Will Increasing the Dose Actually Move the Scale?

[tubby]

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

 

[tubby]

lessthanhalf said:

In my experience, the most satiating food per calorie is very lean meat. It also keeps hunger away for a longer stretch. I take in roughly 3g/kg/day, and I don't use protein powders or shakes at all — only low-fat dairy and meat. One upside is that you get a bonus of extra calories: digesting and metabolising protein burns around 20% of its calories, so for every 100 calories you eat you effectively get 20 cal at no cost, and free calories are welcome when you're trying to shed weight. That means if my daily protein intake is 800 kcal, the impact on my weight only amounts to 640 cal. That works out as one small extra snack each day, or a bit more or quicker weight loss.

As you approach a normal weight, your body fights harder to hold on to fat, cutting energy expenditure to match how much you're eating whenever it can. When I began at 145kg, I dropped 6 kg per month on the dot until I reached roughly 90kg, and then across the following 6 months the loss gradually slowed until it stopped completely, even though my calorie intake never changed at all during that whole period (about 1600kcal/day). The fall in energy expenditure caused by weight loss and metabolic adaptation can be enormous. Going from 6kg/mo to nothing is a drop of 1500kcal/day in under a year. And that 1600 a day was the amount I needed to eat just to avoid gaining weight — noticeably lower than what you'd predict for my age and activity level.

On paper, I get the idea that "protein is protein" — though I suppose you could dig deeper into amino acid composition. That said, I've noticed in my own experience that dairy-based protein (protein shakes, cottage cheese, greek yogurt, etc.) hits me in a different way than ground beef or steak does.

Whether it comes down to how quickly it's absorbed or something else entirely, I can't say. What I do know is that eating ground beef or steak makes me feel better, yet it appears to push my weight upward for some reason. I haven't done any body composition scans, so it's possible this is a lean mass versus fat issue. Still, when I switched from a keto diet to a carnivore diet, I put on a significant amount of weight.

 

[HereKittyKitty]

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

 

[tubby]

HereKittyKitty said:

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

I get why that idea gets repeated. Still, I can't bring myself to see it as even close to believable. For it to hold, your body would need some mechanism that records the exact schedule of dose increases you used.

Think back to the speed versus gas pedal comparison I made before. It would mean your car recalls how fast you built up speed, and now that same pedal position on that same stretch of road holds you at 85 MPH rather than 80 MPH simply because your acceleration pattern differed. Sure, I'll grant that on other sections of road — less wind, a different incline — the identical pedal position produces a different speed. But that is a completely separate matter.

Drawing on my history with diets, the way I picture body weight is this: you aren't really "gaining" or "losing" on any given diet so much as every diet pulls toward some particular weight outcome. When you move from one diet to another, the gain or loss comes from whether the new diet pulls toward a different outcome than the old one did. Take someone on the standard American diet — switching to carnivore would usually mean weight loss for them. On the flip side, a very thin raw-vegan with a low BMI who switches to carnivore would be expected to put weight on. Which diets pull toward which end weights does differ somewhat between individuals, naturally, given that our hormonal and biochemical profiles aren't identical.

The same reasoning fits a gym routine. Suppose one exercise program takes you from 250 pounds down to 240 pounds. Once you quit that program, you'd presumably drift back toward 250 pounds. Now suppose a different program gets you all the way to 230 pounds. If you'd begun with the milder program (the one that only reached 240) and then moved to the harder program, it seems far-fetched that you'd land somewhere other than 230 pounds merely because of which program you did first.

Apply that to GLPs, and it would be strange for them to be the one exception, where changing the pace of dose escalation alters the hormonal end result. What I can accept as possible — and here I'm on the same page as the slower-escalation crowd — is this: IF you dropped a lot of weight by racing up to the top dose, you might be poorly prepared to handle hunger (after months of heavy suppression) when it eventually shows up. The slower-escalation group, by contrast, may have built stronger hunger-coping habits during the process. How strong that effect is, I genuinely don't know, but it strikes me as plausible that something along those lines could shape the final outcome somehow.

