Case Series: Reducing GLP1 Dosing Frequency Maintains Weight, Body Composition, and Metabolic Syndrome Improvements
- Thread starter Chili777
- Start date
FarmgirlRebel
Explorer
Interesting. It's good that research is starting to appear about how best to handle maintenance without giving up other health benefits.
I've been considering extending my injection interval to around 10 days once I move into maintenance, since at 10 days the peptide would be almost cleared from my body and then it would push me back up... something to think about.
I've been considering extending my injection interval to around 10 days once I move into maintenance, since at 10 days the peptide would be almost cleared from my body and then it would push me back up... something to think about.
lessthanhalf
Explorer
Seeing genuine long-term maintenance research is a welcome change. That said, I have several problems with this particular study.
I looked for details on how long participants had already been taking the drug before the switch to maintenance, and I came up empty. Had they already spent roughly 18 months on the GLP, their weight would in all likelihood be steady. What I am trying to establish is whether they were still shedding pounds at the moment of the swap, because I believe that point is decisive for reading this research. My reasoning goes like this: if keeping the weight-loss dose also keeps weight steady, which is what virtually every other study shows, then on what basis would a smaller dose work just as well? Sure, studies ought to confirm this, but it strikes me as an obvious inference from the evidence already in hand.
The only relevant line I could locate was this: "Patients who reported weight loss plateau (defined as less than 5% variation over a 3-month period) were invited to switch from standard once-weekly dosing to reduced-frequency dosing (every other week) at their current effective dose." That sounds quite sensible.
Yet when I examine the weight-over-time graphs, nearly every one of those patients was still dropping weight at the point they were moved to maintenance. So a plateau was not actually present. Most of them kept losing weight on the less frequent schedule, just more slowly. My view is that the flaw lies in how they defined plateau. A 5% weight change across 3 months is in fact rapid loss, equal to 20% per year, and I fail to see how that could satisfy any meaningful definition of plateau. That is precisely what the graph showed me. From where I stand, then, the study has a serious defect. I will run it through a heavily prompted chatgpt and report back what it concludes, and I will say so if I am misreading it.
Switching to a lower maintenance dose while weight is still falling is an entirely different study from switching at a truly stable weight. Repeat the same study after 18 months of treatment at a genuine plateau, and the results would very likely differ. So in my view the study has no real use. It only shows that when people whose obesity is mostly not severe are moved to less frequent dosing while still losing weight, they either keep losing more slowly or hold steady on that schedule. That is simply not useful information, it is fairly obvious and more or less pointless. The whole thing amounts to saying that people with mild obesity may be maintained on low or less frequent doses if they lost weight on low doses, or were still losing weight at higher doses.
Fortunately the image uploaded correctly this time, which makes it easier to see this in the graph.
Why peer review failed to catch this, I cannot say. Unless I am mistaken, which is possible and you should tell me, this is a bad study and probably ought to be retracted. It certainly does not demonstrate what it claims to.
I looked for details on how long participants had already been taking the drug before the switch to maintenance, and I came up empty. Had they already spent roughly 18 months on the GLP, their weight would in all likelihood be steady. What I am trying to establish is whether they were still shedding pounds at the moment of the swap, because I believe that point is decisive for reading this research. My reasoning goes like this: if keeping the weight-loss dose also keeps weight steady, which is what virtually every other study shows, then on what basis would a smaller dose work just as well? Sure, studies ought to confirm this, but it strikes me as an obvious inference from the evidence already in hand.
The only relevant line I could locate was this: "Patients who reported weight loss plateau (defined as less than 5% variation over a 3-month period) were invited to switch from standard once-weekly dosing to reduced-frequency dosing (every other week) at their current effective dose." That sounds quite sensible.
Yet when I examine the weight-over-time graphs, nearly every one of those patients was still dropping weight at the point they were moved to maintenance. So a plateau was not actually present. Most of them kept losing weight on the less frequent schedule, just more slowly. My view is that the flaw lies in how they defined plateau. A 5% weight change across 3 months is in fact rapid loss, equal to 20% per year, and I fail to see how that could satisfy any meaningful definition of plateau. That is precisely what the graph showed me. From where I stand, then, the study has a serious defect. I will run it through a heavily prompted chatgpt and report back what it concludes, and I will say so if I am misreading it.
