscle mass as you age, new study says

    Coffee may help with muscle mass as you age, new study says

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    Coffee may help with muscle mass as you age, new study says

    “The research shows a clear association.”

    Your go-to cup of coffee may do more than pep you up in the morning—it could help you to age more comfortably. That’s the main takeaway from a new study, which found a link between drinking coffee every day and having higher muscle mass. Video above: Six ways drinking coffee is linked to better healthIn case you’re not familiar with it, muscle mass is the amount of muscle in your body, and it helps with your strength, balance, and metabolism. Plus, as you age, having a higher muscle mass has been linked with more mobility and a lower risk of falls.But what does coffee have to do with muscle mass? Here’s the deal.What did the study find?For the study, which was published in Frontiers in Nutrition in August, researchers analyzed health data from more than 8,300 adults in the United States. The scientists looked at participants’ muscle mass through bone density scans and then compared that with their coffee intake from questionnaires.The study authors found that people who drank coffee every day had an 11 to 13 percent higher muscle mass than non-coffee drinkers. This, they concluded, may help lower the risk of developing sarcopenia, a musculoskeletal disease. (Worth noting: There did not seem to be an association between drinking decaf coffee and muscle mass.)“An appropriate increase in coffee and caffeine intake may be advocated in populations at high risk for low skeletal muscle mass,” the researchers added.Does coffee improve muscle mass?It’s important to point out that the study didn’t prove that drinking coffee gives you higher muscle mass. Instead, it found a link between a daily coffee and having higher muscle mass. “It’s not definitive proof that coffee alone will preserve muscle mass as you age,” says Scott Keatley, RD, co-owner of Keatley Medical Nutrition Therapy.Still, Keatley says that findings are “fascinating,” adding, “The research shows a clear association between coffee and caffeine intake and improvements in skeletal muscle mass.” As for why, Keatley says it could be due to the anti-inflammatory and antioxidant properties of caffeine. Inflammation is linked to decreased muscle mass, so tamping down on it could potentially have the opposite effect, he explains. Coffee may also help clear out damaged cells and maintain muscle integrity, Keatley says. “That could help prevent the muscle degradation typically seen with aging,” he says. Should I start drinking coffee for muscle mass? Nope, we’re not there yet. “While the research suggests coffee can have benefits for muscle mass, I wouldn’t recommend starting a coffee habit solely for that purpose,” Keatley says. “While coffee may have some benefits, it’s not a one-size-fits-all solution,” he says. “People need to take into account their own health, lifestyle, and whether caffeine affects them negatively.”If you want to build up your muscle mass, Keatley suggests focusing on having a balanced, protein-rich diet with lean sources like fish, chicken, and plant-based proteins. “Engaging in resistance training is a proven method to build and maintain muscle mass, and combining that with activities like walking or cycling helps improve overall function,” he says. And, if you happen to drink coffee, that may help you out, too.

    Your go-to cup of coffee may do more than pep you up in the morning—it could help you to age more comfortably. That’s the main takeaway from a new study, which found a link between drinking coffee every day and having higher muscle mass.

    Video above: Six ways drinking coffee is linked to better health

    In case you’re not familiar with it, muscle mass is the amount of muscle in your body, and it helps with your strength, balance, and metabolism. Plus, as you age, having a higher muscle mass has been linked with more mobility and a lower risk of falls.

    But what does coffee have to do with muscle mass? Here’s the deal.

    What did the study find?

    For the study, which was published in Frontiers in Nutrition in August, researchers analyzed health data from more than 8,300 adults in the United States. The scientists looked at participants’ muscle mass through bone density scans and then compared that with their coffee intake from questionnaires.

    The study authors found that people who drank coffee every day had an 11 to 13 percent higher muscle mass than non-coffee drinkers. This, they concluded, may help lower the risk of developing sarcopenia, a musculoskeletal disease. (Worth noting: There did not seem to be an association between drinking decaf coffee and muscle mass.)

    “An appropriate increase in coffee and caffeine intake may be advocated in populations at high risk for low skeletal muscle mass,” the researchers added.

    Does coffee improve muscle mass?

    It’s important to point out that the study didn’t prove that drinking coffee gives you higher muscle mass. Instead, it found a link between a daily coffee and having higher muscle mass. “It’s not definitive proof that coffee alone will preserve muscle mass as you age,” says Scott Keatley, RD, co-owner of Keatley Medical Nutrition Therapy.

