Semaglutide and lean mass: DEXA scan longitudinal data

PharmacoVig_BOS said:

Worth knowing that the injection site changes very little.

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:

1. Food diary review — is intake creeping up?
2. Protein check — minimum 100g/day
3. Activity audit — steps + resistance training
4. Sleep quality — poor sleep kills GLP-1 efficacy
5. 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.

PharmacoVig_BOS said:

Worth knowing that the injection site changes very little.

PharmacoVig_BOS 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.

PharmacoVig_BOS said:

Worth knowing that the injection site changes very little.

Thank you for spelling out the reasoning rather than just the conclusion. I will report back once I have actually tried it.

From the other side of the consultation, briefly.

OMG yes. lean mass + resistance training is the combo. Can confirm.

Closing the loop on my own question.

Update since I posted: I held at 1.7mg for a further twelve weeks and lost another 4kg slowly, which settles it for me. I was escalating because the number was available, not because I had stopped responding.