What Losing 87 Pounds Taught Me About Weight Loss Medicine
Authored by: Joshua Lindsley
I’ve been on both sides of the scale—literally.
Before medical school, I was a personal trainer. I understood macros, programming, and progressive overload. I helped clients lose weight and build muscle. I thought I understood metabolic health.
Then life happened. I lost my father in a drowning accident in Costa Rica. I channeled my grief into medicine, eventually matching into emergency medicine at UT Southwestern. And somewhere between the 80-hour weeks, the sleep deprivation, and the vending machine dinners, I became the overweight physician I never imagined I’d be.
I knew the textbook answers. I just couldn’t apply them to myself. Sound familiar?
The First 87 Pounds
When I finally committed to change, I did what many patients do now—I started GLP-1 therapy. Semaglutide. The weight came off fast. I watched the scale drop week after week and felt like I was finally winning.
Eighty-seven pounds gone. By every conventional measure, I was a success story.
But I made a mistake that I now see patients make constantly: I treated the scale as the only metric that mattered.
The Mistake Nobody Warned Me About
When I finally ran my own body composition data through a DEXA scan, the picture changed. Yes, I’d lost 87 pounds. But a significant portion of that loss was muscle—not just fat.
This matters more than most people realize. Muscle isn’t just for aesthetics. It’s a metabolic organ. It drives your resting metabolic rate, regulates glucose, protects your bones, and is one of the strongest predictors of how well you’ll age. Studies show that up to 40% of weight lost on GLP-1 medications can be lean mass.
I had lost weight, but I’d also lost some of my metabolic engine. I was lighter but more fragile. The scale said success; my physiology told a different story.
Redesigning the Approach
I had to start over—not from scratch, but with a completely different framework.
I set a protein floor based on my lean body mass, not my total weight. I prioritized resistance training three times per week with compound lifts. I tracked body composition, not just body weight. And I lost an additional 17 pounds—this time, almost entirely fat—while preserving and rebuilding lean tissue.
That experience fundamentally changed how I practice medicine.
What the ER Taught Me
My years in emergency medicine showed me the end stage of chronic disease: the 54-year-old with his first heart attack, the diabetic who ignored warning signs until she couldn’t feel her feet, the family receiving news that their loved one’s stroke was devastating and largely preventable.
Emergency medicine is heroic work. But it’s reactive. By the time patients reach the ER, the damage is often done.
I kept thinking there had to be a better way—one that intervenes before the crisis, not after. I wanted to stop pulling people out of the deep end and start teaching them how to swim.
What I Wish More Patients Understood
Here’s what my personal transformation and clinical experience have taught me:
The scale lies. It tells you how much you weigh, not what you’re made of. Two people at 180 pounds can have completely different health trajectories based on their ratio of muscle to fat.
Muscle is medicine. It’s your glucose sink, your metabolic insurance policy, and one of the best predictors of longevity we have. Protecting it during weight loss isn’t optional—it’s essential.
Data changes decisions. A DEXA scan takes 10 minutes and tells you exactly what you’re losing. An RMR test removes the guesswork from calorie targets. These aren’t luxury diagnostics—they’re the foundation for a plan that actually works.
Weight loss and weight maintenance are different games. Losing weight is hard. Keeping it off requires different skills entirely—consistent habits, regular self-monitoring, and often more physical activity than people expect.
The Path Forward
I built my practice around the lessons I learned the hard way. Every patient gets body composition data. Protein targets are based on lean mass. We use gold-standard measurements—DEXA, RMR, VO2 max—to build individualized plans, not cookie-cutter protocols.
My goal isn’t to help patients hit a number on a scale. It’s to help them become the leanest, strongest, most metabolically resilient version of themselves—and to maintain it for decades.
I spent years in the ER watching preventable disease end lives too soon. Now I’m trying to prevent those emergencies before they happen.
That shift—from reactive to preventive, from weight loss to body composition, from treating disease to optimizing health—started with my own 100-pound lesson.
Author bio: Joshua Lindsley, DO, is board-certified in Emergency Medicine and Obesity Medicine. He is the founder of Highland Longevity, a concierge longevity and wellness clinic in Fort Worth, Texas.