woundcarping said:
5byfive said:
lessthanhalf said:
In the trials, every participant is obese — the minimum BMI is typically 30, and the mean tends to be considerably higher — so it makes complete sense that larger doses are used in that setting.
Here on this forum, though, likely over half of members are not obese. They are either in the overweight range with BMIs of 25 to 30, or sometimes already leaner with fairly low body fat percentages, pursuing aesthetic goals or extremely low body fat for bodybuilding and similar. For that population, 12mg doses are genuinely neither suitable nor necessary. A year of 1mg reta was sufficient to produce an average 9% weight reduction, so it follows that those looking to shed modest amounts can do so at low doses, typically below 4mg. These drugs were never intended for that use case, and the studies were not built around it either. I get that even people who are irritatingly thin still want to be thinner, and that is their call, but the risk-to-benefit calculus is vastly different. Severe obesity carries very high health risks, so serious adverse events, even if uncommon, can be acceptable; those same health risks do not exist for someone who is only mildly overweight, yet the serious adverse events remain just as probable. A bodybuilder chasing a bit less fat will not be pleased when NAION costs them an eye — whereas for treating severe obesity, a small risk like that is a tolerable trade-off.
I am aware there are more than 2 groups here — the severely obese and the bodybuilders / mildly overweight — but for the purposes of this issue, splitting things into 2 camps does seem reasonable.
A recurring problem on the forum is when people in this latter category try to project their dosing logic or personal experience — usually low and slow — onto those with severe obesity, where the situation is simply not comparable. Those individuals are generally better served by doses and schedules closer to what the studies used, aiming higher rather than lower, and pursuing maximum weight loss that may still fall short of their target weight or the normal range.
And I think the endlessly repeated low and slow mantra really does lodge itself in people's minds, so even someone with 50 or 100 kilos to lose will often try to stay at unrealistically low doses, then wonder why it is not working.
The reverse seems less common: people applying severe-obesity GLP logic to those who are trying to lose a little weight or fine-tune body fat percentages.
Another point that keeps coming up: people say to just stick with the trial dosing schedule, but that doesn't automatically make sense. That schedule wasn't chosen because it's optimal — nobody actually knows what optimal looks like. It's a guess, applied uniformly to everyone. We're still in the early days of working out what the best doses are.
With any medication, I figure the lowest dose that works is the best approach. There's a saying: 'if it doesn't have side effects its probably not doing anything'. There's always some trade-off. It could be a higher chance of a rare problem, it could be extra cardiovascular strain, or it could be any number of other things. The important word there is effective. If it's already doing what you need, there's no reason to go up just for the sake of going up. When you notice effectiveness dropping, that's when to raise it. And it isn't a race either. Faster isn't necessarily better, its just faster.
Going slower doesn't equal doing better—it simply means it takes longer.
What works right now isn't the same as what works over the long haul, and "works" itself is a pretty fuzzy measure.
Across the trials, every dose levels off on roughly the same schedule. That suggests time plays some role. As far as I know, nobody has looked into whether raising the dose after you've already plateaued produces anything meaningful, particularly when stacked against the schedules that were actually trialed.
"Everything has a cost" holds true for the slow route too. Obesity comes with downsides that are well documented, widespread, and severe. Plateaus set in as time passes. Again—what are the usual severe downsides of GLP drugs?
From the standpoint of someone big:
"It's not a race"—but why crawl on your knees when bikes, cars, and public transit are available?
Life throws things at you. I'd rather seize the opening and the resilience while it's there instead of betting everything stays in my favor. Shedding 80-100lb over 8-10 months at 1% w/w crushes taking 16-22 months at .5% w/w. That plateau timeline definitely starts to matter somewhere around 69-95 weeks.
