ZaraB_AL said:There is also a quality change that the scan cannot see.
ZaraB_AL 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.
Following on from MASHdoc_SA — and this may be the naive question:
Whether resistance training and protein change the ratio or only the absolute amount?
dave_SLC said:ZaraB_AL 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: -0.8 → -0.8 (stable to slightly improved)
Femoral neck T-score: -0.9 → -0.9 (stable)
No significant bone loss despite 50 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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Shop Reference StandardsClosing the loop on my own question.
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.
LipidDoc_ATL said:Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution. Hydration status moves the lean compartment by a kilogram or more between scans, so any comparison of scans done at different times of day or different hydration states is noise.