Dr.MetabolicMD 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…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

A1cHero_PHX said:

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

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:

1. Food diary review — is intake creeping up?
2. Protein check — minimum 100g/day
3. Activity audit — steps + resistance training
4. Sleep quality — poor sleep kills GLP-1 efficacy
5. Stress/cortisol management

Only after addressing all of these do we increase the dose. Often fixing one lifestyle factor restarts progress without needing more medication.

NurseKim_ATL said:

I think this board over-worries about lean mass.

OMG yes. lean mass + resistance training is the combo. Can confirm.

A narrower follow-up, since the general answer is now clear:

Whether resistance training and protein change the ratio or only the absolute amount?

Closing the loop on my own question.

Follow-up: I dropped the cardio to two easy sessions and put the effort into three real lifting sessions. The scale slowed and the scan improved.