The Weight Is Coming Off. But What Exactly Are You Losing?

By Dr. Tanesha Handy Lloyd, MD · Wellness by Design, MD

I have been on both sides of this conversation.

Before I opened Wellness by Design, MD, I spent several years as a physician at a popular telehealth weight management company. We had patients across the country — different ages, different incomes, different education levels, different geographies, different life circumstances. Men and women. People in their 30s and people in their 60s.

What struck me, every single week, was how consistent the experience was across all of them. The same frustrations. The same confusion. The same sense of trying hard and not getting the answers they deserved. The scale moving in the right direction — and something still feeling deeply off.

I also spent several years as Medical Director at a MedSpa, where I saw the same pattern from a different angle. People investing in their appearance, their wellness, their confidence — and still missing the underlying metabolic picture that was driving everything they were trying to address on the surface.

And before all of that, I spent 20 years as a primary care physician — practicing in the East, the Midwest, and the South. Across all of it, the same thing was true: metabolic dysfunction does not care about your zip code, your income, your education, or your age. It is remarkably, almost stubbornly, universal.

What is also universal is how little time anyone gets to actually talk about it. A 15-minute appointment — which is what most primary care visits amount to — is simply not enough time to investigate what is happening beneath the surface. I know this not just as an observation. I lived it as a practitioner. You triage. You manage what is actively on fire. And the slow-burning metabolic story in the background keeps burning.

I am telling you all of this because I want you to understand where this post is coming from. Not from a textbook. From years of sitting across from patients who were not getting the conversation they needed — and from my own experience with my own body, which I will get to.

Something I hear almost every week

"The scale is moving. I know I should feel good about that. But I look in the mirror and I just feel deflated. My clothes fit differently even at the same number. My strength is down. I am tired in a way I was not before I started the medication."

If you are on a GLP-1 medication — semaglutide, tirzepatide, or any of the others — and this sounds familiar, I want to say something clearly before we go any further.

You are not imagining it.

What the scale cannot tell you

The scale measures one thing: total weight. It cannot tell you whether the number going down represents fat, muscle, water, or some combination of all three. For anyone on a GLP-1 medication, that distinction is not a minor detail. It is the entire story.

Research consistently shows that without deliberate physician oversight, a significant portion of the weight lost on GLP-1 medications comes from lean mass — not just fat. Some studies suggest this proportion can be as high as 30 to 40 percent of total weight lost. That means for every 10 pounds lost, up to 4 of those pounds may be muscle.

The scale shows you 10 pounds lost. It does not show you what those 10 pounds were made of.

I watched this happen at the telehealth company. Weight was going down. Patients were technically succeeding by every metric the platform measured. But nobody was looking at body composition. Nobody was checking whether the weight being lost was the kind of weight loss that would serve them long-term. The visits were too short, the panel too narrow, and the framework too focused on the number.

I understand why. It is a systems problem, not an individual provider problem. But understanding why it happens does not make it acceptable.

Why muscle loss matters beyond the mirror

When I talk to patients about muscle loss, the first thing I want them to understand is that this has nothing to do with appearance. It has everything to do with metabolism, longevity, and what happens after the medication.

Muscle is metabolically active tissue. It burns calories at rest. The more lean mass you carry, the higher your resting metabolic rate — the number of calories your body burns simply by existing. When muscle is lost, resting metabolism slows. This is one of the primary drivers of weight regain when GLP-1 medications are reduced or stopped. The medication created the deficit. The muscle loss slowed the engine that was supposed to sustain the results.

Muscle supports insulin sensitivity. Skeletal muscle is one of the primary sites of glucose uptake in the body. More functional muscle means better insulin sensitivity. Less muscle means glucose has fewer places to go — contributing to the insulin resistance that GLP-1 medications are trying to address in the first place.

Muscle drives energy and recovery. The fatigue many GLP-1 patients experience is frequently attributed entirely to caloric restriction. But muscle loss plays a direct role in reduced stamina, slower recovery, and the persistent low-energy feeling that sleep cannot fix. I see this constantly. And it is not the medication. It is what is happening to the lean mass underneath.

The two things that actually protect muscle

The research on this is consistent enough that I feel confident calling these requirements — not suggestions.

Adequate protein — more than you think you need.

The appetite suppression from GLP-1 medications is powerful. That is largely the point. But the consequence is that many patients significantly under-eat protein without realizing it, because their hunger cues have been dramatically reduced.

Research suggests that adults in a caloric deficit need approximately 1.2 to 1.6 grams of protein per kilogram of body weight daily to protect lean mass. For a 150-pound adult, that is roughly 82 to 109 grams of protein per day. Most people eating under appetite suppression are nowhere near that number — not because they are not trying, but because the medication has removed the signal that would normally tell them to eat more.

Protein has to be deliberate. Prioritized at every meal. Measured, at least initially.

Resistance training — compound movements, consistently.

Two to four sessions per week of compound resistance exercises — movements that recruit multiple muscle groups, like squats, rows, and presses — creates the anabolic signal your body needs to hold onto lean mass during caloric restriction. This does not require a gym. It requires consistency and progressive challenge. It requires giving your muscles a reason to stay.

What physician oversight actually looks like

In my practice, every patient on a GLP-1 medication undergoes InBody 580 body composition scanning — not once, but every two to four weeks. The InBody shows us lean mass by segment, fat mass, visceral fat level, and a marker called phase angle that reflects cellular health.

We also run PNOE breath analysis at baseline — which reveals the true resting metabolic rate and metabolic flexibility. These two numbers tell us, precisely, how the metabolism is functioning before a single element of the protocol is built.

When something changes — when lean mass starts declining — we see it early, while it is still reversible, and we adjust. That is what physician management looks like. Not a prescription and a monthly check-in. A comprehensive, continuously updated picture of what is actually happening.

A personal note

I have a closet that holds several sizes. I know what it feels like to watch your body change in ways that do not match your effort. I had my children after 40 — both of them — and the metabolic reality of pregnancy and postpartum at that age is something I experienced firsthand. After my first child and nursing, I actually felt better than I had before. After my second, all bets were off.

I am not sharing this because my story is the same as yours. It is not. But I want you to know that when I sit across from a patient who is frustrated, confused, and not getting answers — I am not operating from theory. I have been in that body. I know what it feels like to try hard and not understand what is happening.

And I know what changes when you finally have your data.

What to do if you are on a GLP-1 and concerned

Bring these questions to your next appointment:

- Can we assess my body composition — not just my weight — to see what I am actually losing?

- Is my protein intake adequate to protect my lean mass at this dose?

- What is your monitoring plan for my body composition throughout my treatment?

- Should we discuss a resistance training protocol built specifically for where I am right now?

If your prescriber does not have clear answers, that is information too.

If you want to understand what is actually happening in your body — a Metabolic Snapshot™ is exactly where I would start. PNOE breath analysis, InBody 580 scanning, and a physician-authored report that tells you what your metabolism is doing, what your lean mass picture looks like, and what to address first.

Or if you would rather have a conversation first, a Reset Rx Clarity Call is 60 minutes with me — your history, your goals, your clinical picture. Either way, you deserve more than a number on a scale.

Here’s to your Reset,

Dr. Tanesha Handy Lloyd, MD  ·  Wellness by Design, MD  ·  Lincoln Park, Chicago

Physician-prescribed. Data-driven. Built around you.

This post is for informational and educational purposes only and does not constitute medical advice. Please consult your physician before making any changes to your medication, supplement regimen, or exercise routine. All patients of Wellness by Design, MD are required to have a primary care physician. Wellness by Design, MD works alongside your existing care team — not instead of it.