    Still, Keatley says that findings are “fascinating,” adding, “The research shows a clear association between coffee and caffeine intake and improvements in skeletal muscle mass.”

    As for why, Keatley says it could be due to the anti-inflammatory and antioxidant properties of caffeine. Inflammation is linked to decreased muscle mass, so tamping down on it could potentially have the opposite effect, he explains.

    Coffee may also help clear out damaged cells and maintain muscle integrity, Keatley says. “That could help prevent the muscle degradation typically seen with aging,” he says.

    Should I start drinking coffee for muscle mass?

    Nope, we’re not there yet. “While the research suggests coffee can have benefits for muscle mass, I wouldn’t recommend starting a coffee habit solely for that purpose,” Keatley says.

    “While coffee may have some benefits, it’s not a one-size-fits-all solution,” he says. “People need to take into account their own health, lifestyle, and whether caffeine affects them negatively.”

    If you want to build up your muscle mass, Keatley suggests focusing on having a balanced, protein-rich diet with lean sources like fish, chicken, and plant-based proteins.

    “Engaging in resistance training is a proven method to build and maintain muscle mass, and combining that with activities like walking or cycling helps improve overall function,” he says. And, if you happen to drink coffee, that may help you out, too.

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  • The Truth About Marijuana And Muscle Mass

    The Truth About Marijuana And Muscle Mass

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    A lot of time is spent in the guy working on chest and legs…but what about marijuana and muscle mass?

    When you are young, it is easier to work out and look good. But if you are into competing or just want to look great, it still take discipline, diet and determination. As you age, you have to focus on it even more, but is using a little weed every now and then undermining your efforts?  What is the truth about marijuana and muscle mass.

    RELATED: How To Keep The Munchies From Ruining Your Diet

    The good news is, all a man has to do is fix his diet and dedicate time to cardio and strength training, and he can get himself back into fighting shape. You can’t turn back the clock, but you can wind it up again. In fact, many fitness conscious men claim to be in the best condition of their lives around middle age. It takes a lot of work to reach the goal though. After all, the body of an older male just doesn’t respond and recover like it did when 20. Which is a key reason men, especially older ones, have to be careful not to do anything that can destroy their gains. 

    Photo by Brodie Vissers via Burst

    Marijuana is legal to over 50% of the population. And it is starting a new heathly “ish” trend by having people drink less and consume more.  The beer companies are the first to feel the pain, but with Gen Z really slowing up on drinking, more changes are coming. Since cannabis can help with a workout, more fitness-minded people are open to adding it to the routine. Some athletes swear it makes workouts more productive, some use it as part of their recovery process (to combat inflammation), and others just do it because it is fun, relaxing and doesn’t come with the mega-calorie count of alcoholic beverages.

    As men age, there can be a drop in testosterone, the male sex hormone produced in the testes and adrenal glands. If testosterone levels drop, it makes it difficult to build lean muscle mass, maintain bone density and create an Insta worthy chiseled physique. Avoiding things like alcohol and fatty foods can help keep testosterone in check. So can lifting heavy weights. There is some research out there, however, suggests consuming marijuana might be harmful to testosterone levels.

    workouts
    Photo by Flickr user ThoroughlyReviewed

    But what is the marijuana and muscle mass. Can the herb, something with therapeutic properties, really sabotage your fitness goal?  Research has not given an answer. But it does seem light or moderate use is harmless toward your muscle goal. Heavier yes may have an impact, but more research needs to be done.

    RELATED: New Study Confirms Cannabis Users Are Not Lazy Stoners After All

    A study published in the Journal of Clinical Pharmacology says it could: “Cannabinoid administration acutely alters multiple hormonal systems, including the suppression of the gonadal steroids, growth hormone, prolactin, and thyroid hormone and the activation of the hypothalamic-pituitary-adrenal axis,” researchers wrote. This means marijuana users might have a tougher time keeping the testosterone levels needed to get ripped. But researchers admit that “the effects in humans have been inconsistent,” and they believe “tolerance” may even play a role. 

    fitness
    Photo by Greg Roebuck

    Other studies have found heavy marijuana use can lead to dramatic reductions in testosterone, while some have shown otherwise. One study indicated testosterone levels decrease after consuming weed, but those levels seem to return to normal after 24 hours. All in all the ill-effects of marijuana on testosterone remain a mystery. Still, it is more likely a man will harm his testosterone production with a junk food dieand a lack of exercise rather than smoking a moderate amount of marijuana.  

