Grogu said:
5byfive said:
I don't mean to come across as combative, yet my position hasn't changed. These trials aren't built to fine-tune the protocol; their aim is FDA clearance and media coverage. Everyone gets pushed upward fast to a set dose, then it stops there. As additional research comes out, my guess is we'll see that if diet is accounted for and the dose is raised according to weight loss rather than a calendar, people will climb doses more gradually and the medication will keep working for a longer stretch. Any specific dose will probably lose some punch as the body adjusts, but it defies logic that it would quit entirely, even when the dose goes up. In my view, a person who adjusts their diet and moves up in dose more slowly, guided by results and pounds lost, won't fare much worse than someone who doesn't do that and simply keeps raising the dose to shed weight. That also means the slower escalator has more room left to go up later, so they won't run into a ceiling on effectiveness at roughly the 1-year mark. Seems fairly sound to me. Eventually there will be more detailed studies that dissect this and either confirm or refute it, but I'm sticking with that take.
Good-faith disagreement is healthy, and everyone is allowed to hold their own views, myself included. I'll freely acknowledge that my perspective is shaped by my own circumstances: I was someone who had 100+ pounds to shed, which amounted to 39% of the weight I started at. And honestly, from the bottom of my heart, I wish the scenario you're describing were how things actually work. Yet when it comes to people with severe obesity, slow titration paired with low doses strikes me as a recipe where a lot of people simply never reach their target.
Take a relative of mine: she dropped 50 pounds without ever exceeding 2mg. She sits 3 pounds away from her goal and never once increased her dose. That said, she has only been on tirzepatide for roughly 9 months. Still, I suspect she wouldn't even have been eligible for the drug under the conventional criteria, since her BMI never went above 30 and she had no other medical conditions.
So if you (or anybody who reads this later) resemble my relative, then fine, sure, start low and move slowly. But when someone has a serious amount of weight to lose, that approach strikes me as illogical.
As of right now, I've dropped 115#s, which is 34% of my starting body weight. Plainly, I've sailed way beyond what the clinical trials predicted I would lose. My titration was fast and furious. I never sat around waiting through month-long stalls to decide my next dose. It's established that larger doses of every one of these medications produce the greatest weight loss, and that's the bottom line.
your receptors adapt to the dose, which is exactly why titration upward is possible 