 

[lessthanhalf]

HereKittyKitty said:

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

My view is that this belief about how GLP drugs behave comes from internet folklore rather than from the actual research. Nothing shows that the speed at which you move up in dose changes the total weight lost at the end; only the final dose matters. Going up slowly exists purely to keep side effects manageable, since jumping straight to maximum doses would land a sizable share of patients in the hospital with vomiting that will not stop, so easing the process and making it less miserable is very reasonable. The same folklore surrounds the idea of beginning with a weaker GLP so that a stronger one can be saved for when progress halts. That makes no sense whatsoever; choose the most effective option or the one that causes the fewest side effects. As things stand, I see no strong argument for semaglutide, since it produces more side effects while delivering less effect.

What I think drives the feeling of having "run out of runway" is simply expecting miracles from GLP drugs. There is a ceiling on how much weight is typically lost with them, and many people with more severe obesity have more to lose than these drugs can deliver. Also, exactly 50% of people will lose below the average weight loss recorded in the trials, with some unlucky individuals losing far less and a few fortunate ones losing far more.

The weight losses I encounter on this forum frequently exceed what the studies report, and I attribute that mostly to selection bias: those who experienced dramatic, life-changing results are the ones most inclined to post and keep discussing them.

For someone at a true plateau, meaning on the maximum standard dose and stuck there for a month or longer, they have simply reached what that drug can do for them. Accepting that and remaining on it strikes me as extremely important, because any meaningful weight loss improves health, even without reaching a BMI that is fully out of the overweight range. Prior to GLP drugs, doctors readily treated 5 or occasionally 10% weight loss that was maintained as a major win, given the substantial drop in long-term health risks.

No proven fix for this situation exists yet, backed by actual studies confirming safety, though anecdotal accounts show that stacking GLP drugs or raising doses can help. Hopefully future research will demonstrate that the health benefits justify the risks of these unstudied approaches.

 

[bbbilly]

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

yep, which is exactly why i said i seem to sit in a different camp from most folks on here. treating any appetite at all as the drug failing, and answering that by stacking on more, is the norm in this place. i look at it the other way: the med is a tool for coping with however much hunger shows up. being a little peckish instead of flat-out HANGRY and ravenous while the weight comes off? that counts as a win. you are no longer swallowed by that dark shadow of hunger — you just get a reminder that clouds exist up there while you get on with your day.

speaking for myself, i am running 1.5mg of tirz each 8 days, and that is plenty to put food on my radar — i catch myself on the edge of a binge and can tell myself "im not ACTUALLY hungry, but i WANT to eat", which is enough to send me to my meal prep rather than whatever snack is within reach. and as the half life fades close to injection day, i land in a familiar spot of "ok now i AM hungry, the otherday i guess i was just bored", and that reference point drags me back from the edge of a binge too.

i have got my own hangups and way of looking at all this, and i know other people are wired differently and their take is just as legit as mine. still, framing every bit of hunger as the enemy looks like a shortcut straight into dependence and over consumption.

 

[HereKittyKitty]

This discussion happened back when Ozempic was prescribed off label, several years prior to its weight loss approval and rebranding. Given how scarce the information was and how little context existed, calling someone's lived experience internet folklore is a bold move.

My words have been twisted. Maybe I didn't express myself well. These aren't ideas I feel like debating tonight. It's been an extremely long week and I'm exhausted.

Edited for typo

 

[tubby]

lessthanhalf said:

HereKittyKitty said:

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

My view is that this belief about how GLP drugs behave comes from internet folklore rather than from the actual research. Nothing shows that the speed at which you move up in dose changes the total weight lost at the end; only the final dose matters. Going up slowly exists purely to keep side effects manageable, since jumping straight to maximum doses would land a sizable share of patients in the hospital with vomiting that will not stop, so easing the process and making it less miserable is very reasonable. The same folklore surrounds the idea of beginning with a weaker GLP so that a stronger one can be saved for when progress halts. That makes no sense whatsoever; choose the most effective option or the one that causes the fewest side effects. As things stand, I see no strong argument for semaglutide, since it produces more side effects while delivering less effect.

