Dr.PulmRoch said:

Physical therapist weighing in on 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.

Dr.PulmRoch said:

Physical therapist weighing in on lean mass.

This is exactly what I could not find anywhere else. I will report back once I have actually tried it.

Clinical perspective, offered as context rather than as advice.

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Lumbar spine T-score: -0.10 → -0.7 (stable to slightly improved)
Femoral neck T-score: -0.10 → -0.8 (stable)

No significant bone loss despite 57 lbs of weight loss. Key factors: adequate calcium (1200mg/day), vitamin D (5000 IU/day), resistance training 3x/week, and adequate protein. Weight-bearing exercise is critical for maintaining bone density during rapid weight loss.

PharmHunterJen said:

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Second this. Nothing to add that would improve it.

PharmHunterJen said:

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):

Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.