Dr.AddMedPHL said:

NurseKim_ATL said: ...the muscle loss concern with lean mass...

Sharing my comprehensive lab data relevant to lean mass:

Protocol: Semaglutide 2.4mg/wk, resistance training 3x/week, protein 1.4g/kg/day.

The improvements in lean mass are clearly reflected in these numbers. The inflammatory marker reduction (hsCRP) is particularly striking.

RunnerRach said:

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.

Thank you for spelling out the reasoning rather than just the conclusion. I will report back once I have actually tried it.

Dr.AddMedPHL said:

NurseKim_ATL said: ...the muscle loss concern with lean mass...

Muscle fiber type changes during GLP-1-mediated weight loss, relevant to lean mass: preliminary biopsy data suggests that weight loss shifts the skeletal muscle fiber type distribution:

• Decreased Type IIx (glycolytic, fast-twitch) fibers
• Increased Type I (oxidative, slow-twitch) fibers
• Improved mitochondrial density and function
• Enhanced insulin-stimulated glucose uptake per fiber

This "metabolic remodeling" of muscle may contribute to improved insulin sensitivity independent of total lean mass changes. The muscle you keep becomes metabolically better, even if there's less of it[1].

DataDave said:

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

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.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. No action needed from anybody.