100 lbs lost in 14 months — comprehensive DEXA and lab data

Dr.ObesityMed 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…

Muscle fiber type changes during GLP-1-mediated weight loss, relevant to lean mass: preliminary biopsy data suggests that weight loss shifts the skeletal muscle fiber type distribution:

• Decreased Type IIx (glycolytic, fast-twitch) fibers
• Increased Type I (oxidative, slow-twitch) fibers
• Improved mitochondrial density and function
• Enhanced insulin-stimulated glucose uptake per fiber

This "metabolic remodeling" of muscle may contribute to improved insulin sensitivity independent of total lean mass changes. The muscle you keep becomes metabolically better, even if there's less of it[1].

mona_PHX said:

Right, and protein targets should be set on a reference weight rather than current weight.

This answered a question I did not know how to ask.

Dr.ObesityMed 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…

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.

JakeSmashed95 said:

I lifted three times a week throughout and still lost lean mass.

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):

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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