Dr.NephBHM_UK said:

lean mass + resistance training is the combo.

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.

PeptideSynthNJ said:

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

Thank you for spelling out the reasoning rather than just the conclusion. Taking it to my next appointment.

Dr.NephBHM_UK said:

lean mass + resistance training is the combo.

Dr.NephBHM_UK 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.

adam_van said:

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

Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.

Lumbar spine T-score: -0.9 → -0.8 (stable to slightly improved)
Femoral neck T-score: -0.11 → -0.9 (stable)

No significant bone loss despite 76 lbs of weight loss. Key factors: adequate calcium (1200mg/day), vitamin D (5000 IU/day), resistance training 3x/week, and adequate protein. Weight-bearing exercise is critical for maintaining bone density during rapid weight loss.

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