Is losing slowly a mistake?

Labcat said:

Great question, though I don’t think anyone has studied it for glps.

Rapid weight loss does seem to make faces look gaunt at first, and that usually settles again — I saw the same thing in plenty of people back before glps existed. What I am not aware of is any real study showing a lasting difference in skin laxity based on how fast the weight came off.

In the same way, before glps there were large multi-year studies finding that fast weight loss was not any less likely to still be held at the 3 year mark, and because the excitement tends to produce the motivation to stay on a strict calorie limited diet, the rapid losers actually appeared to lose more.

When something works for you, your own case is the only data point you have that it works for you. I suspect we could all look inward and work out whether our reasons are internally or externally driven.

The one thing I keep coming back to is that the longer we sit at an unhealthy weight, the longer the problems tied to it — inflammation, for instance — keep affecting our health, possibly irreversibly. I have not seen data saying rapid weight loss is unhealthy unless malnutrition comes into it.

The mortality drop from glps (12%) appears to hold across all-cause death and across people with various or no underlying conditions, so glps probably do more than just keep weight off — they likely improve health regardless of that. (For comparison, tirz against glp1s in type 2 diabetics showed a 42% better mortality rate.)

I don’t think we really understand how the body adapts and accommodates to glp1 meds. They do trigger antibodies, but those do not seem to generally neutralise. We do know the body adapts in some ways, which is why paced escalation is recommended. Whether people stop responding and regain while on these meds would be a study well worth having… from what exists, it seems to work for 4 years at least.

Overall though, I don’t think anyone can tell you for certain. What you are doing is very health positive, so if being in control of your health matters to you, that is a good thing in itself.
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Over the course of my 50-pound loss, my BP has fallen sharply during the last 5. Regardless of the weight coming off, I'm happy to be reaching a healthy BP sooner.
 
For the last 18 months, I have stayed the course with a loss of just 1-2 lbs per week. Now at 52, I am sure that going at this pace has stopped my skin from sagging as badly as it otherwise would have.
 
I believe the window of opportunity is genuinely something to consider. Tolerance does build, and the medication's effectiveness does drop off over time. Getting as much weight off as possible while hunger suppression is still strong seems like a reasonable plan. There's also the setpoint idea suggesting your body keeps shedding pounds until it settles at a new "equilibrium." Either way, the take it slow method probably only offers one advantage: preserving more lean body mass and losing more fat, provided you train and eat right.

As for skin laxity, I doubt there's any link. Once your skin has been stretched past what it can snap back from, you'll have loose skin. That's it. Genetics play some role, and it also comes down to how much fat you gained as a percentage.
 
I hit the gym nearly every night because I don't want to end up skinny fat. I've just begun klow, hoping it will keep my skin from getting loose. Perhaps I'll end up looking 20 once more (and perhaps pigs will fly).
 
Devilseye said:

I believe the window of opportunity is genuinely something to consider. Tolerance does build, and the medication's effectiveness does drop off over time. Getting as much weight off as possible while hunger suppression is still strong seems like a reasonable plan. There's also the setpoint idea suggesting your body keeps shedding pounds until it settles at a new "equilibrium." Either way, the take it slow method probably only offers one advantage: preserving more lean body mass and losing more fat, provided you train and eat right.

As for skin laxity, I doubt there's any link. Once your skin has been stretched past what it can snap back from, you'll have loose skin. That's it. Genetics play some role, and it also comes down to how much fat you gained as a percentage.
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All of that sounds right to me. The one point I'd tack on: it's still unclear what role combining multiple glp-1s, or layering in other treatments, plays once the window of opportunity for pushing further weight loss has closed.

For tirzepatide specifically, the picture is fairly settled: losses level off around 12-15 months, and as long as the medication keeps being taken, patients hold at that lower weight, with no meaningful extra loss past the 12-15 month mark.

Where things get murky is what occurs after that window if someone moves to reta, or stacks phentermine, phentermine/topiramate, or naltrexone/bupropion on top of tirzepatide. Could that get a person all the way to "goal"? As far as I can tell, there isn't solid evidence or current clincial guidlines covering what to do when the first glp-1 doesn't get someone to their weightloss target.
 
Devilseye said:

I believe the window of opportunity is genuinely something to consider. Tolerance does build, and the medication's effectiveness does drop off over time. Getting as much weight off as possible while hunger suppression is still strong seems like a reasonable plan. There's also the setpoint idea suggesting your body keeps shedding pounds until it settles at a new "equilibrium." Either way, the take it slow method probably only offers one advantage: preserving more lean body mass and losing more fat, provided you train and eat right.

As for skin laxity, I doubt there's any link. Once your skin has been stretched past what it can snap back from, you'll have loose skin. That's it. Genetics play some role, and it also comes down to how much fat you gained as a percentage.
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Age matters too. How much laxity you get is also influenced by how old you are.
 
HereKittyKitty said:

Devilseye said:

I believe the window of opportunity is genuinely something to consider. Tolerance does build, and the medication's effectiveness does drop off over time. Getting as much weight off as possible while hunger suppression is still strong seems like a reasonable plan. There's also the setpoint idea suggesting your body keeps shedding pounds until it settles at a new "equilibrium." Either way, the take it slow method probably only offers one advantage: preserving more lean body mass and losing more fat, provided you train and eat right.

