Been promising to post this for a while. I got DEXA scans at baseline and 6 months on tirzepatide (currently at 10mg). I also lift 4x/week and eat 150g+ protein daily. Here are my actual numbers:

DEXA Results:

Key takeaway: Of the 40.7 lbs I lost, 36.6 lbs (89.9%) was fat and only 3.9 lbs (9.6%) was lean mass. This is SIGNIFICANTLY better than the typical weight loss ratio of 65-75% fat / 25-35% lean mass you see with caloric restriction alone.

I attribute this to:

1. Consistent resistance training (upper/lower split, progressive overload)
2. High protein intake (0.8-1g per lb lean mass)
3. Possibly GIP's effects on muscle preservation (speculative but intriguing)

The visceral fat reduction is insane. Cut it by HALF. My metabolic health markers reflect this — will post bloods in a follow-up.

these numbers are INCREDIBLE. 90% fat loss to 10% lean loss is elite-level body recomposition. For context, the SURMOUNT trials showed approximately 60-65% fat / 35-40% lean mass loss in the overall population. You're significantly outperforming that.

This should be pinned as evidence that lifting + protein on tirz is non-negotiable if you care about body composition. The drug works even without exercise, but the QUALITY of weight loss is dramatically better with resistance training.

What's your protein source breakdown? And are you using creatine?

Protein sources: chicken breast, Greek yogurt, whey isolate (2 scoops/day usually), egg whites, lean ground turkey. I aim for 150-160g/day and track with MacroFactor.

Yes on creatine — 5g/day monohydrate. Have been for years though, so that's not a new variable.

I will say — eating 150g protein on tirz is WORK. The appetite suppression makes it really hard to hit protein targets some days. I basically have to treat protein like medicine and just get it down even when I'm not hungry. The whey shakes are crucial for this.

Can we talk about the bone density line? Even though it's "stable" — is there concern about long-term BMD loss with rapid weight loss on these drugs? I'm a 54yo postmenopausal woman and this terrifies me.

Valid concern, Sarah. Weight loss of any kind — surgical, pharmacological, or dietary — is associated with some degree of bone mineral density loss. The mechanical unloading hypothesis: bones adapt to support the load they carry, and rapid weight reduction removes that stimulus.

That said, Dan's results (-0.01 g/cm²) are essentially within measurement error for DEXA and suggest his resistance training is providing adequate skeletal loading stimulus.

For postmenopausal women, I recommend:

• Baseline DEXA scan before starting GLP-1 therapy
• Resistance training with emphasis on weight-bearing exercises
• Adequate calcium (1,200mg/day) and vitamin D (2,000-4,000 IU/day)
• Monitoring with repeat DEXA at 12 months
• Discussion with your provider about osteoporosis risk factors

The SURMOUNT data did not show clinically significant BMD loss at 72 weeks in the overall population, but subgroup analyses in postmenopausal women are limited. This is an active area of research.

— Board-certified endocrinologist