Adding the clinical framing, because it changes how the question reads.
Sharing my comprehensive lab data relevant to lean mass:
| Biomarker | Baseline | Month 3 | Month 6 | Month 9 |
|---|---|---|---|---|
| Weight (lbs) | 259 | 264 | 239 | 219 |
| A1C (%) | 7.9 | 6.9 | 5.6 | 5.6 |
| hsCRP (mg/L) | 9.0 | 5.0 | 2.5 | 1.5 |
| Triglycerides | 249 | 189 | 119 | 119 |
Protocol: Tirzepatide 15mg/wk, resistance training 4x/week, protein 1.6g/kg/day.
The improvements in lean mass are clearly reflected in these numbers. The inflammatory marker reduction (hsCRP) is particularly striking.
From the other side of the consultation, briefly.
Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Lumbar spine T-score: -0.10 → -0.7 (stable to slightly improved)
Femoral neck T-score: -0.12 → -0.8 (stable)
No significant bone loss despite 77 lbs of weight loss. Key factors: adequate calcium (1200mg/day), vitamin D (5000 IU/day), resistance training 3x/week, and adequate protein. Weight-bearing exercise is critical for maintaining bone density during rapid weight loss.
andrew_nyc said:Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
This matches mine closely enough to be worth saying so out loud. Posting only so the count is not one.
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Shop Reference Standardsandrew_nyc said:Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Physical therapist weighing in on lean mass. I work with bariatric and metabolic patients daily.
The resistance training evidence is critical here:
The Lundgren 2024 JAMA paper[1] showed that structured resistance training preserved 73% more lean mass in GLP-1 patients vs medication alone. When discussing lean mass, we MUST include the exercise component.
My minimum prescription: 3x/week compound movements (squat, deadlift, press, row), progressive overload, 7-10K steps/day, and 1.2-1.6g protein/kg/day.
[1] Lundgren JR, et al. JAMA. 2024;331(1):38-48.
Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. No action needed from anybody.