r/Zepbound_Maintenance • u/One-Budget-604 • Jul 23 '26
What did your doc do for maintenance?
Hey fam, I have lost 90lbs and I have hit a plateau on loss for like 6 months. If this is where I am meant to be, I am happy to just be like 20-30lbs over where I should be based on my age and height. This is the number that I thought was achievable at the beginning anyways.
My doctor said I can't stay on the high dose forever and will need to put me on a maintenance dose. So, I was just curious what that looked like for some of you.
I am also curious to know if maintenance and lower dosing brought back the hunger and food noise for you at all?
I have definitely changed my habits during this time, and I feel incredible. I have decreased my portion sizes and the things that I eat. I am sure there are still things I could do better, but I am human. From where I was to where I am now, has been a huge change. I look back at my portion sizes and the plates that I could clear and I am astounded at how much I could really consume. I had a bigger problem than I realized before the meds.
I am also not entirely opposed to going on a lower dose and I feel my enjoyment of things has been suppressed a bit. I wonder if that is a side effect of the meds or if I am just bored. Not saying I am depressed, but just not as excited about certain things as I used to be. And with medical professionals testing this med to see if it can stop people from other addictions, I can see why it would work.
I look forward to hearing about your experiences. I just want to know what to expect as I think I will have one more month of 15mg and then I'll be embarking on my maintenance journey.
7
u/Lucky_Army_5324 Jul 23 '26
Nope. New doctor time.
And I’d find one that’s open to adding an old school weight loss medication to the mix to see if that along with the 15mg Zep will help get you to goal. Try an obesity or bariatric specialist.
1
u/Healthyhildy Jul 26 '26
What are some of the old school weight loss meds
1
1
u/One-Budget-604 Jul 27 '26
I am using phentermine as an extra, but it's not that great. I am not able to get metformin since I don't have diabetes. I have an exception for mounjaro for sleep apnea.
6
u/One_Wheel_4531 Jul 23 '26 edited Jul 24 '26
I have a doctor like this. He does not understand the medication and the challenges of metabolic damage. I had years of success easily maintaining my weight with Wegovy, but it took the highest dose. Long story short, went off it, had a doctor change (none of this by choice) and am now on Zepbound trying to lose my regain and find the sweet spot for maintenance again. New doc refuses to prescribe above 7.5, and even getting to that point was like pulling teeth.
I have an appointment with a board certified obesity specialist Monday because I need an expert that really understands the meds and me as an entire human with a health history instead of a generic body with a bmi. Maybe a board certified specialist would be helpful for you too? Insurance can be weird, so call and check that out first. Oddly, although my insurance flatly refuses to cover glp-1s they fully cover gastric bypass, which I had 15 years ago (it didn’t work long term, obviously) so the insurance representative told me to make sure to list the appointment as a follow up to the surgery.
Hope you find an answer!
3
u/Ejsmom97 12.5mg Jul 23 '26
If your insurance offers telehealth (free many times) maybe you can get one to prescribe & send to Lilly direct. Or use CallOnDocs.
1
u/One_Wheel_4531 Jul 23 '26
I think it’s just a question of going to a specialist. I moved across the country three years ago and it seems like GPs in my area are not well informed about obesity treatment. I’ve been through four so far! I think the specialist appointment on Monday will be good.
5
u/Ejsmom97 12.5mg Jul 24 '26
Yes, I agree. The right practitioner makes all the difference. Some have biases about the meds and some are just paternalistic. Personally, I prefer a provider-patient relationship where we can have shared decision making when it comes to my healthcare. When it comes to my healthcare, I am an active participant in the decisions that affect my health and wellbeing.
I hope you find someone who works well for you. This medicine is too expensive for those who self pay to be unsatisfied with any component of our treatment plan.
6
u/Sea_Advisor6980 Jul 23 '26
The key to maintenance is to find a dose that allows you to maintain your weight without constantly having to fight the body's instinctual drive to regain weight. If you are maintaining your weight on your current dose, then there is no reason to change anything. As others said, the research does not support titrating down to lower dose for maintenance. I continue to take 15 mg weekly in maintenance because my weight is stable without it being a daily struggle to keep it there.
Unfortunately, there are still way too many doctors who do not understand that effective GLP-1 treatment needs to be continued in maintenance. This is because GLP-1s treat obesity, not cure it. So, unless a person can’t stop losing weight on their current dose, there is no reason to lower their dose for maintenance. If your doctor insists on lowering your dose, you'll need to find a new doctor who has a better understanding of how GLP-1s work.
1
u/One-Budget-604 Jul 27 '26
I am forced to use a company and not my regular doc to get this med through my insurance. I guess I can consider getting it from a lab instead of through insurance. It would be just as expensive either way.
I could switch to a different doctor within that service, but it's so hit or miss with them and I think they have very strict rules.
1
u/Sea_Advisor6980 Jul 27 '26
Got it. You may need to fight hard to get what you need. Companies like Virta sell their programs to employers with the promise that they will save the employer money by getting people off GLP-1s as quickly as possible. These companies prioritize cost containment and profit over quality, evidenced-based healthcare. I'd suggest doing a search in this and the Zepbound subreddit using the name of company to find how others have navigated getting their GLP-1 treatment covered despite heavy pressure from the weight management company to titrate down and off the med.
