james_edin said:Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep).
james_edin 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.
MikeKY_noInsulin said:Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.
That reframing is the part I needed. Sending this to two other people who asked me the same thing last week.
james_edin said:Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep).
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.
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View ResultsLeilaHI said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
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.