PedsEndoPhilly said:The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate…
PedsEndoPhilly 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.
Dr.GutHealth said:PedsEndoPhilly said: ...the muscle loss concern with lean mass...
Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Lumbar spine T-score: -0.10 → -0.6 (stable to slightly improved)
Femoral neck T-score: -0.9 → -0.7 (stable)
No significant bone loss despite 62 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.
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Follow-up: I dropped the cardio to two easy sessions and put the effort into three real lifting sessions. The scale slowed and the scan improved.
Dr.Martinez said:Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.