SleepDoc_PDX said:There is also a quality change that the scan cannot see.
Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
Lumbar spine T-score: -0.12 → -0.8 (stable to slightly improved)
Femoral neck T-score: -0.9 → -0.9 (stable)
No significant bone loss despite 74 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.
A narrower follow-up, since the general answer is now clear:
Whether resistance training and protein change the ratio or only the absolute amount?
Dr.GutHealth said:Bone density monitoring on lean mass: DEXA bone density at baseline and month 12.
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.
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Shop Reference StandardsClosing the loop on my own question.
Follow-up: I dropped the cardio to two easy sessions and put the effort into three real lifting sessions. The scale slowed and the scan improved.
DeniseRN_TPA said:Physical therapist weighing in on lean mass.
Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.