LindaRN_retired said:My endo's protocol for lean mass plateau: if weight loss stalls for 6+ weeks at current dose, we go through this checklist before titrating up: Food…
LindaRN_retired said:...the muscle loss concern with lean mass...
This is a legitimate and well-studied concern. Let me put some numbers on it:
In STEP 1, approximately 39% of weight lost was lean mass. However, the Lundgren 2024 study showed that structured resistance training reduced this to ~25% lean mass loss.
Context matters: at BMI 35+, you're carrying excess lean mass to support the extra weight. Losing some lean mass is expected and not inherently harmful if you maintain adequate muscle function through exercise.
The solution isn't avoiding the medication — it's combining it with proper exercise and protein intake.
oliver_london said:Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.
Genuinely useful, thank you. I had the facts and not the framework. I will report back once I have actually tried it.
LindaRN_retired said:My endo's protocol for lean mass plateau: if weight loss stalls for 6+ weeks at current dose, we go through this checklist before titrating up: Food…
Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):
| Metric | Baseline | Month 3 | Month 6 | Month 9 |
|---|---|---|---|---|
| Skeletal Muscle (lbs) | 71 | 69 | 73 | 75 |
| Body Fat (lbs) | 93 | 79 | 63 | 43 |
| Body Fat % | 43% | 34% | 28% | 22% |
| Visceral Fat (cm²) | 168 | 113 | 88 | 58 |
Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.
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Browse GL Biochemrachel_ABQ said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 45 lbs shifts your center of gravity and your core muscles need time to adjust.
Physical therapy has been essential. Core strengthening exercises (planks, dead bugs, bird dogs) daily for 10 minutes have eliminated my lower back pain. Your body is literally relearning how to carry itself.
Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Tagging this one for the weekly digest.