labquiet_amy said:

The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. I think this board over-worries about lean mass. Some lean loss is obligatory — you need less muscle to move a smaller body, and preserving mass you no longer need is not a health outcome. The question is whether strength and function held, and mine did.

That is the short version; the long version is somebody else's post.

RunnerRach said:

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

Back pain as a lean mass side effect: not from the medication itself, but from rapid body composition changes. Losing 42 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.

mike_nyc said:

I think this board over-worries about lean mass.

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

Following on from Dr.GastroMayo — and this may be the naive question:

Whether resistance training and protein change the ratio or only the absolute amount?

OP back with an update, since a thread like this is useless without one.

Second scan under matched conditions, six months apart, same time of day: the lean number came back nearly a kilo higher than the panic scan. Strength was up throughout.