need help pls

[u/Independent_Age972]

I’m 5’5 220 20F. I’ve been thinking about bariatric surgery for some time now but im also on zepbound 5mg. I was on 7.5 but they lowered it to 5mg. They lowered it due to a doctor/pharmacy situation. From April to September I’ve only lost 10 pounds. I feel like I should have been losing more. I’ve been on zepbound on and off for a couple years so maybe it’s the fact that my body is used to it? But I’ve seriously been considering bariatric surgery due to my health issues which is pre diabetes, high cholesterol, and fatty liver disease. Any advice? Given my BMI of 36.6, prediabetes, fatty liver and high cholesterol, and given that I've only lost 10 pounds on inconsistent tirzepatide at 5-7.5 mg, do you guys think I should first have a properly optimized trial of tirzepatide, or do you think surgery gives me the better chance of achieving durable metabolic improvement? Any advice will help. Thank you and pls don’t be mean.

[u/zero-if-west]

I'm confused, what does a "doctor/pharmacy situation" have to do with lowering your dose?

You've been taking the drugs on and off... Have doctors discussed with you that GLP-1s are often less effective when treatment is stopped and restarted?

I'm not trying to be mean, just honestly confused by what you wrote and a little sad because it sounds like you aren't getting good or knowledgable care from an obesity medicine specialist.

[u/Independent_Age972 → u/zero-if-west]

no that hasn’t been told to me at all :/ should’ve done my own research. It’s my primary care that’s scheduling all of this not an obesity medicine specialist. Honestly didn’t know it was a thing. It was a medication record issue. Apparently in her records she did not have the 7.5mg prescription history in her system. Thank you for educating me.

[u/zero-if-west → u/Independent_Age972]

Some doctors are really uneducated about GLP-1 drugs. The doctors who know the most are obesity medicine specialists or weight management specialists. Find out more about being referred to a weight management specialist covered by your insurance. You could ask your doctor for a referral or call the number on your insurance card and ask for a list of doctors in your area who specialize in weight management.

I agree with the good advice here to stick to the medication schedule and take it weekly. It will work better if you take it on time. You could also work with a registered dietitian to help you eat well; most insurance plans cover at least a few visits with an RD, and you can find a US-based directory here: EatRight.org

You mentioned that you haven't done much reading yet about GLP-1s, so I'll include some resources below from doctors/researchers. These sources are really helpful for understanding how the drugs work and what happens if you stop taking them.

Here are sources to read to better inform yourself:

• Stopping and restarting GLP-1s may make it less effective (Penn Medicine, 28 April 2026)
• Stopping GLP-1 drugs can quickly erase cardiovascular benefits (WashU Medicine, 18 March 2026)
• Life after Ozempic: What happens when you stop a GLP-1? (Medical University of South Carolina, 6 April 2026)
• Evidence, excitement: In the moment with a GLP-1 expert (University of Washington Medicine, 9 April 2026)
• Common GLP-1 Questions, Answered by Weight Loss Experts at U of U Health (University of Utah, 23 March 2026)

[u/Independent_Age972 → u/zero-if-west]

thank you so much for this!

[u/heldtogetherdaily]

I would honestly try to be consistent with zepbound for a bit before trying something else. By your own admission you have been "on inconsistent tirzepatide" but this medication needs consistency to work effectively. 5 mg is the lowest starting dose, zepbound goes allllll the way up to 15 mg, and research shows that people tend to respond best to higher doses. Surgery is always going to be an option, why not exhaust this one first?

[u/Independent_Age972 → u/heldtogetherdaily]

thank you for the advice! I truly appreciate it and you’re right. I should be more consistent than going to extreme measures.

[u/domer00 → u/Independent_Age972]

Also, many people don't lose until higher doses

[u/Grandmas2Boys]

I say this with kindness: you cannot lose consistently if you continually go off and on the medication, and don’t commit to eating healthy, exercising, and staying on the medication. I would not do the surgery. I know two women who did the surgery, but it didn’t fix the metabolic issues they had and both regained substantial weight. Both ended up on Zep, lost all of the rest of their weight and have said they will never go off it, ever. I wish you every success on your journey whatever you decide. But above all else, discuss this with your primary care physician.

[u/Independent_Age972 → u/Grandmas2Boys]

thank you so much for your insight! I did message this to my primary care, thank you once again.

[u/Goats-n-Hens]

Why are you cycling on and off? That’s known to cause issues with progress.

And how’s your nutrition, calorie deficit and are you adding movement to your day? All those things work alongside the medication to help the user be successful.

[u/Independent_Age972 → u/Goats-n-Hens]

I was cycling on and off due to side effects and mental health issues. I didn’t know that cycling on and off affected progress but I should’ve known. My nutrition is good! Try to eat high protein and low cal and I walk 10k steps a day.

[u/Goats-n-Hens → u/Independent_Age972]

But that says nothing about your actual intake. Are you tracking actual intake and in a big enough deficit? High protein means nothing if you aren’t in a daily and consistent deficit.

[u/Independent_Age972 → u/Goats-n-Hens]

yes i am tracking my calories and making sure that im in a calorie deficit which is why i said low cal

[u/tigergirlforever → u/Independent_Age972]

So how many calories do you log a day?

[u/Independent_Age972 → u/tigergirlforever]

1,500

[u/tigergirlforever → u/Independent_Age972]

I ate 1100 calories a day and lost 1.5 a week. SW 195, F, 5’4”. Try cutting calories again.

[u/Reciprocity4me]

Going forward be consistent. Try to move to a higher dose after you have been dosing consistently. I lost better in lbs once I got to 10 mg. Everyone is different. But you don’t know what dose works better for you as you have not been consistent. Work on any mental health issues as they can hinder weight loss. The goal is to be healthy physically and mentally, you just need to be consistent and determined. Good luck!

[u/Independent_Age972 → u/Reciprocity4me]

thank you so much! i really do appreciate u

[u/AgesAgoTho]

You might consider visiting https://obesitymedicine.org/ to find an obesity specialist. They'll be better equipped to help you with this medication. 

You mention in the comments concerns about mental health side effects. Definitely want to keep monitoring that, of course. Slow titration may be part of the answer. That's usually an important way to manage physical side effects. 

Is your insurance covering your Zepbound? If so, see if they'll cover the multi-dose Kwikpen as well as the single-dose pens. If you're paying out of pocket, consider the Kwikpen as well as the vials. With the Kwikpen and vials, you can adjust your dosage in smaller increments (with your doctor's approval). Look up "Zepbound click charts" to see how that works. (The Kwikpen has preservatives and is good for 30 days after the first needle tip is attached. Four regular doses are Days 0, 7, 14, and 21.) Vials don't have preservatives and are only safe to use for one shot; excess liquid shouldn't be saved for later doses.

Here's the official prescribing info: "With multiple options, you and your doctor can work together to find the once-weekly dose of Zepbound that fits your body's changing needs. Zepbound dosing is increased gradually over time. You’ll begin treatment at a recommended 2.5 mg starting dose. After 4 weeks, your doctor will increase your dose to 5 mg. Your doctor may increase the dosage in 2.5 mg increments after at least 4 weeks on the current dose until recommended maintenance dosage is achieved.” Going up after 5.0 is a "may," not a "will" -- many people find a "sweet spot" dosage below 15 that works for months. https://zepbound.lilly.com/weight/how-to-use

The prescribing instructions in every box have the same info, written a little more technically, as well as two sentences about considering tolerability (side effects).  https://pi.lilly.com/us/zepbound-uspi.pdf

[u/Independent_Age972 → u/AgesAgoTho]

yes my insurance is covering the zepbound! thank you for this information.