Dr.LeslieOBGYN said:

lean mass + resistance training is the combo.

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.

bri_stats said:

Right, and protein targets should be set on a reference weight rather than current weight.

Thank you — that is the clearest version of this I have read, and I have read a lot of them. Sending this to two other people who asked me the same thing last week.

Dr.LeslieOBGYN said:

lean mass + resistance training is the combo.

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.

BethLabQueen said:

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

Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 43 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.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Tagging this one for the weekly digest.