    RELATED: Smoking Marijuana Before Exercises Can Increase Workout Productivity

    Men in their forties trying to get back into shape should consult with a doctor and have their testosterone levels checked. There are many replacement therapies available for men. It is important to be forthright with your healthcare provider about any marijuana use, as treatment may need to be altered to account for this variable. There’s a chance it won’t matter to them at all.  

    If you are worried about marijuana destroying your gains, don’t. With the proper focus on eating right and a consistent workout regimen, your body should respond positively, with or without pot.

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    Terry Hacienda

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  • Ozempic Makes You Lose More Than Fat

    Ozempic Makes You Lose More Than Fat

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    The newest and much-hyped obesity drugs are, at their core, powerful appetite suppressants. When you eat fewer calories than you burn, the body starts scavenging itself, breaking down fat, of course, but also muscle. About a quarter to a third of the weight shed is lean body mass, and most of that is muscle.

    Muscle loss is not inherently bad. As people lose fat, they need less muscle to support the weight of their body. And the muscle that goes first tends to be low quality and streaked with fat. Doctors grow concerned when people start to feel weak in everyday life—while picking up the grandkids, for example, or shoveling the driveway. Taken further, the progressive loss of muscle can make patients, especially elderly ones who already have less muscle to spare, frail and vulnerable to falls. People trying to slim down from an already healthy weight, who have less fat to spare, may also be prone to losing muscle. “You have to pull calories from somewhere,” says Robert Kushner, an obesity-medicine doctor at Northwestern University, who was also an investigator in a key trial for one of these drugs.

    Kushner worries about patients who start with low muscle mass and go on to become super responders to the drugs, losing significantly more than the average 15 to 20 percent of their body weight. The more these patients lose, the more likely their body is breaking down muscle. “I watch them very carefully,” he told me. The impacts of losing muscle may go beyond losing just strength. Muscle cells are major consumers of energy; they influence insulin sensitivity and absorb some 80 percent of the glucose flooding into blood after a meal. Extreme loss might alter these metabolic functions of muscle too.

    Exactly how all of this will affect people on Wegovy and Zepbound, which are still relatively novel obesity drugs, is too early to say. (You may have heard these same two drugs referred to as Ozempic and Mounjaro, respectively, which are their names when sold for diabetes.) These drugs cause a proportion of muscle loss higher than diet and exercise alone, though roughly on par with bariatric surgery. Lifestyle changes can blunt the loss, but pharmaceutical companies are on the hunt for new drug combinations that could build muscle while burning fat.

    The arrival of powerful weight-loss drugs has moved the field beyond simple weight loss, Melanie Haines, an endocrinologist at Massachusetts General Hospital, told me. That challenge is largely solved. Instead of fixating on the number of pounds lost, researchers, doctors, and ultimately patients can focus on where those pounds are coming from.


    Doctors currently offer two pieces of standard and unsurprising advice to protect people taking obesity drugs against muscle loss: Eat a high-protein diet, and do resistance training. These recommendations are perfectly logical, but their effectiveness against these drugs specifically is unclear, John Jakicic, a professor of physical activity and weight management at the University of Kansas Medical Center, told me. He is now surveying patients to understand their real-world behavior on these drugs.

    Fatigue, for example, is a common side effect. “When you’re tired, and you’re fatigued, do you really feel like exercising?” he said. Haines wonders the same about eating enough protein. The drugs are so good at suppressing appetite, she said, that some people might not be able to stomach enough food to get adequate protein. (Food companies have started pitching high-protein snacks and shakes to people on obesity drugs.)

    If patients stop taking Wegovy and Zepbound—and about half of patients do stop within a year, at least in real-world studies of people taking this class of drugs for diabetes—the weight regained comes back as fat more than muscle, says Tom Yates, a physical-activity professor at the University of Leicester. Muscle mass tends not to entirely recover. It’s “almost as if you’re better off staying where you are than going through cycles of weight loss,” he told me.