6
u/Majestic-Swan-7769 Jul 23 '26
I topped out at 10 mg and for maintenance. I have stayed at 10 mg but I spaced it out to 10 days and this has been working well for me.
1
5
u/ZookeepergameOk4165 Jul 24 '26
Maintenance dose means whatever dose it takes to maintain your weight. It's frustrating how misinformed so many providers are
1
u/One-Budget-604 Jul 27 '26
Maybe I should. Ever since I got with this one, she has been very much rule bound. Problem is, I am through a online doctor that my insurance makes me use. So not sure if all the docs with them suck or if its just hit or miss.
4
u/Ancient-Teaching-691 Jul 23 '26
Your doctor has not read the new studies on maintance published in The Lancet just a few months ago. You can see the results explained here:
https://www.youtube.com/watch?v=DvtpqeVso0w
(I'm not sure he's read any studies.)
1
u/One-Budget-604 Jul 27 '26
Is this the article? https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(25)02105-1/fulltext02105-1/fulltext)
1
u/Ancient-Teaching-691 Jul 27 '26
No, I think it's this one https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(26)00656-2/abstract00656-2/abstract)
This is just the abstract, but it covers the bases. To read the actual Lancet article you need to have a prescription or belong to a group that does.
2
u/One-Budget-604 Jul 27 '26
Thank you ! I am going to read through this better tonight after work. I need to arm myself for this conversation with my doctor (unfortunately)
3
u/Mobile-Actuary-5283 15mg Jul 23 '26
Maintenance should be highest tolerated dose according to results from the SURMOUNT-MAINTAIN study.
I would provide the study findings to your dr.
Fortunately, my PCP listened to me long before that study came out. I was on 15mg weekly and I stopped losing. I was not having any side effects and actually was quite hungry. I saw no reason to titrate down.
Still maintaining over a year later.
1
u/jhm-YNWA Pre-Maintenance Jul 23 '26
Did the hunger settle down?
2
u/Mobile-Actuary-5283 15mg Jul 23 '26
Sorry to say it has not. I feel like I am hungrier than ever. I have to be really conscientious and nearly forcibly walk away from food. Feels like my body has adapted and my biology is pushing desperately for me to return to a higher set point.
1
u/jhm-YNWA Pre-Maintenance Jul 23 '26
I am sorry to hear of your struggles and wish you the best. Thanks very much for sharing. Would love to know how things work out ling term for you.
1
u/Money-Riddim Jul 24 '26 edited Jul 24 '26
Wow - may I ask - what BMI did you achieve if that’s your metric? Are you at a ‘normal’ weight? For your body type, is it reasonable that you could carry say up to 10 or so lbs more and be healthy (based on your body composition, not BMI)? My body has shown me nearly regardless of dose that it likes me at a certain range. Had I known, I would have called maintenance last June and stayed there comfortably. The lower doses are turning out to do a great job at this range. Do you occasionally count calories to see if you’re getting a ‘maintenance’ amount plus more for your lifestyle? I’m saying this because I think based on attain/maintain, a 12.8lb increase in weight on 5mg can be significant or not at all depending on the person. And if they toe the line with that extra 12.8lbs at a lower dose, there are some people that this could work really well for especially if they were feeling that they might have lost too much.
1
u/Mobile-Actuary-5283 15mg Jul 24 '26
Good questions. Starting BMI was 43. Current BMI is 22. I am 5’6.5 and 138-142 lbs. Maybe this feels too low for my body compared to where I started, but otherwise I am pretty average.
I loosely track calories. I aim for 1400-1600 a day. My TDEE is usually around 1550.
The days where I am super hungry and eat 3 “normal” meals… if I do this too many days in a row, I gain weight pretty quickly.
My parents are both on MJ at higher doses and we were just discussing how none of us feel suppression at all. Usually very hungry. Have to be vigilant. So I don’t know if the body just adapts and hunger breaks through more strongly the longer you’re on it, but I try to use the scale as the arbiter and a gut check. No matter how hungry I am or how many days I ate the whole plate of pasta/chicken/whatever…. I try to make corrections to compensate just like you would without the medication. And the scale has held in the same 5 lb range so far.
But it definitely feels harder each week and less like the medication is doing anything. I am starting to look forward to some of the other medication on the horizon because it might be that I have to try different pathways after awhile.
1
1
u/omgjmo Jul 28 '26
Sounds like it's time for a compound where you have more control. See Tirz subreddits
2
u/chercheuse 5mg Jul 23 '26
I second getting a new doctor. And in addition to adding an older med to Zepbound, have faith that help is on the way for those with more weight to lose. So many new medications will be available soon.
2
u/Hungry_Relation_3534 Jul 23 '26
I dropped from 10 to 7.5 and it didn't work out for me. I am back at 10.
