Adding the clinical framing, because it changes how the question reads.

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.

Dr.RheumBOS said:

Physical therapist weighing in on lean mass.

This is my experience too, for whatever a second data point is worth.

Dr.RheumBOS said:

Physical therapist weighing in on lean mass.

DEXA scan update relevant to lean mass:

Scanned at months 0, 6, and 12. Here are the body comp numbers:

Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.4g/kg protein. The lean mass discussion needs to include body comp data, not just scale weight.

The figures, for anyone assembling their own picture. The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the same conditions. Nobody wants that answer and it is still the answer.

Closing the loop on my own question.

Reporting back for the archive rather than for the thread: I did the narrow version of what was suggested, gave it the full interval, and it settled. Posting it because threads without a follow-up are half a thread.