Tirz or Reta for Maintenance....What's Your Approach?

[lessthanhalf]

Grogu said:

lessthanhalf said:

Since you're on that dose and have dropped that much weight, it's clear tirz is working well for you — that's a good sign. Whether you stick with tirz or switch to reta for the remaining weight or for upkeep probably won't change much; you appear to have plenty of room in your dosage to reach your goal while staying on tirz. The one point I consider key: according to the evidence, keeping the weight off means remaining at the dose that got you there — although some folks in this community do maintain on lower amounts. Still, since you'll be working to keep off a substantial amount, experimenting with reduced maintenance doses is reasonable, but should the weight start creeping back, don't be shocked if you need to push the dose up again.

Is that something you're certain about? I can't think of any research that looked at how maintenance dosing should be handled. That said, it's entirely possible I overlooked something.

From SURMOUNT, the takeaway I'd point to is this: when a person continues at the same dose they used while losing weight, weight regain tends not to happen. Still, that doesn't prove those individuals had to remain at those exact doses in order to hold their weight steady. Another thing SURMOUNT tells us is that quitting leads to regain, but for everything in the middle, I'm not confident about what conclusions we can draw.

The doses needed for maintenance are far from being definitively established, and some members here are holding their weight on low doses. My own view—that the same doses used for losing weight are needed to keep it off—rests on certain evidence along with how I understand the physiology of a plateau. At that point, the drug's dose counterbalances the weight-regain pressures of the reduced-weight state (appetite suppression from the medication against heightened hunger and lower energy expenditure from the loss), which explains why weight loss stops there: those forces are in equilibrium. Lowering the dose, then, ought to shift the balance back toward regaining.

My reasoning comes from the 4-year extension graph after the initial 1-year trial, where weight over time forms a flat line at the doses studied and remains flat across those 4 years. That logically implies the dose is maintaining the weight, at least on average, and does so across different doses. At this point I doubt there is much else long-term to rely on. So my inference from the data available is certainly not gold-standard clinical trial proof, and far more targeted, longer studies are clearly needed.

What puzzles me is that nearly every study I have come across on maintenance or plateaus defines stable weight as under 5% loss or gain over the prior 3 months. Since someone on the maximum semaglutide dose losing weight at the typical rate could still fit that definition, it strikes me as insufficiently strict to reliably identify plateau states—which makes me doubt the findings.