sarah.morrison 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…
This is where I part company with the consensus forming above. I think this board over-worries about lean mass. Some lean loss is obligatory — you need less muscle to move a smaller body, and preserving mass you no longer need is not a health outcome. The question is whether strength and function held, and mine did.
amsterdam_pete said:Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.
Sharing my comprehensive lab data relevant to lean mass:
| Biomarker | Baseline | Month 3 | Month 6 | Month 9 |
|---|---|---|---|---|
| Weight (lbs) | 266 | 241 | 236 | 216 |
| A1C (%) | 7.6 | 6.6 | 5.5 | 5.3 |
| hsCRP (mg/L) | 6.0 | 5.0 | 1.5 | 1.2 |
| Triglycerides | 226 | 186 | 126 | 116 |
Protocol: Semaglutide 2.4mg/wk, resistance training 3x/week, protein 1.4g/kg/day.
The improvements in lean mass are clearly reflected in these numbers. The inflammatory marker reduction (hsCRP) is particularly striking.
Dr.ObesityLA said:I think this board over-worries about lean mass.
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.
[1] Lundgren JR, et al. JAMA. 2024;331(1):38-48.
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Browse GL BiochemFollowing on from pam_columbus — and this may be the naive question:
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?
Closing the loop on my own question.
Second scan under matched conditions, six months apart, same time of day: the lean number came back nearly a kilo higher than the panic scan. Strength was up throughout.