    Yet, he pointed out, the U.K. recommends Wegovy for a maximum of two years. In the U.S., patients who can’t afford the steep out-of-pocket price have been forced to stop when insurance companies abruptly cut off coverage or a manufacturer’s discount coupon expires. These policies are likely to trigger cycles of weight loss and gain that lead, ultimately, to net muscle loss.


    Meanwhile, drug companies are already thinking about the next generation of weight-loss therapies. “Wouldn’t it be great to have another mechanism that’s moving away from just appetite regulation?” Haines said. Companies are testing ways to preserve—perhaps even enhance—muscle during weight loss by combining Wegovy or Zepbound with a second muscle-boosting drug. Such a combination could, in theory, allow patients to lose fat and gain muscle at the same time.

    Years ago, scientists first became interested in potential muscle-enhancing drugs that mimic mutations found in certain breeds of almost comically ripped dogs and cattle. At the time, they hoped to treat muscle-wasting diseases. The drugs never quite worked for that purpose, but the trial for one such drug, an antibody called bimagrumab, found that patients also lost fat in addition to gaining lean mass. A start-up acquired the drug and began testing it for weight loss in combination with semaglutide, the active ingredient in Wegovy, or Ozempic. And last year, Eli Lilly, the maker of Zepbound, snapped up that company for up to $1.9 billion—in hopes of making its own combination therapy.

    Pairing bimagrumab with an existing obesity drug could potentially maximize the weight loss from both. Losing weight tends to get harder over time; as you lose muscle, your body burns fewer calories. A drug that minimizes that muscle loss—or even flips it into muscle gain—could help patients boost the amount of energy their body expends, while Wegovy or Zepbound suppresses calories consumed. The mechanisms of how this might actually work in the body still need to be understood, though. Previous studies of bimagrumab found that patients grew more muscle, but they didn’t necessarily become faster or stronger. Haines, who is planning a small study of her own with bimagrumab, is most interested in how the combination affects not the structural but the metabolic functions of muscle.

    Bimagrumab is the furthest along of several drugs that tinker with the same pathway for muscle growth. The biotech company Regeneron recently published promising data on two of its muscle-enhancing antibodies paired with semaglutide in primates; a trial in humans is due to begin later this year. The start-up Scholar Rock is testing another antibody called apitegromab. Other companies are interested in combining the obesity drugs with different potential muscle boosters that work by mimicking certain hormones such as apelin or testosterone. If they succeed, the next generation of drugs could help sculpt a more muscular body, not just a smaller one. Eating less can only do so much to better your health.

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    Sarah Zhang

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  • ‘If Exercise Could Cure This, I Would Have Been Cured So Quickly’

    ‘If Exercise Could Cure This, I Would Have Been Cured So Quickly’

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    In the weeks after she caught COVID, in May 2022, Lauren Shoemaker couldn’t wait to return to her usual routine of skiing, backpacking, and pregaming her family’s eight-mile hikes with three-mile jogs. All went fine in the first few weeks after her infection. Then, in July, hours after finishing a hike, Shoemaker started to feel off; two days later, she couldn’t make it to the refrigerator without feeling utterly exhausted. Sure it was a fluke, she tried to hike again—and this time, was out of commission for months. Shoemaker, an ecologist at the University of Wyoming, couldn’t do her alpine fieldwork; she struggled to follow a movie with a complex plot. She was baffled. Exercise, the very thing that had reliably energized her before, had suddenly become a trigger for decline.

    For the majority of people, exercise is scientifically, physiologically, psychologically good. It boosts immunity, heart function, cognition, mood, energy, even life span. Doctors routinely prescribe it to patients recovering from chronic obstructive pulmonary disease and heart attacks, managing metabolic disease, or hoping to stave off cognitive decline. Conditions that worsen when people strive for fitness are very rare. Post-exertional malaise (PEM), which affects Shoemaker and most other people with long COVID, just happens to be one of them.

    PEM, first described decades ago as a hallmark of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is now understood to fundamentally alter the body’s ability to generate and use energy. For people with PEM, just about any form of physical, mental, or emotional exertion—in some cases, activities no more intense than answering emails, folding laundry, or digesting a particularly rare steak—can spark a debilitating wave of symptoms called a crash that may take weeks or months to abate. Simply sitting upright for too long can leave Letícia Soares, a long-hauler living in Brazil, temporarily bedbound. When she recently moved into a new home, she told me, she didn’t bother buying a dining table or chairs—“it just felt useless.”