Switching to a lower maintenance dose while weight is still falling is an entirely different study from switching at a truly stable weight. Repeat the same study after 18 months of treatment at a genuine plateau, and the results would very likely differ. So in my view the study has no real use. It only shows that when people whose obesity is mostly not severe are moved to less frequent dosing while still losing weight, they either keep losing more slowly or hold steady on that schedule. That is simply not useful information, it is fairly obvious and more or less pointless. The whole thing amounts to saying that people with mild obesity may be maintained on low or less frequent doses if they lost weight on low doses, or were still losing weight at higher doses.
Fortunately the image uploaded correctly this time, which makes it easier to see this in the graph.
Why peer review failed to catch this, I cannot say. Unless I am mistaken, which is possible and you should tell me, this is a bad study and probably ought to be retracted. It certainly does not demonstrate what it claims to.
lessthanhalf
Explorer
I asked chatgpt to review the study along with my post. It agrees with the earlier post that no unreasonable effectiveness claims are made about less frequent dosing, and it considers my description of the study as bad and deserving retraction to be overly severe. (So, if the authors happen to see this, I apologize.)
Even so, it does not dispute my core point: the plateau definition is completely nonsensical, since it matches the weight-loss rate produced by 15mg of tirzepatide over 1 year, roughly 20%, which is fast weight loss rather than a plateau. That makes the study's reasoning fundamentally flawed. What it actually demonstrates is only that less frequent dosing may work for maintenance in people with mild obesity and mostly normal BMI, provided it begins while they are still losing weight, which is essentially nothing new.
Even so, it does not dispute my core point: the plateau definition is completely nonsensical, since it matches the weight-loss rate produced by 15mg of tirzepatide over 1 year, roughly 20%, which is fast weight loss rather than a plateau. That makes the study's reasoning fundamentally flawed. What it actually demonstrates is only that less frequent dosing may work for maintenance in people with mild obesity and mostly normal BMI, provided it begins while they are still losing weight, which is essentially nothing new.
Their choice of "plateau" strikes me as under-explained and like it was selected to fit their particular sample — that part I'll grant. Still, once you get to 36 weeks on every-other-week dosing, what they found is promising. Whether that holds no matter how the group was assembled, or only because of how it was assembled, I can't say. Either possibility still needs more research to settle, and on that point I'm with you.
lessthanhalf
Explorer
Just to be clear, I didn't mean any shade toward whoever shared that study. This topic genuinely interests me, and it hits close to home since I'm in the unusual position of having begun GLP medications largely after the weight was already gone — so my purpose in taking them is upkeep, nothing more. Research aimed specifically at maintenance remains thin; about all we have comes from inferring based on weight curves in long-term follow-ups of people who stayed on the drugs or quit them. Reading that evidence, my takeaway is that maintenance demands full-strength dosing. Yet around here, the picture looks different: plenty of members appear to hold their weight steady on doses smaller than what got them to goal in the first place. So whatever can help square that contradiction is worth having.
Beyond what the conclusion states, there is also a lengthy, detailed section where the authors lay out the study's shortcomings — essentially:
- self-selection bias
- sample that is primarily white
- very few participants with obesity
- missing data for some follow-up points
- no control group
- the sample appears weighted toward older individuals
- a higher proportion of males than is typical in obesity studies
- the reduced frequency was not uniform among participants
- small sample size
True, a group of 30 participants isn't large. Rarer still are individuals resembling my own circumstances. Believe me, finding sasquatches willing to enroll in trials is no simple matter.
By the way - appreciate it, Chili!
By the way - appreciate it, Chili!
CNCCurrency
Explorer
From what I understand, the clearance period is roughly 28 days
CNCCurrency
Explorer
There is plenty here to unpack, thanks for sharing