anders_CPH 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…
DEXA scan update relevant to lean mass:
Scanned at months 0, 6, and 12. Here are the body comp numbers:
| Baseline | Month 6 | Month 12 | |
|---|---|---|---|
| Total mass | 260 lbs | 225 lbs | 197 lbs |
| Fat mass | 100 lbs | 80 lbs | 47 lbs |
| Lean mass | 153 lbs | 155 lbs | 154 lbs |
| Body fat % | 45% | 35% | 21% |
Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.6g/kg protein. The lean mass discussion needs to include body comp data, not just scale weight.
One thing that is still open after anders_CPH’s answer:
What did you change at the same time, and can you separate the two now?
TrialTracker_MD said:DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.
Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 66 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.
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Shop Reference StandardsTrialTracker_MD said:DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.
TrialTracker_MD 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.
TrialTracker_MD said:DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.
That reframing is the part I needed.