    When it comes to PEM, intense exercise—designed to boost fitness—is “absolutely contraindicated,” David Putrino, a physical therapist who runs a long-COVID clinic at Mount Sinai, in New York, told me. And yet, the idea that exertion could undo a person rather than returning them to health is so counterintuitive that some clinicians and researchers still endorse its potential benefits for those with PEM; it’s dogma that Shoemaker heard repeatedly after she first fell ill. “If exercise could cure this,” she told me, “I would have been cured so quickly.”

    The problem is, there’s no consensus about what people who have PEM should do instead. Backing off physical activity too much might start its own downward spiral, as people lose muscle mass and strength in a phenomenon called deconditioning. Navigating the middle ground between deconditioning and crashing is “where the struggle begins,” Denyse Lutchmansingh, a pulmonary specialist at Yale, told me. And as health experts debate which side to err on, millions of long-haulers are trying to strike their own balance.


    Though it’s now widely accepted that PEM rejiggers the body’s capacity for strain, scientists still aren’t sure of the precise biological causes. Some studies have found evidence of impaired blood flow, stymieing the delivery of oxygen to cells; others have discovered broken mitochondria struggling to process raw fuel into power. A few have seen hints of excessive inflammation, and immune cells aberrantly attacking muscles; others point to issues with recovery, perhaps via a slowdown in the clearance of lactate and other metabolic debris.

    The nature of the crashes that follow exertion can be varied, sprawling, and strange. They might appear hours or days after a catalyst. They can involve flu-like coughs or sore throats. They may crater a patient’s cognitive capacity or plague them with insomnia for weeks; they can leave people feeling so fatigued and pained, they’re almost unable to move. Some of Shoemaker’s toughest crashes have saddled her with tinnitus, numbness, and extreme sensitivity to sound and light. Triggers can also change over time; so can people’s symptoms—even the length of the delay before a crash.

    But perhaps the worst part is what an accumulation of crashes can do. Rob Wüst, who studies skeletal-muscle physiology at Amsterdam University Medical Center, told me that his team has found an unusual amount of muscle damage after exertion in people with PEM that may take months to heal. People who keep pushing themselves past their limit could watch their baseline for exertion drop, and then drop again. “Every time you PEM yourself, you travel a little further down the rabbit hole,” Betsy Keller, an exercise physiologist at Ithaca College, told me.

    Still, the goal of managing PEM has never been to “just lay in a bed all day and don’t do anything,” Lily Chu, the vice president of the International Association for Chronic Fatigue Syndrome/Myalgic Encephalomyelitis (IACFS/ME), told me. In the 1960s, a group of scientists found that three weeks of bed rest slashed healthy young men’s capacity for exertion by nearly 30 percent. (The participants eventually trained themselves back to baseline.) Long periods of bed rest were once commonly prescribed for recovery from heart attacks, says Prashant Rao, a sports cardiologist at Beth Israel Deaconess Medical Center, in Massachusetts. But now too much rest is actively avoided, because “there’s a real risk of spiraling down, and symptoms worsening,” Rao told me. “I really fear for that, even for people with PEM.”

    There is no rulebook for threading this needle, which has led researchers to approach treatments and rehabilitation for long COVID in different ways. Some clinical trials that involve exercise as an intervention explicitly exclude people with PEM. “We did not feel like the exercise program we designed would be safe for those individuals,” Johanna Sick, a physiologist at the University of Vienna who is helping run one such trial, told me.

    Other researchers hold out hope that activity-based interventions may still help long-haulers, and are keeping patients with PEM in experiments. But some of those decisions have been controversial. The government-sponsored RECOVER trial was heavily criticized last year for its plan to enroll long-haulers in an exercise study. Scientists have since revised the trial’s design to reroute participants with moderate to severe PEM to another intervention, according to Adrian Hernandez, the Duke cardiologist leading the trial. The details are still being finalized, but the plan is to instead look at pacing, a strategy for monitoring activity levels to ensure that people stay below their crash threshold, Janna Friedly, a physiatrist at the University of Washington who’s involved in the trial, told me.

