5byfive said:
Sounds like the moment has come to put more emphasis on what you eat and rely less on the medication. A stall lasting months tells me your intake is not below maintenance. Tracking what you eat and choosing foods with fewer calories per bite is a better path than simply piling on additional drugs. The meds work best as a tool that helps you shift toward healthier eating, not as the main engine of weight loss.
Staying as active as you are is great, and plenty of people never manage that. It probably feels like your eating has been fine, but a stall of that duration means you are still taking in more calories than you burn. A calorie tracking app plus consistent, careful logging would be my strong recommendation; examine closely what actually goes in, and skip the app's own targets, since those have been found to be way off.
I get wanting that appetite suppression back, and hopefully it returns, but until then I would push you to seek out foods that are less calorie dense and to prioritize protein along with overall volume. That ought to help somewhat.
In this particular situation, I'd push back on that recommendation — I don't think it's the right call. Here we have someone dealing with serious, long-standing obesity, already eating very little, and stuck 2/3rds of the way toward their target while on the max tirz dose. Sure, the 1300 calorie figure might be off; most people are notoriously poor at tracking intake. But relying on deliberate mental restriction of calories over the long haul to manage obesity simply doesn't hold up well — you may get short-term wins, yet far fewer lasting ones. Changing what kinds of foods you eat is a less flawed strategy; I favor low calorie density, high protein patterns, since that makes it simpler to eat enough to feel less hungry without taking in excessive calories.
So far, apart from surgery, the only thing that appears capable of producing a meaningful shift in severe obesity is GLP medication. Research on how to proceed when someone stalls at max doses is still thin, though it will accumulate in time, and a fair number of members here have seen results well beyond trial data by combining agents and using higher doses. For me, they sustain a 55% loss, but achieving that takes a tirz/reta/cagri combo.
I'm deeply unconvinced by the idea of eating more to lose more in this setting. That isn't how the body operates. Yes, a handful of people online report success with it, but in my own case — fairly close to the OP's, with chronic adaptation to low intake and weight holding steady at 1600-1800 kcal/day — even an extra 100kcal/day puts weight on.
Should the hunger be causing real distress, one path is to raise reta doses more quickly, though that also raises the odds of stronger, more abrupt side effects. The safer route is split dosing — every 2 to 3 days, or twice weekly — so with twice weekly you might step up by 0.5mg of reta per dose: 2.5 twice a week, then 3mg twice a week, and so on, provided you ease off the increases once side effects or appetite suppression appear. Check glp plotter first, though. With smaller, more frequent doses, side effects usually resolve in about half the time once they show up.
If higher reta doses still leave you with major issues, returning to tirz with cagri added, or some reta plus tirz version — which appears to work in my case — may suit you better. Or simply raise tirz back to 15 mg alongside the lower reta dose, plus low dose cagri, which is basically my own regimen. Polypharmacy at this level with GLP's calls for at least some monitoring, ideally medical; checking blood pressure, lipids, liver function, renal function, blood counts and blood sugars is a sensible minimum. If diabetic, particularly on other meds, watch blood sugar very carefully.
Also worth noting: some people do get hungrier when starting reta because of the glucagon agonism, and that tends to fade as the body adjusts.
