hans_munich 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…
hans_munich 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 hans_munich — and this may be the naive question:
What did you change at the same time, and can you separate the two now?
labquiet_amy said:hans_munich said: ...the muscle loss concern with lean mass...
OMG yes. lean mass + resistance training is the combo. Can confirm.
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Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Lumbar spine T-score: -0.9 → -0.6 (stable to slightly improved)
Femoral neck T-score: -0.11 → -0.7 (stable)
No significant bone loss despite 76 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.
labquiet_amy said:hans_munich said: ...the muscle loss concern with lean mass...
This answered a question I did not know how to ask. Printing the relevant bit and taking it with me.