Would you increase your dose?

OMG absolutely! I found this on Reddit and it strikes me as a clean, straightforward chart that removes the feelings from the choice. (Also, props on your profile for featuring two of my top things: cats and Vegas - Red Rock Canyon ranks among my absolute favorite spots on the planet!)
 
DrPEPr said:

Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
At that body weight, 1300 is far too little.

Your system interprets this as famine.

By slowing your metabolism, you are working against your own fat loss.

Work out what you need to maintain (my guess is roughly 2600ish), take off no more than 500kcal, and hold that steady for the coming 3-4 months.

#TrustmeBro
This ☝️

1300 is far too little. It sounds as though you're aiming to consume more, yet getting near the 2000 calories you ought to be taking in is proving difficult? Raising the dose is the wrong move (imo), since it will probably only make you eat even less. A lot of people hit a plateau and assume the fix is more medication, but here that might backfire and make things worse.

You brought up gut problems; is that tied to an earlier dose increase, or to something separate? If it were me, I'd hunt for calorie-dense foods to raise your intake and then watch what happens once you're nearer that 2000 mark. If chicken works for you, pick thighs rather than breasts (per oz, thighs carry roughly 25% more calories than breasts). Consider tossing in a few protein shakes for added protein and calories. Protein helps you, and a shake makes it simple to tack on 25 grams and 100 calories daily. It also tends not to leave you as full as something more solid would.

Honestly, if eating has been a struggle and/or the gut trouble began around an earlier dose increase, it might be worth thinking about lowering the dose somewhat. You said you keep gaining and losing the same 5lbs across the last 7 weeks? That may be your body signaling it isn't pleased and is clinging on. Keep in mind, this is a marathon not a sprint. Nobody put on all their weight within a couple months, so expecting to drop it all within a couple months doesn't make sense. (Not saying that's you, but it's a common mindset people fall into and then they undermine themselves.)

Do you work out? People often fixate on the scale number, but if you're exercising and building muscle, then it's worth noticing things such as whether your clothes fit better, whether your face has gotten thinner, and so on. My weight held steady for several weeks, yet I tightened my belt by a notch (nearly 2) during that same stretch. So the number didn't move, but I was shedding weight in the places that mattered, adding muscle, and so forth.
 
If your weight hasn't moved for roughly a month, that seems like a reasonable point to bump the dosage up slightly. That's what happened to me not long ago. From May 14 through mid June I was sitting at about 220-225. After I raised the dose, my appetite is totally gone at the moment.
 
Appreciate the response!

My digestive problems go back roughly 20 years. The thing was...I prefer to skip breakfast and have 2 bigger meals plus a snack afterward in the day. GERD and slow stomach emptying made that approach a poor fit for me. Eating isn't a problem for me, not even at this point. A diverticulitis attack meant I needed softer foods so my sigmoid colon could rest (I consume a lot of raw vegetables and fruit, so I changed my pattern to smaller, more frequent meals, finishing around 4-5pm since I wake early). I'm someone who snacks at night, so after...years of setting calories aside for the evening, and now flipping that around, I'm still figuring out how to distribute my calories while eating more often and earlier to support my gut. Protein shakes are a solid suggestion, and I do use them, but perhaps mixing in some peanut butter would help with calories....and it tastes great. I've been doing the lean protein plus high fiber thing for quite a while, so working in fattier meats is a good thought.

I've just started adding some walking....I've walked off and on, but my interest is in raising my activity without raising my hunger, so walking fits that perfectly in my view. Once I'm leaner (I get injured easily) at about 240, I'll bring back some lifting....my body naturally carries a good amount of lean muscle.

This morning I was 260.6, so whatever stall my body was clinging to, it has released it (thankfully) and I absolutely intend to stay on 10 for as long as it keeps working for me, even with a smaller loss (.5-1 pound per week)
 
Stace_wow said:

Appreciate the response!

My digestive problems go back roughly 20 years. The thing was...I prefer to skip breakfast and have 2 bigger meals plus a snack afterward in the day. GERD and slow stomach emptying made that approach a poor fit for me. Eating isn't a problem for me, not even at this point. A diverticulitis attack meant I needed softer foods so my sigmoid colon could rest (I consume a lot of raw vegetables and fruit, so I changed my pattern to smaller, more frequent meals, finishing around 4-5pm since I wake early). I'm someone who snacks at night, so after...years of setting calories aside for the evening, and now flipping that around, I'm still figuring out how to distribute my calories while eating more often and earlier to support my gut. Protein shakes are a solid suggestion, and I do use them, but perhaps mixing in some peanut butter would help with calories....and it tastes great. I've been doing the lean protein plus high fiber thing for quite a while, so working in fattier meats is a good thought.

