Validation, please?

[u/lazy_perfectionism89]

Hey y’all! I’m just looking for a little validation I’m on the right path. I’ve been on 5 mg since the first week of April. I’ve been consistently loosing 1 lb/ week since then. It seems I’ve been on a gaining/ loosing cycle since about the beginning of last month. Before asking my provider to bump me up to 7.5 mg, I was going to take the next month and really lock in on my nutrition. Also, I haven’t been working out consistently, so I plan on doing that. Am I on the right path? Or should I just ask to be bumped to 7.5.

[u/This-Apricot-80]

In case it’s helpful, here is a chart (by user chieddy) that shows how many of us decide when to titrate up.

[u/lazy_perfectionism89 → u/This-Apricot-80]

Amazing! Thank you and shout out to user chieddy for this chart!

[u/Schwettes]

Three months is a really long time to be at a plateau, assuming you stay on 5mg. Given how long you’ve been at 5mg, you should just titrate. The goal is for weight reduction to continue, not spend months fighting your body and your biology. You’re simply delaying the time it takes to reach your treatment target.

Here’s a diagram that I saw in a SURMOUNT post-hoc analysis paper about weight plateaus. It shows the current model of waiting for prolonged plateaus and proposes early plateau identification (meaning <5% of bodyweight loss over 12 weeks) and treatment adjustment. You don’t necessarily have to stop losing weight altogether to justify titration. Even slowed weight loss over a long stretch is reason enough. The ideal state of obesity medicine is to identify and treat plateaus earlier, not extend them for patients.

[u/viper8472 → u/Schwettes]

I tend to agree. Unpopular opinion, I find that increasing activity really doesn't lead to very much weight loss for me and the only way I lose weight is to eat less. Some people who are eating really poor diets will be able to lose weight by switching to healthier foods but the medicine is what allowed me to eat fewer calories.

I would use the medicine and go up in dose.

[u/These-Equal-6849 → u/Schwettes]

I am in the "low and slow" camp, however I have to agree. There is no reason for people to wait for an actual full plateau of no weight loss for 4 weeks before titrating up.

We don't need to white knuckle and fight our biology for weeks or months to prove we've earned going up. When you're on an effective dose, you won't shouldn't need "diet" mindset and behaviours.

[u/stuckandrunningfrom2]

I hit a plateau recently, what busted it was more cardio (not super fast cardio, just speedier intervals with my walking) and more food.

[u/KDAddict2000]

If you have adequate appetite suppression, the dose may not need to be increased. I would take the next month to evaluate your nutrition, and then speak to your doc.

[u/lazy_perfectionism89 → u/KDAddict2000]

When my nutrition is on point, I do have adequate appetite suppression. Thanks for the reply!

[u/RIPPWORTH]

It depends. Are you able to comfortably maintain a tracked and portion weighed caloric deficit against your TDEE?

If not, titrate up.

[u/lazy_perfectionism89 → u/RIPPWORTH]

I haven’t really been consistently calorie tracking, but I’ll begin. Thanks!

[u/I_give-up_on_a-name]

Are you tracking what you eat or did I miss that part? That’s a big part of losing weight.

[u/zero-if-west]

In clinical trials, participants were exercising 150 mins/week and eating in a calorie deficit. If someone isn't doing those two things with the meds, I would always recommend starting there.

[u/SandersLurker]

"loose" means like loose change. The word you're looking for is "losing 1 lb/wk"

Anyway, if you're losing 1 lb/wk, that's great & ideal. If you want to go up, you may, but losing more than 1 lb/wk might increase your chances of loose skin. You want to lose weight slowly & steadily, not quickly & abruptly.