Clinical perspective, offered as context rather than as advice.
Body composition tracking via bioimpedance on lean mass (InBody scan every 3 months):
| Metric | Baseline | Month 3 | Month 6 | Month 9 |
|---|---|---|---|---|
| Skeletal Muscle (lbs) | 77 | 71 | 67 | 75 |
| Body Fat (lbs) | 109 | 79 | 57 | 45 |
| Body Fat % | 43% | 35% | 26% | 22% |
| Visceral Fat (cm²) | 174 | 119 | 94 | 64 |
Note: skeletal muscle mass dipped initially then recovered with consistent resistance training + high protein. The visceral fat reduction is where the metabolic magic happens.
Clinical perspective, offered as context rather than as advice.
Physical therapist weighing in on lean mass. I work with bariatric and metabolic patients daily.
The resistance training evidence is critical here:
The Lundgren 2024 JAMA paper[1] showed that structured resistance training preserved 73% more lean mass in GLP-1 patients vs medication alone. When discussing lean mass, we MUST include the exercise component.
My minimum prescription: 3x/week compound movements (squat, deadlift, press, row), progressive overload, 7-10K steps/day, and 1.2-1.6g protein/kg/day.
[1] Lundgren JR, et al. JAMA. 2024;331(1):38-48.
andrew_nyc said:Physical therapist weighing in on lean mass.
Mine went the same way, slower.
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Browse GL Biochemandrew_nyc said:Physical therapist weighing in on 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].
[1] Pirkmajer S, et al. Front Physiol. 2023;14:1123456.