I've just started adding some walking....I've walked off and on, but my interest is in raising my activity without raising my hunger, so walking fits that perfectly in my view. Once I'm leaner (I get injured easily) at about 240, I'll bring back some lifting....my body naturally carries a good amount of lean muscle.

This morning I was 260.6, so whatever stall my body was clinging to, it has released it (thankfully) and I absolutely intend to stay on 10 for as long as it keeps working for me, even with a smaller loss (.5-1 pound per week)
It's great to hear the stall is lifting. I used to fast and have a few big meals too, but now I get full more quickly, so I've had to move to smaller, more frequent meals.

After a walk, a protein shake is an excellent way to take in calories and protein. Feed those muscles. That's my usual morning routine: walk the dog, then have a protein shake once I'm back.
 
Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
Neither age nor height is mentioned, and both would be useful.

If side effects are not an issue, my suggestion would be to move upward, targeting 15mg weekly provided it is tolerated. Based only on a weight of 260 lbs and the 40 lbs already shed, and without any height information, this still appears to be substantial obesity.

On GLP1Chat the usual refrain is to stay at the smallest dose for the longest time, and for someone overweight or mildly obese that may be sound, but with severe long-standing obesity the likelihood is that the top dose will be needed in the end, and those are the doses with the strongest evidence for improving long-term health outcomes. I am not suggesting a dose increase when weight is already dropping quickly or when side effects are troublesome, though that does not appear to be the situation described here.

Looking further ahead, shifts in fluid balance will produce rises and falls on the scale. If your calorie intake matches what previously drove weight loss, it is probably still working even when the scale stays put; weighing yourself less frequently may help, or you could track waist circumference instead. Over the very long term, beyond 6 months to a year or longer, weight loss tends to decelerate because fewer cells are using energy, lowering energy expenditure, and because of metabolic adaptation to prolonged low calorie intake. I do not accept the idea that eating more calories fixes this. Actual energy expenditure seldom matches what EE calculators produce, particularly in severe obesity and even more so following weight loss. The only reasonably accurate method for finding the caloric deficit is to derive it from weight lost, where every kg lost equals 7700 kcal.

When you eventually reach a genuine stall, which typically takes around a year, or a year once at maximum doses, you can then decide what to do next. Without knowing BMI it is difficult to judge, but at an average height there is a decent chance you may need to think about doses above the standard range, or adding cagri or elora at that stage, depending on whether your weight loss ends up below or above average.
 
lessthanhalf said:

Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
Neither age nor height is mentioned, and both would be useful.

If side effects are not an issue, my suggestion would be to move upward, targeting 15mg weekly provided it is tolerated. Based only on a weight of 260 lbs and the 40 lbs already shed, and without any height information, this still appears to be substantial obesity.

On GLP1Chat the usual refrain is to stay at the smallest dose for the longest time, and for someone overweight or mildly obese that may be sound, but with severe long-standing obesity the likelihood is that the top dose will be needed in the end, and those are the doses with the strongest evidence for improving long-term health outcomes. I am not suggesting a dose increase when weight is already dropping quickly or when side effects are troublesome, though that does not appear to be the situation described here.

Looking further ahead, shifts in fluid balance will produce rises and falls on the scale. If your calorie intake matches what previously drove weight loss, it is probably still working even when the scale stays put; weighing yourself less frequently may help, or you could track waist circumference instead. Over the very long term, beyond 6 months to a year or longer, weight loss tends to decelerate because fewer cells are using energy, lowering energy expenditure, and because of metabolic adaptation to prolonged low calorie intake. I do not accept the idea that eating more calories fixes this. Actual energy expenditure seldom matches what EE calculators produce, particularly in severe obesity and even more so following weight loss. The only reasonably accurate method for finding the caloric deficit is to derive it from weight lost, where every kg lost equals 7700 kcal.

When you eventually reach a genuine stall, which typically takes around a year, or a year once at maximum doses, you can then decide what to do next. Without knowing BMI it is difficult to judge, but at an average height there is a decent chance you may need to think about doses above the standard range, or adding cagri or elora at that stage, depending on whether your weight loss ends up below or above average.

