Dr.ObesityLA said:

There is also a quality change that the scan cannot see.

I read this differently from Dr.ObesityLA, on substance rather than tone. 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.

zoe_NC said:

Two DEXA scans eleven months apart: down 24kg total, of which the scan says 6kg was lean.

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.

anders_CPH said:

I think this board over-worries about 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.

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

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

Reporting back.

Second scan under matched conditions came back with the lean number nearly a kilogram higher than the first, so a chunk of what I panicked about was hydration. Strength numbers were up throughout.