Your scale says you're doing great. Your DEXA might disagree.

DAILY RHYTHM · 4 MIN READ

Before you start a GLP-1, get a DEXA scan first.

Weight on a scale tells you one thing. It doesn't tell you how much of what you lost was fat versus muscle. That distinction matters more than the number itself.

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1. 01The scale isn't enough. GLP-1s and the newer dual and triple agonists can produce significant weight loss. But a meaningful portion of that loss can be lean mass, not fat, particularly if protein intake is low and resistance training is absent. If you only track the scale, you will not see this happening. A DEXA scan before you start gives you an actual baseline: total fat mass, lean mass, and bone density, measured, not estimated. Without it, you are flying blind on the thing that matters most for long-term metabolic health.
2. 02Muscle loss is a cost most people overlook. Losing muscle while on a weight loss drug is not a minor side effect. Skeletal muscle is where most of your glucose gets cleared. Losing it raises insulin resistance over time, which is the opposite of what you are trying to do. It also affects strength, falls risk as you age, and resting metabolic rate. The problem is that someone who drops 12kg and looks thinner may have lost 3-4kg of lean mass alongside the fat. That person's DEXA looks very different from someone who lost the same weight but preserved muscle. The number on the scale is identical. The clinical picture is not.
3. 03Baseline testing changes the approach. When we know your starting lean mass, we can set a protein target that actually fits your body weight and activity level, not a generic guideline. We can calibrate resistance training volume around the drug's appetite suppression. And we can run a follow-up scan at 12 or 16 weeks to see what actually changed in composition, not just weight. This is what personalised dosing looks like in practice. The molecule is one input, but the baseline body composition data shapes the plan.

OUR VIEW

GLP-1s are useful tools, but prescribing them without a body composition baseline is risky. The dose, the protein targets, the exercise prescription, all of it should be built around what the scan shows, not assumed from a BMI or a weight reading. At Expand Health, we treat the DEXA as the starting point, not an optional add-on.

P.S. If you have started a GLP-1 (or are thinking about it), have you had a DEXA scan before or during? Hit reply and tell me. I'd be curious to hear how many people are actually getting one.

— Emilian