What I think drives the feeling of having "run out of runway" is simply expecting miracles from GLP drugs. There is a ceiling on how much weight is typically lost with them, and many people with more severe obesity have more to lose than these drugs can deliver. Also, exactly 50% of people will lose below the average weight loss recorded in the trials, with some unlucky individuals losing far less and a few fortunate ones losing far more.

The weight losses I encounter on this forum frequently exceed what the studies report, and I attribute that mostly to selection bias: those who experienced dramatic, life-changing results are the ones most inclined to post and keep discussing them.

For someone at a true plateau, meaning on the maximum standard dose and stuck there for a month or longer, they have simply reached what that drug can do for them. Accepting that and remaining on it strikes me as extremely important, because any meaningful weight loss improves health, even without reaching a BMI that is fully out of the overweight range. Prior to GLP drugs, doctors readily treated 5 or occasionally 10% weight loss that was maintained as a major win, given the substantial drop in long-term health risks.

No proven fix for this situation exists yet, backed by actual studies confirming safety, though anecdotal accounts show that stacking GLP drugs or raising doses can help. Hopefully future research will demonstrate that the health benefits justify the risks of these unstudied approaches.

That same question has crossed my mind. It really does look as though nearly everyone in this space sits above the average. Selection bias could explain it, as you suggest, yet I also wouldn't be shocked to learn that having finer command over one's own dose amount and timing produces better outcomes than sticking to a fixed dose.

Of course, I just finished making the case that the speed of dose increases hardly matters, so this may read as me talking out of both sides of my mouth. What I'm really getting at is that I wouldn't be shocked if the intensity with which the people here fixate on GLPs and on managing them (rather than treating it as something in the fridge they grab once a week and otherwise barely consider) carries some indirect effect, and maybe lines up with taking on other helpful challenges.

Because you have to check out suppliers, get your head around crypto, and deal with all of that added friction, your psychological stake in both the process and the outcome ends up far greater than if a doctor simply handed you the thing and told you to take it weekly. It's a bit like valuing a bike you saved for all summer on a paper route far more than one your parents simply bought you.

And in striving to hold to the lowest effective dose the way bbbilly described, he does appear to be lining himself up for a possible slight extra advantage once he plateaus, since if he keeps that habit going at plateau it would seem to squeeze more out of the results, just as doing it before starting would probably yield some modest, sustained weight loss from sticking with it consistently.

 

[lessthanhalf]

Researchers actually use the phrase "Internet folklore" to describe the way GLP's or Anabolic steroids get discussed online. No personal criticism was meant by it.

To be honest, I find those perspectives on the drugs unhelpful. They can produce worse outcomes over the long term, and they can leave people feeling let down by their results and ready to quit.

This forum's strength is that members describe what they have lived through on these medications. That gives access to certain subjective experiences the studies simply cannot capture, and it is striking how much variation there is between people in both effects and side effects. Still, anecdotal reports have their own way of misleading, which is exactly why studies are run double blinded and why every result gets pooled together, so that placebo effects and genuine effects can be told apart.

 

[lessthanhalf]

tubby said:

lessthanhalf said:

HereKittyKitty said:

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

My view is that this belief about how GLP drugs behave comes from internet folklore rather than from the actual research. Nothing shows that the speed at which you move up in dose changes the total weight lost at the end; only the final dose matters. Going up slowly exists purely to keep side effects manageable, since jumping straight to maximum doses would land a sizable share of patients in the hospital with vomiting that will not stop, so easing the process and making it less miserable is very reasonable. The same folklore surrounds the idea of beginning with a weaker GLP so that a stronger one can be saved for when progress halts. That makes no sense whatsoever; choose the most effective option or the one that causes the fewest side effects. As things stand, I see no strong argument for semaglutide, since it produces more side effects while delivering less effect.

