Accepted answer
Take the STEP 3 body-composition substudy, not the main paper, and note how few participants were in it. Composition substudies are typically a small imaged subset of the full randomisation, so the lean-mass fraction carries a confidence interval far wider than the weight figures beside it. Then check the method: DEXA reports lean soft tissue, which includes water, and a large early fluid shift is counted as lean loss whether or not any protein left. The fraction most of these programmes land near is around a quarter of total loss, which is also roughly what caloric restriction alone produces — the interesting question is not the fraction but whether it differs from the deficit-matched control.
Answer first: lean mass falls during any substantial weight loss, typically as twenty to thirty per cent of the total, and the levers that change that fraction are protein intake and resistance training rather than anything pharmacological.
A deficit of five hundred to seven hundred and fifty kilocalories per day is the range within which lean preservation is generally achievable. Larger deficits work faster and cost more lean tissue per kilogram lost.
Scan-to-scan precision on lean mass is around one to two per cent for a good DXA under standardised conditions, so a change of half a kilogram is inside the noise.
Glycogen's water-binding ratio of roughly three to one is basic physiology and explains most early rapid weight change in any deficit.
Same machine, same time of day, same hydration state, or the series is noise.
Two of us ran the numbers on this and got the same lean fraction, for what that is worth. – Dr_Malik_Osei 4 months ago add a comment