Sarcopenia is a diagnosis, not a synonym for losing lean mass
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
Exercise
Page 3 of 4 of this archive, newest first.
What we would need to randomise to answer this properly
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
The one randomised trial that combined an incretin with supervised exercise
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
The advice is mostly reasonable. The certainty is not earned.
A tour of the source literatures, with an assessment of how far each legitimately reaches.
The substudies, read properly: who was scanned, when, and with what
Both the reassuring reading and the alarming reading are supportable from the same tables. This piece sets out which is which.
Two scans, six weeks apart, and the arithmetic of believing the difference
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
Bone density during rapid weight loss: what is known, which is less than you would hope
Density is a proxy for strength and an imperfect one, particularly when soft-tissue thickness over the measurement site is changing.
Grams per kilogram of what? The denominator problem in protein guidance
Where the familiar figures come from, what populations they were measured in, and how far the extrapolation reaches.
Eating enough protein on a suppressed appetite is an arithmetic problem before it is a nutritional one
The practical difficulty is not knowing the target. It is meeting it on an appetite that has been pharmacologically reduced by half.
Bone density during rapid weight loss: what is known, which is less than you would hope
Density is a proxy for strength and an imperfect one, particularly when soft-tissue thickness over the measurement site is changing.
The one-quarter rule, and the paper that took it apart
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
Grams per kilogram of what? The denominator problem in protein guidance
Where the familiar figures come from, what populations they were measured in, and how far the extrapolation reaches.
Sarcopenia is a diagnosis, not a synonym for losing lean mass
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.
Why "muscle-sparing" is a marketing term and not a measurement
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
What the protein literature actually shows, and in whom it was shown
Where the familiar figures come from, what populations they were measured in, and how far the extrapolation reaches.
Why "muscle-sparing" is a marketing term and not a measurement
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.
Why "muscle-sparing" is a marketing term and not a measurement
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.
What we would need to randomise to answer this properly
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
Bone density during rapid weight loss: what is known, which is less than you would hope
Weight loss reduces bone mineral density at load-bearing sites. Whether that translates into fractures in this population is unmeasured.
Why the bone question is harder than the muscle question
What the Journal would want measured before treating this as settled in either direction.