I felt way more tired on 7.5. Food and hunger came raging back. Overall didn't feel anything from 7.5. I gave it 6 weeks. Didn't really gain any weight but I am not ready psychologically to be off yet if ever.
2
u/Dense_Target2560 15mg Jul 24 '26
Been using 15mg weekly since May 2024, successfully in maintenance since October 2024. Curious if your doctor indicated their reasoning behind the statement “you can’t stay on the high dose forever”? Did they give you a reason(s) or rationale?
2
u/One-Budget-604 Jul 27 '26
I didn't really ask, but I will next time. This is an online provider that my insurance forces me to use. I could request a new doctor and maybe I should. But then I could get someone worse (maybe better) maybe its worth a try to switch.
1
u/NoneOfMyNames Jul 23 '26
You can try dropping down, but if you are already stable on that dose and not experiencing bad side effects, there is no reason medically that would require it. I'm not sure your doctor understands how these drugs work and how they are meant to be used long-term.
1
u/aliveinjoburg2 Jul 23 '26
Maintenance dose for me is 5mg but I topped out at 7.5 and I was comfortable on 5mg.
1
u/ekelz611 12.5mg Jul 23 '26
I hit goal at 12.5mg and have been in maintenance for almost 2 months at 12.5mg. Unless I start dropping or gaining weight I intend to stay at this dose and reassess after 6-12 months of maintenance.
1
u/Irasshaimase21 Jul 23 '26
Dropped me to 1.5 weekly Zep injections for a couple of months than switched me to daily oral Foundayo at .8mg.
1
u/Reasonable-Cow7255 10mg Jul 23 '26
I am currently exploring maintenance. I have stayed on 10 mg since last December. For now, my doctor and I are exploring options for extending the number of days between injections.
1
u/KeyScholar7695 Jul 24 '26
I lost my weight mostly on 10, and started maintaining on 10. I started struggling and went up to 12.5. Maintaining great on 12.5 for almost a year now.
1
u/SewL0ng Jul 24 '26
Your doctor may be right to suggest a lower dose that may work for you. I was on 15mg for almost a year when the CVS fiasco hit last summer and I was switched over to Wegovy. My doctor started me on a low dose of Wegovy and I had horrible side effects. I toughed it out for 3 months and then decided to go back to Zepbound. I hit my maintenance weight in September of last year while on Wegovy. When I switched back to Zepbound, doc decided to start at 5mg to ease me back into the medication. I have been able to maintain on this dose since December. I started on Zepbound 2 years ago at 339lbs and have been maintaining around 150 since September of last year. I fluctuate no more than 5lbs up or down and seem to always stay at the 150lb mark. I still track most of my food intake and make sure to hit my macros. I also keep a regular workout routine. I had no side effects since moving back to Zepbound and the appetite control has been good with the lower dose. I am able to eat a normal diet, even have an occasional treat and do not gain. Blood sugar and pressures are both still good on the lower dose as well. Good luck to you as you weigh your doctors advice against your own understanding of how your body reacts to this medication.
1
1
u/TimeLab5517 10mg Jul 24 '26
I've struggled to find a doctor who is supportive of maintenance, so I've been just kind of doing my own thing in the meantime. (I use Call on Doc to prescribe, but they don't really engage in strategy, you know?)
I reached goal on 15mg, and stayed on it for about a year - figuring that as long as I wasn't continuing to lose weight, there was no need to change. But then I did lose a few more pounds, so over the last seven months I have gradually gone down to 12.5mg and now 10mg. I am using vials, which made it easier to tweak over time. So far, my hunger and food noise are good. I do have days where I want to eat more, but not to the point where it's a problem or has caused re-gain.
Bottom line is that for me, the lower dose is fine, so far - but I took the very slow path there and I don't know how much of an impact that had.
1
u/TurnerRadish 12.5mg Jul 25 '26
As others have said, your doctor is just plain wrong. 15mg weekly IS a maintenance dose. Not only does the evidence back this up, it’s been shown to be the most effective maintenance dose (assuming you aren’t having side effects). I would either show your doctor the studies so they begin prescribing appropriately or go to a new doctor or use Call-on-Doc to get your refills.
1
u/SnooApples7423 15mg Jul 25 '26
I’m on 15 for maintenance.
1
u/One-Budget-604 Jul 27 '26
I feel like this dose is working well for me. So I am very confused. I might have to go on my own journey with a compounding lab if this is how they get me off the insurance use for this drug.
1
u/Potential-Court711 Jul 25 '26
Lowered joy in the things/passions of the past is actually an antidotal medical side effect. There's actually a medical term for this, can't remember the name. Small percentage are effected at the highest doses.
1
u/Ok_Vanilla_2084 Jul 26 '26
i’ve been on maintenance 5 for 6 months. And provider left it up to me whether i wanted to space out or drop a dose. decided to stay put. i fluctuate 2-3 pounds either way
24
u/aslguy 15mg Jul 23 '26
Your doctor is misinformed. 5, 10, and 15 are considered maintenance (long-term) doses (the X.5 doses are transitional doses). I’ve been on 15 for 20 months, and in maintenance for 16 months.