Female, 45 years old

5’6

BMI 42.3

When I began GLP on 3/27/26, I weighed 285 (the first 20 pounds came off during weeks 1-2), and my highest weight had been 400 pounds (115 of that was lost through diet and exercise on my own)

No side effects at all (even once I titrated Tirz to 10mg)

This is the logic behind why I went up on my dose….

Yesterday I raised my calories to 1750, and I still dropped weight, so moving to 10mg was the correct choice.

I appreciate your comment and insight 😊
 
Skidude said:

My weigh-ins happened just 1 time per week, always at the same time.

Titration was something I did only when necessary, and that included weeks where the scale went up.

Below is how my titration went on the way to goal:

View attachment 10095

Losing 1 lb per week is solid — any loss at all means progress!!

Before adding more GLPs, my recommendation would be to increase steps or add another form of resistance, since things are going well and what you are already doing will carry you to your goal.

The 1 thing I wish I had done differently is paying closer attention to muscle loss; since then I have put on 4-6lbs through resistance and high protein.
That description matches my own situation almost exactly. My starting point was 215, and I began the first week of January at 2mg. During those opening 2 weeks I dropped 5 and 4lbs, which I'm certain was water weight. For the most part I stayed at each dose for 4 weeks, though a few that were producing good results I stretched to 6 weeks. Right now I'm on 9mg. My original target was 170-175, but I've since moved it down. On average I lost 2.2lbs/week. There were a couple of weeks where the scale didn't move at all, and a few where it crept up slightly. I still need to sort out a maintenance dose and plan. My intention is to remain on it for as long as possible. I also only step on the scale 1 day per week. Everything I'm using is Reta.
 
DrPEPr said:

Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
At that body weight, 1300 is far too little.

Your system interprets this as famine.

By slowing your metabolism, you are working against your own fat loss.

Work out what you need to maintain (my guess is roughly 2600ish), take off no more than 500kcal, and hold that steady for the coming 3-4 months.

#TrustmeBro

Tracking every single thing you consume is impressive—that kind of commitment isn't easy! I'm with you: your intake is too low. Going up to 1800 would make a real difference. Your energy levels would improve, and after your body stops thinking it's in starvation mode, you ought to see the scale drop more.
 
midlifeoptimized said:

DrPEPr said:

Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
At that body weight, 1300 is far too little.

Your system interprets this as famine.

By slowing your metabolism, you are working against your own fat loss.

Work out what you need to maintain (my guess is roughly 2600ish), take off no more than 500kcal, and hold that steady for the coming 3-4 months.

#TrustmeBro

Tracking every single thing you consume is impressive—that kind of commitment isn't easy! I'm with you: your intake is too low. Going up to 1800 would make a real difference. Your energy levels would improve, and after your body stops thinking it's in starvation mode, you ought to see the scale drop more.
I'd genuinely like to read a scientific citation backing the claim that eating more can lead to more weight loss. It sounds appealing, yet it doesn't generally line up with how the body operates, whether in ordinary conditions or in the much less understood state of weight loss or the reduced energy expenditure that follows it.

In my own case, the drop in energy expenditure as I lost weight happened slowly across a year, alongside 70 kg of weight loss. On the very same calorie intake, I shed 6kg per month going from 145kg down to roughly 90kg, after which it decelerated and eventually halted at 75 kg about a year later, still on the same 1600-1800 kcal/day. Following that I stayed between 75 to 83 kg through the next year, then had another year on low dose ozempic. Small upticks in calories produced clear weight gain, and even 1-200 kcal / day translated into a few kilos over a few months. That is how physiology is supposed to behave. Despite being in a reduced energy expenditure state, I definitely did not lose more weight by eating more.

I have not come across any research indicating that the long term reduction in energy expenditure caused by weight loss can be altered, apart from regaining weight. ( or greatly increasing exercise ) How long it lasts is not known with certainty, and I have read conflicting accounts, some saying it tends to renormalise over years, others that it may be permanent at that lower weight. For me it has remained unchanged for 3 years after the weight loss, and to stay weight neutral my calorie intake needs to be about 1600-1800 kcal/day, with or without GLP drugs.

My guess is that the post weight loss reduced energy use mode starts and stops very slowly, unfolding over several months, and my guess is that it tracks weight more than calorie intake, meaning rises in EE would require gaining weight first, since the point of this metabolic adaptation is to hold onto some fat reserves under seriously adverse conditions like famines, an adaptive state that boosts survival there. But not so useful in the current environment.
 
Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
Aim for a protein intake of no less than 1.2g for every kg of lean mass. Add more electrolytes to your routine. Fit in additional exercise. The usual step-up plan runs 2.5 -> 5 -> 7.5 -> 10 -> 12.5 -> 15.0, which leaves you lots of room to move higher. Wait at least 4 weeks between any increase, and skip going up if the higher dose brings sides that are too rough, and also skip it when your food noise is already managed. Those are the fundamentals, and for me the results were tremendous.
 
Stace_wow said:

lessthanhalf said:

Stace_wow said:

Would you increase your dose? I went ahead and did. I'm interested to hear how others would have handled this situation.

Weight 264

My daily calorie intake averaged slightly below 1300 over the past week, and during that same week I dropped .4 pounds hahahhahahaaa fuk

I'm losing roughly 1 pound each week, and considering the calories I'm eating and my current weight, that doesn't feel like enough in my view.





View attachment 10092

View attachment 10093
Neither age nor height is mentioned, and both would be useful.

If side effects are not an issue, my suggestion would be to move upward, targeting 15mg weekly provided it is tolerated. Based only on a weight of 260 lbs and the 40 lbs already shed, and without any height information, this still appears to be substantial obesity.

On GLP1Chat the usual refrain is to stay at the smallest dose for the longest time, and for someone overweight or mildly obese that may be sound, but with severe long-standing obesity the likelihood is that the top dose will be needed in the end, and those are the doses with the strongest evidence for improving long-term health outcomes. I am not suggesting a dose increase when weight is already dropping quickly or when side effects are troublesome, though that does not appear to be the situation described here.

Looking further ahead, shifts in fluid balance will produce rises and falls on the scale. If your calorie intake matches what previously drove weight loss, it is probably still working even when the scale stays put; weighing yourself less frequently may help, or you could track waist circumference instead. Over the very long term, beyond 6 months to a year or longer, weight loss tends to decelerate because fewer cells are using energy, lowering energy expenditure, and because of metabolic adaptation to prolonged low calorie intake. I do not accept the idea that eating more calories fixes this. Actual energy expenditure seldom matches what EE calculators produce, particularly in severe obesity and even more so following weight loss. The only reasonably accurate method for finding the caloric deficit is to derive it from weight lost, where every kg lost equals 7700 kcal.

When you eventually reach a genuine stall, which typically takes around a year, or a year once at maximum doses, you can then decide what to do next. Without knowing BMI it is difficult to judge, but at an average height there is a decent chance you may need to think about doses above the standard range, or adding cagri or elora at that stage, depending on whether your weight loss ends up below or above average.

Female, 45 years old

5’6

BMI 42.3

When I began GLP on 3/27/26, I weighed 285 (the first 20 pounds came off during weeks 1-2), and my highest weight had been 400 pounds (115 of that was lost through diet and exercise on my own)

No side effects at all (even once I titrated Tirz to 10mg)

This is the logic behind why I went up on my dose….

Yesterday I raised my calories to 1750, and I still dropped weight, so moving to 10mg was the correct choice.

I appreciate your comment and insight 😊
I hate to bring this up, but there's likely a problem with how you're framing the starting point. For estimating total loss or when a stall becomes a genuine concern, the starting weight should probably be whatever you weighed before any loss at all, not what you weighed on day 1 of Tirz. That said, the stall timing itself might be counted from the most recent dose bump, though I'm skeptical that moving from 10 to 15mg buys you an additional full year of slow loss.

Why does the starting point matter? Dropping from 400 to 285 lbs almost certainly involved a long stretch of eating very little, and that combination—the loss itself plus prolonged low intake—drives daily energy expenditure down. So sustaining a deficit later requires fewer calories coming in. And the break-even weight, where loss halts, arrives sooner or at a higher number if you began at 400 rather than 285. A true stall happens when energy expenditure has dropped from the loss, hunger has climbed from the loss, and the drug's appetite suppression is now only strong enough to stop regain—not to produce further loss. That typically takes about a year.

All that said, individual responses vary wildly. Plenty of people on this forum have exceeded what average results would predict, and it sounds like both of you are getting decent loss from tirz without obvious side effects that cap the dose. If needed, cagri or elora can always be layered in at that stage.

