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Does a DEXA repeated every eight weeks give me an usable lean-mass trend?

Asked 24 Aug 2024Modified 20 months agoViewed 34k times
19

The trend is what I care about; individual weeks are obviously noise.

I am trying to choose between two options that are usually discussed as though only one exists.

I am not optimising for price, but I am not indifferent to it either.

Which axes does this decision turn on?

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KN
askedklara_novotna16k1624 Aug 2024
3Good answer, but the confidence interval in the cited trial is wider than implied. – Dr_Otto_Lindqvist 9 months ago
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5 Answers

Accepted answer first, then by votes
49

Accepted answer

What the data supports is narrower than what gets recommended, so it is worth separating the two.

Hydration state moves a DEXA lean-mass figure directly, because the algorithm assigns water to the lean compartment. Scanning fasted, at the same time of day, before training and without a recent high-carbohydrate day is the difference between a comparable sequence and a noisy one. Bioelectrical impedance is far more sensitive to hydration again, which is why its trend is unusable at this timescale.

On the detail: cardio does not interfere with lean-mass retention at the volumes anyone here is doing; the interference effect in the literature appears at high concurrent volumes in trained athletes. What cardio does at a large deficit is add to the deficit, which is either the point or a problem depending on the objective.

The body-composition substudies in the major programmes consistently report that the proportion of weight lost as fat mass is approximately three quarters or better, with the lean-mass fraction falling within the range seen in dietary weight loss of comparable magnitude[1].

The caveat is that population averages tell you about populations. Your own trajectory is a sample of one and should be read as a trend, not as a deviation from a published mean.

Train, eat the protein, measure something functional, and give the trend three months before you interpret it.

edited 10 Dec 2024 by Dr_Colm_Fitzhenry — tightened the wording; no substantive change

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answered · acceptedDr_Colm_Fitzhenry85k24810 Nov 2024
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58

The mechanism is worth having straight, because it predicts which interventions can work and which cannot.

The regain trajectory after stopping is roughly a mirror of the loss trajectory, and it is not primarily a willpower phenomenon. Appetite signalling returns, energy expenditure remains suppressed relative to the original mass, and the two combine. That is an argument for a maintenance plan existing before the stop, rather than an argument against stopping.

Worth being precise here: the first four weeks of loss is substantially fluid and glycogen. Each gram of stored glycogen carries roughly three grams of water, and total glycogen is on the order of 400 to 500 g, so the obligatory water shift alone accounts for a couple of kilograms. This is why the first month looks dramatic and the second looks like a plateau when in fact the fat-loss rate has not changed.

Measure strength as well as mass. It is cheaper, it is less noisy, and it is closer to what you actually care about.

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NT
answerednominal_ten14k172 Dec 2024
Useful. I have added the accept threshold suggestion to my own notes. – vialroom 9 months ago
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40

The commonly quoted figures for lean-mass loss are mostly measurement artefacts, and the artefact is well understood: fat-free mass as measured includes water and glycogen, both of which fall early and neither of which is contractile tissue.

Food noise returning is not obviously tolerance. Receptor desensitisation is one hypothesis; a second is that the initial effect was partly novelty and partly the steep early deficit, and a third is that intake has drifted upward and the signal is being outcompeted rather than weakened. The three make different predictions about what a dose increase would do.

On the detail: fibre at very low total intake is a trap. Soluble fibre needs water and motility to work; insoluble fibre adds bulk to a slow transit. At 900 kcal a day with delayed gastric emptying, an osmotic agent is more predictable than a bulking one, and adequate fluid is doing more work than either.

Worth stating that a DEXA sequence is only as good as its protocol consistency, and most people’s sequences are not consistent enough to support the conclusions drawn from them.

A maintenance plan written before you need it is worth more than a better loss plan.

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answereddeamidation_watch43k3821 Nov 2024
I have seen exactly this failure mode twice and both times it was the diluent. – kwn_analytical 3 days ago
The distinction between purity and content cannot be repeated often enough here. – ruaidhri_o_shea 2 months ago
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22

The part that matters: start with the arithmetic, because the answer to the practical question is usually a number and the number is usually achievable.

The minimum effective resistance-training dose in a deficit is lower than most programmes assume. Two sessions a week covering the major movement patterns, with loads taken close to failure, is sufficient to retain most of what would otherwise be lost. Volume beyond that adds recovery cost that a large energy deficit is poorly placed to pay.

Adaptive thermogenesis — a fall in energy expenditure beyond that predicted by the change in body composition — is documented across weight-loss interventions and is the mechanistic basis for the plateau being expected rather than anomalous.

The plateau is arithmetic. Treat it as arithmetic and the response follows.

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SB
answereds_bhattacharya42k3819 Oct 2024
Do you have a reference for the last claim? Not disputing it, just want to read it. – fibre_or_fragment 5 months ago
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-2

Worth being precise here: a plateau at four to six months is the expected shape of the curve, not a failure of it. Energy expenditure falls with mass, and the deficit closes itself unless intake falls further.

Absolute strength holds up better than scale weight during a deficit for a straightforward reason: strength is substantially neural and skill-based, and the contractile tissue you retain is being trained harder relative to its size. Grip strength and repetition maxima are therefore lagging indicators of muscle loss rather than leading ones, which is an argument for measuring both.

One qualification: none of this is a clinical assessment, and unexplained loss of function rather than of mass is a reason to see someone rather than to adjust a programme.

Two resistance sessions a week and a protein target you actually hit will do more than any refinement beyond them.

edited 10 Nov 2024 by bac_or_bust — updated for the 2026 guidance change

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answeredbac_or_bust37k13830 Oct 2024

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