ingrid_STO said:

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months): Metric Baseline Month 3 Month 6 Month 9 Skeletal Muscle (lbs) 76…

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.

COA_Karl said:

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.

Thank you for spelling out the reasoning rather than just the conclusion. Sending this to two other people who asked me the same thing last week.

ingrid_STO said:

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months): Metric Baseline Month 3 Month 6 Month 9 Skeletal Muscle (lbs) 76…

Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 64 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.

fiona_glasgow said:

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

fiona_glasgow said:

...the muscle loss concern with lean mass...

This is a legitimate and well-studied concern. Let me put some numbers on it:

In STEP 1, approximately 39% of weight lost was lean mass. However, the Lundgren 2024 study showed that structured resistance training reduced this to ~25% lean mass loss.

Context matters: at BMI 35+, you're carrying excess lean mass to support the extra weight. Losing some lean mass is expected and not inherently harmful if you maintain adequate muscle function through exercise.

The solution isn't avoiding the medication — it's combining it with proper exercise and protein intake.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Report rather than reply if it drifts again.