As for skin laxity, I doubt there's any link. Once your skin has been stretched past what it can snap back from, you'll have loose skin. That's it. Genetics play some role, and it also comes down to how much fat you gained as a percentage.
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Age matters too. How much laxity you get is also influenced by how old you are.
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Age matters enormously, in my view. Because I have no stretch marks and didn't end up with sagging skin after my pregnancies, my skin was never stretched past its limit — even though the weight I reached at the end of each pregnancy was much higher than what I weighed before starting GLP-1, and I did shed weight afterward. Still, that was 11 years back, and this time around, although my weight loss wasn't especially rapid, my skin has become loose and feels thin.
 
Grogu said:

Cypress said:

I began tirz a few months back and have increased the dose at a very gradual pace. Weight has come off, and I'm roughly halfway to my target. One reason I prefer a slower loss is to avoid people asking "what are you on". I keep my medication private. The other reason for going slow was loose skin, though I did just start klow. So here's my question: it seems like everyone tries to lose as fast as they can—what benefit does that give? Would I be better off switching up my approach? To me this is a marathon, not a sprint, since I expect to stay on this med for life.
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If you've already dropped 1/2 of the weight you wanted to lose after just a few months, that suggests your starting excess wasn't huge. That context matters, because other readers of this thread may be at the very beginning with far more to lose.

You're asking for the opposite perspective on the slow-and-steady approach, so here it is: for those carrying a lot of excess weight (which, again, may not describe you), there seems to be a limited "window of opportunity" — roughly 12 to 16 months — before glp-1 driven weight loss typically decelerates and stalls. Changing drugs or stacking could potentially overcome that plateau, though that's a whole other topic.

Given that window, low and slow may not be the optimal plan for someone with morbid obesity. Since the tirzepatide trials, the medical field seems to have updated its thinking on titration: if a patient keeps losing and has solid appetite suppression, there's no reason to go up in dose. On the other hand, if someone isn't losing or is battling food noise while handling their current dose well, increasing the dose is logical.



What worries me for people with a lot of weight to lose is that they might buy into the idea that low and slow is "better" and "less cheating," and in doing so miss out on the treatment's full potential — ending up short of the goals they could have hit with a more aggressive titration schedule, assuming they could tolerate it.
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Exactly! Across many subreddits on Reddit, plus FB and similar places, you'll find almost a cult-like devotion to Low and Slow. For certain people that approach does work, but like you said, research has shown that when someone has a large amount to lose, higher doses give the best outcomes—staying low offers no benefit. Still, good grief, in some groups I could say that and get my head bitten off.
 
spanky2026 said:

Grogu said:

Cypress said:

I began tirz a few months back and have increased the dose at a very gradual pace. Weight has come off, and I'm roughly halfway to my target. One reason I prefer a slower loss is to avoid people asking "what are you on". I keep my medication private. The other reason for going slow was loose skin, though I did just start klow. So here's my question: it seems like everyone tries to lose as fast as they can—what benefit does that give? Would I be better off switching up my approach? To me this is a marathon, not a sprint, since I expect to stay on this med for life.
Click to expand...

If you've already dropped 1/2 of the weight you wanted to lose after just a few months, that suggests your starting excess wasn't huge. That context matters, because other readers of this thread may be at the very beginning with far more to lose.

You're asking for the opposite perspective on the slow-and-steady approach, so here it is: for those carrying a lot of excess weight (which, again, may not describe you), there seems to be a limited "window of opportunity" — roughly 12 to 16 months — before glp-1 driven weight loss typically decelerates and stalls. Changing drugs or stacking could potentially overcome that plateau, though that's a whole other topic.

Given that window, low and slow may not be the optimal plan for someone with morbid obesity. Since the tirzepatide trials, the medical field seems to have updated its thinking on titration: if a patient keeps losing and has solid appetite suppression, there's no reason to go up in dose. On the other hand, if someone isn't losing or is battling food noise while handling their current dose well, increasing the dose is logical.



What worries me for people with a lot of weight to lose is that they might buy into the idea that low and slow is "better" and "less cheating," and in doing so miss out on the treatment's full potential — ending up short of the goals they could have hit with a more aggressive titration schedule, assuming they could tolerate it.
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Exactly! Across many subreddits on Reddit, plus FB and similar places, you'll find almost a cult-like devotion to Low and Slow. For certain people that approach does work, but like you said, research has shown that when someone has a large amount to lose, higher doses give the best outcomes—staying low offers no benefit. Still, good grief, in some groups I could say that and get my head bitten off.
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Plus, anyone who watches TV gets hit with Rebel Wilson every day, going on about how great microdosing is. "Micro changes, big results". 😂 No longer Fat Amy — now she's the face of microdosing.

Honestly, back when I started researching Zepbound and reading stuff online, I also believed low and slow was the way to go. After going through the clinical trials and plenty of scientific literature, though, nope. For most people that simply isn't correct.
 
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