What I think drives the feeling of having "run out of runway" is simply expecting miracles from GLP drugs. There is a ceiling on how much weight is typically lost with them, and many people with more severe obesity have more to lose than these drugs can deliver. Also, exactly 50% of people will lose below the average weight loss recorded in the trials, with some unlucky individuals losing far less and a few fortunate ones losing far more.

The weight losses I encounter on this forum frequently exceed what the studies report, and I attribute that mostly to selection bias: those who experienced dramatic, life-changing results are the ones most inclined to post and keep discussing them.

For someone at a true plateau, meaning on the maximum standard dose and stuck there for a month or longer, they have simply reached what that drug can do for them. Accepting that and remaining on it strikes me as extremely important, because any meaningful weight loss improves health, even without reaching a BMI that is fully out of the overweight range. Prior to GLP drugs, doctors readily treated 5 or occasionally 10% weight loss that was maintained as a major win, given the substantial drop in long-term health risks.

No proven fix for this situation exists yet, backed by actual studies confirming safety, though anecdotal accounts show that stacking GLP drugs or raising doses can help. Hopefully future research will demonstrate that the health benefits justify the risks of these unstudied approaches.

That same question has crossed my mind. It really does look as though nearly everyone in this space sits above the average. Selection bias could explain it, as you suggest, yet I also wouldn't be shocked to learn that having finer command over one's own dose amount and timing produces better outcomes than sticking to a fixed dose.

Of course, I just finished making the case that the speed of dose increases hardly matters, so this may read as me talking out of both sides of my mouth. What I'm really getting at is that I wouldn't be shocked if the intensity with which the people here fixate on GLPs and on managing them (rather than treating it as something in the fridge they grab once a week and otherwise barely consider) carries some indirect effect, and maybe lines up with taking on other helpful challenges.

Because you have to check out suppliers, get your head around crypto, and deal with all of that added friction, your psychological stake in both the process and the outcome ends up far greater than if a doctor simply handed you the thing and told you to take it weekly. It's a bit like valuing a bike you saved for all summer on a paper route far more than one your parents simply bought you.

And in striving to hold to the lowest effective dose the way bbbilly described, he does appear to be lining himself up for a possible slight extra advantage once he plateaus, since if he keeps that habit going at plateau it would seem to squeeze more out of the results, just as doing it before starting would probably yield some modest, sustained weight loss from sticking with it consistently.

Complexity, cost, and the time and effort someone puts in all clearly amplify placebo effects. When it comes to squeezing out the strongest placebo response, sham surgery or placebo surgery tends to come out far ahead. On the cost side, the real versions are the clear winners, and it does seem that people lose sight of just how impressive these drugs are and how many years it took to reach a point where anti obesity drugs simply work, largely because they can be obtained so cheaply from China.

As for complexity and the demand for time and effort, the grey versions come out ahead by a wide margin. Hardly anyone using them will have previously had to mix vials with special liquids and work out amounts and doses with great care, on top of the whole semi illicit business of purchasing them. Which one comes out on top overall, I am not sure.

 

[Sasquatch]

Honestly, I just inject whatever the little guy in my medicine cabinet instructs me to.

 

[tubby]

lessthanhalf said:

tubby said:

lessthanhalf said:

HereKittyKitty said:

tubby said:

bbbilly said:

i'm pretty new around here, but i'm discovering that my way of thinking and my approach seem to put me in a different group than most folks, so i'll throw in my 2 cents and find out if that lands me in hot water.

in that first opening post you mentioned that hunger isn't a problem for you at your current dose and with your current diet. that's a good thing. with a diet that isn't supported by medication, you'd normally expect to feel some degree of hunger, and i realize just about everyone in this community seemingly wants to dodge that entirely, but if it isn't bothering you right now, why not simply reduce your intake a bit more until you do notice a little hunger, before you go up in dose? or you could flip it and tack on, say, a 10 minute walk each day to nudge yourself into a mild deficit, again without raising the dose, so you keep your possible... runway? (if i'm using that term correctly, somebody please tell me) intact with the meds, like someone els pointed out.

