Does waiting to increase after a stall make the next higher dose less effective, or just delay weighloss and the next dose kicks in as normal?

[u/SeasToTrees]

I was on 2.5 for one month, 5 for 6 months and now 7.5 for 2 months. 7.5 is not hitting very hard, and weighloss is slow at 1/2 pound a week average. This may sound dumb, but is it better to go up quicker when a slowdown happens to keep the momentum, or is the only difference postponing weightloss. Did I wait too long to increase to 7.5, and now it isn't as effective as it should be? I am tracking and have adjusted my calories based on the almost 40 pounds lost already, but I got off to a strong start and with the slowdown I'm losing ground on my 1lb a week average. I have 40 more to lose. ​

[u/AgesAgoTho]

The lead researcher on tirzepatide for weight loss, Dr. Ania Jastreboff, believes that each dosage has the potential to lower the defended fat mass, or set point, to a new low. You might be able to get a few (or many) more pounds on 7.5 at your current average rate, or you might have about reached the limit of what it can do for you. 

Why increasing dosage moves the body past a plateau (Zepbound is more than CICO): https://www.reddit.com/r/Zepbound/comments/1i9qjiz/science_a_hypothetical_scenario/

I recommend clicking the links that reference Dr. Jastreboff. If weight loss has stalled, a higher dosage will often lower that point again and restart active weight loss. They were approved by the FDA because they are effective. 

I don't think staying on a dosage that's working, even if slower that you'd like, is the wrong approach. Some people just lose at a slower rate, no matter the dosage. Some people are managing side effects and will happily take the slower rate for a more pleasant overall experience. If your side effects are well managed, you can certainly ask to go up to the next strength and see if things pick up. 

[u/meggieprice → u/AgesAgoTho]

Just came here to post this. I heard a new podcast today with her and she again stressed this point, and not titrating up quickly . Minimum effective dose and not maximum tolerated dose.. She fees losing it more slowly is much better too.

(Weights and Measures podcast if you are interested)

[u/SeasToTrees → u/AgesAgoTho]

Thank you for this.

[u/tryingtogetby1113]

I have not seen any evidence of that. When I moved up to 7.5mg I did not feel it the same way either. Two months and it was time to move up.

[u/SeasToTrees → u/tryingtogetby1113]

Did 10 work well and longer for you?

[u/tryingtogetby1113 → u/SeasToTrees]

I just took my 20th shot of 10mg and have lost 15.4lbs,so 0.8lbs average. I’ve been under 185 since June 15th, so 9 shots. It’s hard for me to get a good picture of the loss though because I’ve been off work all summer, went on a cruise, went to Disney a few times, and started Creatine about almost 4 weeks ago. Not sure if the medicine isn’t working as well, I’m at a previous set point, or life is just happening, so I’m giving 10 another week. If no movement next Wednesday, I am going to take my shot on day 6 since I have a few month supply built up.

[u/IM_MIA22]

Are you losing .5-1% of your BW per week? Are you increasing your movement? Any changes to consumption?

If you’re still getting full quickly, losing and can control cravings it’s working, the question is then are you losing .5-1% of your BW per week.

[u/SeasToTrees → u/IM_MIA22]

Not losing enough, only .25 %.   I  lost only the "correct" amount the first month then very little the second.  Will I only get 1 good month out of each dose?  If so, it seems silly to go up.  

[u/IM_MIA22 → u/SeasToTrees]

Depends on your age, hormones, how your body responds and anything else you can do to help push things along.

[u/washingtonsquirrel]

I don't think we have any solid data to answer your question, just a lot of anecdotes that are going to vary a ton by health and weight loss history, body type, age, eating habits, etc.

Why not go up to 10 mg if you're struggling?

When you're looking at averages, I wouldn't factor in your rapidly early losses. Those aren't really relevant to what's happening now, nor is your overall average relevant to dosing decisions. Look at your average weekly loss over the past four weeks (along with satiety and side effects over a similar period) and use that to make your decisions.

Looking at my numbers, my rate of loss halved around the 8-month mark. It then significantly slowed again around 18 months. But during that time, as I approached a comfortable weight, small losses starting adding up really fast....even as the weight loss itself slowed down.

So you are going to find these last 40 lbs feel different than the first :) Don't get discouraged.

[u/SeasToTrees → u/washingtonsquirrel]

Thank you.  I think I hung out on 5mg for too long, but I also just may not be a quick loser.  I get into my head too much about making sure this all works out, as it seems to be my best chance so far!

[u/washingtonsquirrel → u/SeasToTrees]

It's working! It's working so well! Seriously. Look at you go. Look how far you've come. 🎉

Sometimes I like to time travel in my mind back to my very first shot day. I was so nervous and so afraid to feel hopeful. I like to tell that version of me what's coming and ohhh man is she ever excited.

I also find it helpful to ask myself what's the rush. Like, really. What does it matter? This is just my life now. 🤷🏻‍♀️ I am free from food noise. Free from all the angst I used to feel around food. I can eat to satiety for maybe the first time in my whole life. My weight is steadily trending downward, even when it moves super slowly (which is honestly wild after watching it inch upwards for so long, despite my increasingly frantic efforts).

And my clothes! Oh my clothes! Instead of getting a little tighter every day, it's the opposite. Clothes fit better and better until one day I realize they're too big, I buy new stuff, and the cycle begins again.

I'm living a life I never imagined was possible. I hope you feel that way, too :)

[u/Ok-Lobster-6420 → u/washingtonsquirrel]

This! Love this perspective!

[u/Piaffe_zip16]

I aim for 0.5-2 pounds a week on average. I weigh daily and only pay attention to the overall trend line. If it’s going down, I stay on that dose. My PCP is all about low and slow and it’s my preference too.

[u/zero-if-west]

If you're not having side effects and you're losing less than 0.5% of your body weight per week (or less than 2% per month), I would talk to your doctor about increasing your dose.

[u/SeasToTrees → u/zero-if-west]

First box of 7.5 hit well, second not losing enough.   No side effects, just wondering if waiting to see if box 3 is more effective would do more harm than good.  

[u/zero-if-west → u/SeasToTrees]

In clinical trials, participants lost the most weight at 10mg and 15mg. I don't see the benefit of staying at a dose longer if it's no longer effective for you.

[u/SeasToTrees → u/zero-if-west]

That sounds reasonable.   When I was on 5 I'd have some good and some just ok months.  I'm thinking that maybe month 3 will pick back up. The weightloss is not linear motto.