This aligns with the emerging literature. The STEP-HFpEF trial and several smaller studies have shown that when adequate protein intake and resistance training are maintained, the proportion of weight lost as lean mass can be reduced from the typical 25-40% range down to 10-15% or potentially even lower.
The key variables appear to be: protein intake above 1.2g/kg/day, progressive resistance training at least 3x/week, and avoiding excessively rapid weight loss. You hit all three.
For anyone reading this who's NOT currently doing resistance training on GLP-1 therapy — please start. You don't need a PPL split or anything complicated. Even 2-3 days per week of basic compound movements will make a meaningful difference in lean mass preservation.
This is exactly what I needed to see. I've been terrified of starting semaglutide because of the muscle loss stories. I lift 3x/week already so it sounds like I just need to keep that up and prioritize protein. Starting next week.
Appendicular lean mass (arms + legs — the best proxy for actual skeletal muscle) INCREASED by 2.6 lbs.
Even with the creatine caveat, this is outstanding. Most of the scary "muscle wasting" headlines are based on studies where participants did zero resistance training and had low protein intake. When you actually control those variables, the outcomes look completely different.
I'd also add: at 34.8% body fat, you were solidly in the "overfat" category. People with higher body fat tend to lose proportionally more fat and less lean during weight loss, especially when training. This may be harder to replicate for someone starting at 22% body fat.
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