fat loss doesn't move in a straight line every time, and a 2 week "stall" isn't anything wild. your fat cells attempt to hold the same size for as long as they can by pulling in water while they're actually shedding stored fat, essentially checking whether they'll be refilled soon, and afterward they release all that extra water in what many fitness folks call the "woosh," when the loss basically catches up after the retained water gets dropped. if you keep pushing the meds higher without letting your body work out that the fat is genuinely gone, you'll wind up at the max dose with nothing left to do except pile on additional compounds.

congrats on the 80lbs by the way, that's massive. you've gotten this far and done a great job, so my opinion is just to wait another couple of weeks and see whether your body catches up.

For OP, I'd guess that a large share of the reduced appetite comes down to which dietary approach they picked — apart from GLPs, that way of eating tends to do a lot to suppress hunger. Cravings, though, are a completely separate matter...

That said, I'm not fully on board with the advice floating around here that says you should hold your dose as low as possible until a stall is definitively confirmed. People naturally want to push the dose up fast (the "if a little works, more works better" mindset), and in trying to hold that impulse back, we might lean too far the other way and keep doses lower than necessary.

Broadly, I'm with you on this.

Back before GLP medications became a common topic of conversation, a relative of mine was taking one. He once told me he regretted not moving his dose up in smaller steps, rather than — as he put it — "blindly" going higher every 4 weeks. He reached the end of what he could escalate and still had pounds left to shed. That left him deeply discouraged. What he chose to do in the end, I never learned. Still, the memory of how frustrated he was has stayed with me.

That experience is the reason I take a cautious approach here.

Today there are plenty of strategies for dealing with a shortage of runway. 4 yrs back, I have no idea which approved options were available to him to make up for hitting the approved maximum dose.

My view is that this belief about how GLP drugs behave comes from internet folklore rather than from the actual research. Nothing shows that the speed at which you move up in dose changes the total weight lost at the end; only the final dose matters. Going up slowly exists purely to keep side effects manageable, since jumping straight to maximum doses would land a sizable share of patients in the hospital with vomiting that will not stop, so easing the process and making it less miserable is very reasonable. The same folklore surrounds the idea of beginning with a weaker GLP so that a stronger one can be saved for when progress halts. That makes no sense whatsoever; choose the most effective option or the one that causes the fewest side effects. As things stand, I see no strong argument for semaglutide, since it produces more side effects while delivering less effect.

What I think drives the feeling of having "run out of runway" is simply expecting miracles from GLP drugs. There is a ceiling on how much weight is typically lost with them, and many people with more severe obesity have more to lose than these drugs can deliver. Also, exactly 50% of people will lose below the average weight loss recorded in the trials, with some unlucky individuals losing far less and a few fortunate ones losing far more.

The weight losses I encounter on this forum frequently exceed what the studies report, and I attribute that mostly to selection bias: those who experienced dramatic, life-changing results are the ones most inclined to post and keep discussing them.

For someone at a true plateau, meaning on the maximum standard dose and stuck there for a month or longer, they have simply reached what that drug can do for them. Accepting that and remaining on it strikes me as extremely important, because any meaningful weight loss improves health, even without reaching a BMI that is fully out of the overweight range. Prior to GLP drugs, doctors readily treated 5 or occasionally 10% weight loss that was maintained as a major win, given the substantial drop in long-term health risks.

No proven fix for this situation exists yet, backed by actual studies confirming safety, though anecdotal accounts show that stacking GLP drugs or raising doses can help. Hopefully future research will demonstrate that the health benefits justify the risks of these unstudied approaches.