    Certain experimental regimens can be light enough—stretching, recumbent exercises—to be tolerable by many (though not all) people with PEM. Some researchers are trying to monitor participants’ heart rate, and having them perform only activities that keep them in a low-intensity zone. But even when patients’ limitations are taken into account, crashes can be hard to avoid, Tania Janaudis-Ferreira, a physiotherapist at McGill University, in Quebec, told me. She recently wrapped a clinical trial in which, despite tailoring the regimen to each individual, her team still documented several mild to moderate crashes among participants with PEM.

    Just how worrisome crashes are is another matter of contention. Pavlos Bobos, a musculoskeletal-health researcher at the University of Western Ontario, told me that he’d like to see more evidence of harm before ruling out exercise for long COVID and PEM. Bruno Gualano, a physiologist at the University of São Paulo, told me that even though crashes seem temporarily damaging, he’s not convinced that exercise worsens PEM in the long term. But Putrino, of Mount Sinai, is adamant that crashes set people back; most other experts I spoke with agreed. And several researchers told me that, because PEM seems to upend basic physiology, reduced activity may not be as worrisome for people with the condition as it is for those without.

    For Shoemaker, the calculus is clear. “Coming back from being deconditioned is honestly trivial compared to recovering from PEM,” she told me. She’s willing to wait for evidence-based therapies that can safely improve her PEM. “Whatever we figure out, if I could get healthy,” she told me, “then I can get back in shape.”


    At this point, several patients and researchers told me, most exercise-based trials for long COVID seem to be at best a waste of resources, and at worst a recipe for further harm. PEM is not new, nor are the interventions being tested. Decades of research on ME/CFS have already shown that traditional exercise therapy harms more often than it helps. (Some researchers insisted that more PEM studies are needed in long-haulers—just in case the condition diverges substantially from its manifestation in ME/CFS.) And although a subset of long-haulers could be helped by exercise, experts don’t yet have a great way to safely distinguish them from the rest.

    Even pacing, although often recommended for symptom management, is not generally considered to be a reliable treatment, which is where most long-COVID patient advocates say funds should be focused. Ideally, Putrino and others told me, resources should be diverted to trials investigating drugs that might address PEM’s roots, such as the antiviral Paxlovid, which could clear lingering virus from long-haulers’ tissues. Some researchers are also hopeful about pyridostigmine, a medication that might enhance the delivery of oxygen to tissues, as well as certain supplements that might support mitochondria on the fritz.

    Those interventions are still experimental—and Putrino said that no single one is likely to work for everyone. That only adds to the challenge of studying PEM, which has been shrouded in disbelief for decades. Despite years of research on ME/CFS, Chu, of the IACFS/ME, told me that many people with the condition have encountered medical professionals who suggest that they’re just anxious, even lazy. It doesn’t help that there’s not yet a blood test for PEM; to diagnose it, doctors must ask their patients questions and trust the answers. Just two decades ago, researchers and physicians speculated that PEM stemmed from an irrational fear of activity; some routinely prescribed therapy, antidepressants, and just pushing through, Chu said. One highly publicized 2011 study, since widely criticized as shoddy science, appeared to support those claims—influencing treatment recommendations from top health authorities such as the CDC.

    The CDC and other organizations have since reversed their position on exercise and cognitive behavioral therapy as PEM treatments. Even so, many people with long COVID and ME/CFS are still routinely told to blow past their limits. All of the long-haulers I spoke with have encountered this advice, and learned to ignore it. Fighting those calls to exercise can be exhausting in its own right. As Ed Yong wrote in The Atlantic last year, American society has long stigmatized people who don’t push their way through adversity—even if that adversity is a medically documented condition that cannot be pushed through. Reconceptualizing the role of exercise in daily living is already a challenge; it is made all the more difficult when being productive—even overworked—is prized above all else.

    Long-haulers know that tension intimately; some have had to battle it within themselves. When Julia Moore Vogel, a researcher at Scripps, developed long COVID in the summer of 2020, she was at first determined to grit her way through. She took up pilates and strength training, workouts she at the time considered gentle. But the results were always the same: horrific migraines that relegated her to bed. She now does physical therapy to keep herself moving in safe and supervised amounts. When Vogel, a former competitive runner, started her program, she was taken aback by how little she was asked to do—sometimes just two reps of chin tucks. “I would always laugh because I would be like, ‘These are not exercises,’” she told me. “I’ve had to change my whole mental model about what exercise is, what exertion is.”

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    Katherine J. Wu

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