CarlaRPh_TPA said:

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: Food…

CarlaRPh_TPA 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.

pam_stl said:

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

Saving this. It is the first explanation that did not require me to already understand it. Sending this to two other people who asked me the same thing last week.

CarlaRPh_TPA said:

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: Food…

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

nancy_portland said:

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

Regarding lean mass: I accidentally injected my dose intramuscularly instead of subcutaneously last week (went in at wrong angle, too deep). Called my pharmacist — they said it's not dangerous but may absorb faster, potentially causing more GI effects.

Sure enough, had worse nausea that day. Lesson learned: pinch the skin properly and use the right needle length for your body composition.

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