That same question has crossed my mind. It really does look as though nearly everyone in this space sits above the average. Selection bias could explain it, as you suggest, yet I also wouldn't be shocked to learn that having finer command over one's own dose amount and timing produces better outcomes than sticking to a fixed dose.

Of course, I just finished making the case that the speed of dose increases hardly matters, so this may read as me talking out of both sides of my mouth. What I'm really getting at is that I wouldn't be shocked if the intensity with which the people here fixate on GLPs and on managing them (rather than treating it as something in the fridge they grab once a week and otherwise barely consider) carries some indirect effect, and maybe lines up with taking on other helpful challenges.

Because you have to check out suppliers, get your head around crypto, and deal with all of that added friction, your psychological stake in both the process and the outcome ends up far greater than if a doctor simply handed you the thing and told you to take it weekly. It's a bit like valuing a bike you saved for all summer on a paper route far more than one your parents simply bought you.

And in striving to hold to the lowest effective dose the way bbbilly described, he does appear to be lining himself up for a possible slight extra advantage once he plateaus, since if he keeps that habit going at plateau it would seem to squeeze more out of the results, just as doing it before starting would probably yield some modest, sustained weight loss from sticking with it consistently.

Complexity, cost, and the time and effort someone puts in all clearly amplify placebo effects. When it comes to squeezing out the strongest placebo response, sham surgery or placebo surgery tends to come out far ahead. On the cost side, the real versions are the clear winners, and it does seem that people lose sight of just how impressive these drugs are and how many years it took to reach a point where anti obesity drugs simply work, largely because they can be obtained so cheaply from China.

As for complexity and the demand for time and effort, the grey versions come out ahead by a wide margin. Hardly anyone using them will have previously had to mix vials with special liquids and work out amounts and doses with great care, on top of the whole semi illicit business of purchasing them. Which one comes out on top overall, I am not sure.

Once things get to that stage, is "placebo" still the right label — especially when it starts producing second-order ripple effects that change the outcome? To me it seems quite believable that, inside their head, all that additional effort isn't filed under the GLP banner at all, but rather under a broader weight-loss banner. If that's what's happening, wouldn't it plausibly raise the odds of someone signing up at a gym, following a specialized diet plan (one that goes past the GLP alone), or picking up other habits?

Then again, maybe that's still a "placebo." I can't think of a better term for it.

 

[lessthanhalf]

That reta trial placebo weight-loss chart you shared was genuinely interesting to me. Yes, across a year placebo results are usually pretty modest next to the GLP's, but 1 participant on placebo dropped around 20%, and the spread clearly isn't symmetrical around zero.

A lot of people get really uneasy about the notion that a drug or medication—and particularly a placebo—could shift how they act, above all when it comes to things we usually think are governed by conscious choice. Yet GLP drugs absolutely do exactly that: they alter what foods get bought, how much alcohol or other drugs someone takes, and in all likelihood a number of other behaviors too.

 

[tubby]

lessthanhalf said:

That reta trial placebo weight-loss chart you shared was genuinely interesting to me. Yes, across a year placebo results are usually pretty modest next to the GLP's, but 1 participant on placebo dropped around 20%, and the spread clearly isn't symmetrical around zero.

A lot of people get really uneasy about the notion that a drug or medication—and particularly a placebo—could shift how they act, above all when it comes to things we usually think are governed by conscious choice. Yet GLP drugs absolutely do exactly that: they alter what foods get bought, how much alcohol or other drugs someone takes, and in all likelihood a number of other behaviors too.

Fair enough — you've got a point. Sounds like the issue is that my own take on what "placebo" means is what has to change. Which makes me curious whether researchers have dug into this: has anyone tried to break placebo down into more specific kinds or categories?

The sugar pill is the textbook case, sure. But to me there'd be value in separating something like an "I know I'm getting the real drug, so I figure I'll do better" kind of placebo response from a "since I'm now putting effort into this one route toward a goal, I'll unconsciously steer other parts of my life toward that same goal as well" kind. Then again, that's probably something to ask someone who actually studies psychology for a living.