Clinical perspective, offered as context rather than as advice.

ben_calgary 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.

hank_denver said:

Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep).

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

hank_denver said:

Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep).

Thank you for spelling out the reasoning rather than just the conclusion.

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: -0.12 → -0.9 (stable to slightly improved)
Femoral neck T-score: -0.10 → -0.10 (stable)

No significant bone loss despite 69 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.

Moderator note: a couple of off-topic posts removed. Thread quality here is what the rules are for. Keep it up.