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

SurmountFan_IN 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.

DanielChem_CHI said:

DEXA scan update relevant to lean mass: Scanned at months 0, 6, and 12.

Genuinely useful, thank you. I had the facts and not the framework.

Clinical perspective, offered as context rather than as advice.

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

anna.melb_AU said:

lean mass + resistance training is the combo.

Same experience, arrived at from the opposite direction. The detail I would add is minor and it is already implied above.

Moderator note: the sourcing question belongs in the vendor section and has been split out. Tagging this one for the weekly digest.