Maintenance deserves attention too. Staying off the weight will almost certainly mean continuing tirz. Even if loss stops short of your goal, holding onto what you've already lost is the biggest single thing you can do to avoid long-term health problems—being stuck at 250 lbs likely carries roughly one-tenth the risk for many issues compared with being at 400 lbs.
 
This is great….

So my WL journey kicked off around 2016 when I weighed 400 pounds. Through a mix of different diets and exercise, I got down to 285, and I managed to hold that weight for a couple of years by loosely following a low carb approach. Month after month, I'd drop and then regain the same 10 pounds, over and over….then in 2020, a friend of mine told me about a diet they said would take the weight off. Basically no carbs and no fat — that's a bodybuilding prep diet — and I stuck with it for 30 days, which got me to 240 pounds.

That diet was extremely restrictive, and it pushed me into a binge eating cycle I couldn't break. After restricting carbs for so long, I really didn't want to keep that same mindset around food, so over the following years I tried to repair my awful relationship with food, and that's what ballooned me up to 330 and into depression by 2023. Halfway through 2024, I started paying attention to my nutrition again..,.I wasn't 'dieting,' just being mindful…..nothing was off limits and everything in moderation was okay….my body dropped back to 285 on its own, with no active calorie restrictions. That's where I stayed until I decided to look into peps late 2025.

With all that said….do you still think I should treat 400 as my start weight for this period, or have I had enough of an 'off diet' reset?

I figured my years of low carb actually altered my 'body set weight' and that 285 is a real starting point given how much time I've spent at this weight.

Thank you, I've found your comments so helpful and insightful….
 
I figured the 400 lbs was closer to now than 2016, so I genuinely can't say what impact it'll have — though definitely smaller than if it had happened last year. The 330 figure might be a better recent anchor, but if you weren't putting on weight at 285 without consciously restricting calories, then 285 could be the right reference too.

My own weight loss began in 2022, and by 2023 I was at 75 kg. Since then, the calories needed to hold steady have barely budged — roughly 1600-1800 kcal/day — so for 3 years it's run below what standard calculators would predict for my age and activity level, though much of that energy expenditure drop comes from the weight I no longer carry. I actually put this question to chatgpt just this morning, and the takeaway is that nobody truly knows whether EE remains suppressed over the long haul or returns to normal; the studies disagree with each other.

My situation was never about using these drugs to shed pounds — it was about making maintenance less of a grind, so I wouldn't have to stop eating while still hungry, or skip food when hungry because I risked exceeding my calorie budget for the day. I stuck fairly rigidly to the diet in terms of which foods were permitted, reasoning that if caloric density was low enough, overeating became impossible. For instance, 1-2 kg of strawberries daily carries very few calories and is quite difficult to exceed no matter how hungry you feel.

I also struggled with food addiction/binge eating. The worst part came after losing weight: if I ate even small quantities of rich/high calorie/highly rewarding/high glycemic index foods, I'd get severe rebound hunger an hour or two later, and stopping was nearly impossible. Once that started, a kilo a week could go on. So my diet contained absolutely none of those foods, and was generally low glycemic index, extra high protein, low fat and low calorific density. That did effectively head off any binge eating problems, but it didn't keep me from being hungry often or having cravings. The GLP drugs, though, help considerably with those. I haven't rigorously tested whether the extreme hunger response still exists, since I really don't want it returning, but I can apparently eat 100 calories at a time of nuts or dark chocolate without trouble, which is an improvement over how it used to be. Hopefully there's a calorie threshold effect — it doesn't trigger unless you go past a certain number of calories — so I could at least eat tiny amounts of extra nice foods instead of none. Or perhaps the GLP drugs have repaired whatever odd brain circuitry was at fault. I believe GLP drugs will eventually become a standard treatment for binge eating disorder, particularly alongside obesity, but the papers on binge eating disorder all come from psychologists or nutrition people who don't view drugs as the answer, since it doesn't fit their worldview well. So adoption in the field will likely take a while. The few papers that do exist are pretty positive.
 
Yes — fruit and vegetables are a normal part of what I eat, and I do my best to tune in to what my body is telling me…my goal is maximum health, and I really enjoy keeping an eye on my micros!

On top of that, GLPs have made a huge difference for me with hunger, and in situations where I might previously have eaten past my limit, I can now put the portion I picked aside and feel content with it.

I appreciate your feedback and your insight! And for telling part of your story too!

I suppose we'll all find out how it unfolds together 😊
 
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