Dr.LeslieOBGYN said:

Physical therapist weighing in on lean mass.

Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 66 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.

laura_annarbor said:

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

This answered a question I did not know how to ask. Sending this to two other people who asked me the same thing last week.

Dr.LeslieOBGYN said:

Physical therapist weighing in on lean mass.

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.

dave_SLC said:

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

DEXA scan update relevant to lean mass:

Scanned at months 0, 6, and 12. Here are the body comp numbers:

Lean mass preserved — actually GAINED 1-2 lbs thanks to progressive overload + 1.4g/kg protein. The lean mass discussion needs to include body comp data, not just scale weight.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part.