Dr.ObesityLA said:There is also a quality change that the scan cannot see.
I read this differently from Dr.ObesityLA, on substance rather than tone. I think this board over-worries about lean mass. Some lean loss is obligatory — you need less muscle to move a smaller body, and preserving mass you no longer need is not a health outcome. The question is whether strength and function held, and mine did.
zoe_NC said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
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.
anders_CPH said:I think this board over-worries about lean mass.
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 diary review — is intake creeping up?
- Protein check — minimum 100g/day
- Activity audit — steps + resistance training
- Sleep quality — poor sleep kills GLP-1 efficacy
- Stress/cortisol management
Only after addressing all of these do we increase the dose. Often fixing one lifestyle factor restarts progress without needing more medication.
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Browse GL BiochemA narrower follow-up, since the general answer is now clear:
Whether resistance training and protein change the ratio or only the absolute amount?
Reporting back.
Second scan under matched conditions came back with the lean number nearly a kilogram higher than the first, so a chunk of what I panicked about was hydration. Strength numbers were up throughout.