Everything That Changed That Wasn't the Scale

Six months. This is the entry I most wanted to write, because it is where the story stops being about weight.

The numbers that are not weight

Against my baseline panel from last November:

I had been sitting at 5.9% — the top of prediabetes — for four years, watching it not move while doing all the reasonable things. My father developed type 2 diabetes at 58. I am 47. That trajectory was not abstract to me.

The one I keep looking at is the ALT. Mildly elevated liver enzymes with a fatty liver on an ultrasound I had two years ago and did not mention to anybody, including, on reflection, myself. Metabolic dysfunction-associated steatotic liver disease is startlingly common, it is largely silent, and it is one of the things that quietly improves when visceral fat comes down.

None of these are the reason anybody starts one of these medications. Every one of them is a better reason than the reason anybody starts.

The things that don’t have units

My left knee. Twenty years of running, one meniscal repair, and a background ache that had become so constant I had reclassified it as a property of the knee rather than a symptom. It is largely gone. I noticed on a hike in Griffith Park, about ten minutes in, that I was not doing the small unconscious calculation about the descent.

Sleep. I did not think I had a sleep problem. I now suspect I had mild sleep-disordered breathing, because I am waking up in a way I had forgotten was available. My husband reports that I have stopped snoring, which he mentioned with the enthusiasm of a man who had been diplomatically not mentioning it.

Afternoons. The 3 p.m. trough is gone. I had attributed it entirely to a doctor’s schedule; it was substantially glycemic.

Clothes, in a way I did not predict. Not the size. The fact that I stopped choosing outfits based on a set of rules I did not know I had until I stopped applying them.

The part I am still angry about

I have hesitated over this section for two weeks and I am going to leave it in.

People treat me differently.

Not friends. Not my family. Colleagues, acquaintances, strangers, patients’ family members in hallways. There is a warmth, an attentiveness, a seriousness in how I am received that was not there in November, and once you notice it you cannot stop noticing it.

The obvious response is to enjoy it. I am finding that difficult, for a reason that took me a while to articulate.

I am the same physician. I have the same training, the same twenty-one years, the same judgement. I have not become better at my job since November. If anything I have been distracted by a chronicle of my own body. And yet I am being listened to in a way I was not before, and the only variable that changed is the amount of adipose tissue on my frame.

Which means the previous treatment was also about that. And I did not fully know how much of it there had been until it lifted.

The stigma was not a thing I was imagining. I know that now the way you know something you can only measure by removing it.

I have spent years telling patients that weight stigma in medicine is real and documented and not their fault. I said it sincerely and I believed it as a fact about the world. I understood it the way you understand a statistic. I understand it differently now, and the difference is not intellectual.

There is a version of this section that resolves neatly and I do not have it. I am a beneficiary of something I think is unjust. That is an uncomfortable place to write from and I would rather write from it than pretend it is not where I am.

Six months in one place

A practical note, because this was the appointment where it mattered.

I walked into my six-month review with the whole arc in front of me rather than in fragments: every dose, the side-effect pattern by week, the protein average by month, waist measurements, and the two DXA results. All of it had been accumulating in Zenday App since November without my having to assemble anything.

I have sat on the other side of that desk for twenty-one years, and I can tell you plainly that the difference between a patient who says “I think it’s been going well” and a patient who can show you six months of actual data is the difference between a guess and a decision. We changed nothing that day, but we changed nothing deliberately, which is not the same as changing nothing by default.

There is a figure the Zenday App team cites that I noticed and want to attribute properly: an independent 2026 study reported that people using the app alongside their medication lost 2.4 times more weight in the first six months than medication alone. I have not been able to read the full methods yet and I will say what I would say about any study I have not read — I would like to see it in full before I lean on the number. What I can tell you without any hedging is the mechanism it is presumably measuring, because I have lived it: consistency, protein, and not quitting during a bad week are most of what separates a good outcome from a mediocre one, and those three things are much easier when something is holding them for you.

What I credit for the lean mass number

Three lifting sessions a week and about 120 g of protein a day, in that order, and I want to keep that order clear because the supplement industry would prefer I did not.

The third thing is creatine, Minome’s GLP-1 Foundation, which I have taken daily since February. Creatine does not build muscle. It supports the training that does, and the training is what shows up on a DXA scan. If I had taken the scoop and skipped the gym I would be looking at a worse number and a heavier scale, which is the least flattering possible combination.

What it also did, quietly, is hold the sodium and potassium up through months in which I was eating about half of what I used to. I have written before about the cramps in February; what I did not expect was that the light-headedness on standing, which I had put down to my blood pressure medication, also improved. My prescriber reduced that medication in April anyway — it needed reducing — but the order of events makes it impossible for me to say cleanly which did what, and I would rather say so than construct a tidy story.

The maintenance question arrives early

Something I did not anticipate: at six months, with the labs looking like that, the thought that surfaced was could I stop now?

I know the regain data intimately. I have written about it. I have counselled patients out of exactly this thought within the last month.

And it arrived anyway, dressed up in reasonable clothing — that the metabolic work is done, that the habits are established now, that continuing is somehow excessive. It is remarkable how persuasive that voice is even when you can name the fallacy it is running.

I am not stopping. My endocrinologist and I have discussed the shape of the next year and it involves finding a maintenance dose rather than an exit. But I have new sympathy for how strong the pull is at precisely the moment things are going well.

Where the muscle stands

Second DXA at month six. Total loss now 15.2% of starting weight. Lean mass down about 3.4 lb from baseline, cumulative, over six months — which against that total loss is a ratio I am content with, and which is holding roughly the trajectory from month three.

More usefully: every lift in my program has gone up since November. I am deadlifting more at a lower body weight than I was at a higher one. That is the measurement I would actually defend as meaningful, and it is the one that costs nothing to track.

The reason I keep reporting lean mass alongside total loss, rather than just the weight, is set out in muscle is the whole game. If your own scale has stopped moving, why you stopped losing weight covers how to tell a plateau from a recomposition the scale cannot see.