Dr.SurgeonPGH said:The honest range is roughly 20 to 40% of total loss as lean mass without deliberate resistance training, and roughly 10 to 20% with it plus adequate…
Genuinely useful, thank you. I had the facts and not the framework. Taking it to my next appointment.
Clinical perspective, offered as context rather than as advice.
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 | 284 lbs | 214 lbs | 211 lbs |
| Fat mass | 114 lbs | 84 lbs | 46 lbs |
| Lean mass | 152 lbs | 151 lbs | 158 lbs |
| Body fat % | 45% | 31% | 25% |
Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.5g/kg protein. The lean mass discussion needs to include body comp data, not just scale weight.
Dr.ObesityLA said:Training does two things here and only one of them is on the scale.
Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):
| Metric | Baseline | Month 3 | Month 6 | Month 9 |
|---|---|---|---|---|
| Skeletal Muscle (lbs) | 76 | 70 | 69 | 74 |
| Body Fat (lbs) | 93 | 78 | 56 | 44 |
| Body Fat % | 42% | 34% | 25% | 21% |
| Visceral Fat (cm²) | 173 | 118 | 93 | 63 |
Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.
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Shop Reference StandardsMikeFit_NJ said:There is also a quality change that the scan cannot see.
MikeFit_NJ 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.