Dr.Martinez said:Physical therapist weighing in on lean mass.
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 | 269 lbs | 224 lbs | 216 lbs |
| Fat mass | 119 lbs | 69 lbs | 51 lbs |
| Lean mass | 157 lbs | 144 lbs | 153 lbs |
| Body fat % | 38% | 30% | 25% |
Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.4g/kg protein. The lean mass discussion needs to include body comp data, not just scale weight.
Dr.SurgeonPGH said:Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.
Saving this. It is the first explanation that did not require me to already understand it. Sending this to two other people who asked me the same thing last week.
Dr.Martinez said:Physical therapist weighing in on lean mass.
OMG yes. lean mass + resistance training is the combo. Can confirm.
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Shop Reference Standardsmia_MS2 said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
mia_MS2 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.
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