lessthanhalf said:
My situation is not typical at all — the 90+% of weight loss happened before I ever began GLP's, and now I use them purely for maintenance. Right now that means 15mg tirzepatide along with 4.5mg retatrutide; pushing either one higher brings on skin sensory side effects that become unpleasant. I have just introduced 0.25mg cagrilintide as well. The goal is to hold onto a 54% weight loss.
For maintenance alone, that strikes me as quite a high amount.
If you're no longer dropping weight at a given dose, there's essentially no data suggesting a maintenance dose ought to differ from the dose that got you there — that's what every study demonstrates. Once people shed whatever percentage on the drug, the weight curve on those graphs flattens out and stays flat for extended stretches at the same dose. The stories that circulate here about reaching goal weights without stalling midway don't match the trial data, in part because trial groups are heavily screened and highly motivated, and in part because people add on other compounds.
Before glp's existed, the odds of someone taking off that much weight and holding it off over the long haul were minuscule — a few percent at most, absent surgery. And as for long-term effects of these drugs, there simply hasn't been enough elapsed time for much research to exist. That lines up with my own history: I could reach a normal BMI, but I could never remain there for long, ever since I turned obese suddenly at age 7.
Once I'd dropped the bulk of it, my weight held steady for roughly a year, though it was a struggle. Even while walking 3 to 11km daily and taking in 1600 to 1800 kcal daily, I felt hungry more or less constantly — and that was while following a diet I'd built myself specifically to blunt hunger: low calorific density, high protein, low glycaemic index, low fat, essentially lean meat, fruit and vegetables.
Semaglutide came next; it made me nauseous but dulled the hunger somewhat, and eventually I found cheap Chinese peptides, which widened my choices. The doses I'm on now are simply what I've arrived at gradually through trial and error, in the hope of making it possible to stay within the normal BMI range — so even with tirzepatide plus a little reta plus a new experiment using low dose cagrilintide, I still hold to a diet of total, absolute avoidance of anything high in calorific density or highly rewarding, and all of that is needed to keep the weight off. Should I ever reach a point where I'm still losing, even slowly, and would rather not lose more — which I doubt is very likely — then cutting doses or streamlining the medications would make sense.
Leaning on willpower to hold weight off long term while extreme hunger is present will essentially always fail. And in people with severe obesity, the appetite-regulating system is broken — that's why they have severe obesity — and it may not be repairable without ongoing treatment.
For most people, particularly those with more severe obesity, the core issue is that these medications still aren't good enough.
Thanks in advance
