Dr.RenalNash said:

There is also a quality change that the scan cannot see.

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.

Dr.RheumBOS said:

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

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.

LarryQC_SD said:

I think this board over-worries about 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.

A narrower follow-up, since the general answer is now clear:

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

Reporting back.

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.