Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean. I want to know whether that ratio is bad, normal, or simply what happens.
If you are tracking this properly: same scanner, same time of day, same hydration, at least six months apart, and read grip strength or a lift number alongside it. Function is the outcome; the scan is the proxy.
The narrow version of the question is what fraction of loss being lean mass is actually normal, because the numbers quoted here range from 10% to 40% and cannot all be right.
I have searched first, so if this is covered somewhere point me at it and I will read it.
Short answer first, then the reasoning. The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0 g/kg of reference body weight, and not making the deficit larger than the training can support. Cardio does not protect lean mass and in a deep deficit competes with recovery.
kate.chem said:The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…
Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.
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Shop Reference StandardsDr.RheumBOS said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
This matches mine closely enough to be worth saying so. 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 protein. Both numbers need a caveat that matters: "lean mass" on a DEXA is not muscle. It includes water, glycogen and the lean fraction of organs, and glycogen alone carries about three grams of water per gram. A large early lean drop is mostly the glycogen and water going, which is why the first scan flatters and the second is the honest one.
Adding the clinical framing, because it changes how the question reads.
Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 59 lbs shifts your center of gravity and your core muscles need time to adjust.
Physical therapy has been essential. Core strengthening exercises (planks, dead bugs, bird dogs) daily for 10 minutes have eliminated my lower back pain. Your body is literally relearning how to carry itself.