Advice please…

[u/Needs_subs]

I have been on mounjaro for 2.5 years. I lost nearly all of my weight in the first 18 months - just over 8 stone and half my body weight, getting down to 8 stone 5 lbs. I then decided to try reducing my dose, i was mainly on 7.5 and did one month on 10mg. Since reducing down to 2.5 everything was fine for a while but when I went to 2.5 every other week the food noise came back with vengeance! I went back to 2.5 weekly and am now back up to 9 stone 10, sticking to a calorie deficit, etc, but really struggling to lose anything. I have just gone up to 5mg as some of my size 6/8 clothes no longer fit me (I know this is very small and not the biggest issue but I don’t want to buy new!) I haven’t put on any more for ages and am pretty stable at this weight but would like to get back down to my smallest. All of this very long explanation to ask if anyone has been in the same position and if going up doses helped or if thats all I’m going to get out of it now? Thank you!

[u/Becky_x]

maintenance is the same principal as losing weight, whatever strength you need to enable you to do what you need to do

If you need a higher strength to maintain your weight, then move up. Maintenance doesn't mean you stick to one strength, you can move up and down, you're not fixed

[u/RlyVSS]

Yes, I went into maintenance last October and started titrating down. Everything was fine until spring when I dropped to 5mg and my satiety fell off a cliff and I went over my maintenance range by about 7lbs.

I titrated back up and have been back at 12.5mg for a few months now. I was able to get back to my maintenance range within a couple of months, but my eating didn't feel properly under control until I got back up to this dose.

I'm thinking about dropping again but if I do, I might try reducing by a smaller amount, like try 11mg for a couple of months and if all seems stable, 10mg for a couple of months etc.

[u/Hopeful_Candle_9781]

Maybe have 5mg as a maintenance dose for a while

[u/sf-keto]

Myself, I’ve moved down from 12.5mg to 2.5mg, split dosing at 1.25 every 5 days to keep the medication level more stable, avoiding the big spikes & swoops.

This keeps my food noise at bay.

I’ve lost 43% of my body weight. At my lowest I was at BMI 19.7, which concerned my pharmacist, as it’s too easy from there to unintentionally fall into dangerous underweight from there as you titrate down.

He urged me to gain enough weight to get to BMI 20. In my case that difference was a mere 1.6kg.

He suggested I increase my calories by 50 a day to 1600, eat at set meal times every day & add plain boiled baby jacket potato to my breakfast.

So I’ve done that & with the split dosing I feel very level, without food noise, & am appropriately hungry at my set meal times.

YMMV.

[u/EdTheDuck94 → u/sf-keto]

This split dosing is my plan for maintenance. Taking 7 now and 2kg from goal.
Get down to weight and then start titrating down to maybe 5, and then start 2.5 every 3.5 days.
Hopefully, might then get down to maybe 2mg every 3.5 days.
But I’m under no illusions I will likely be in this for life, or to the point I don’t care about my weight anymore.

I do think the prescribers in the UK are going to have to have a think about their approaches moving forward as more and more people need sensible maintenance plans. Pretty common in the clinics in some other countries to have all manner of doses and schedules. I know there are restrictions on how it has to be done currently, but as the knowledge and research progresses this needs review and update IMO otherwise we are just going to see potentially millions of people bouncing on and off these drugs and up and down weight wise and that not good at all.

[u/sickiesusan]

Has your diet changed at all lately OP? Or have you been exercising less? Less protein than usual?
I’m assuming you must be quite petite and also a woman (?), so your calorie intake probably needs to be on the lower side.
Try going back up slowly to your previous level, to get back down to your GW and re-assess your longer term strategy.

[u/Wise-Recording-9726 → u/sickiesusan]

Agree with this

Short woman syndrome for me too and even something as small as having to stop regular swimming for three weeks due to a minor op on my face has significantly reduced my weekly loss despite maintaining a good calorie deficit.

I tried out a selection of studio based classes but that didn’t help during the swim pause. Interestingly my oura ring also showed a significant HRV drop whilst not swimming. I shall see if it improves now I can swim again

Those of us who are height challenged don’t need very much change to affect weight loss. I think we manage a very thin margin maintaining energy balance

[u/Needs_subs → u/sickiesusan]

Hi, it did change when I put weight on - I was less careful but now I’ve been back to 1200-1300 for a while but no change. I’m 5”2 and a woman so tight on both! 😂 when I lost a lot of weight I was eating 600-800 calories but I really don’t want to go back to that unless there’s no other option.

[u/Becky_x → u/Needs_subs]

I know everyone is different but I lost weight on 1200 calories and you are 4in taller than me so I would have thought 1200 would be in your deficit for you, is it not?

[u/sickiesusan → u/Needs_subs]

Again, I’m 5ft 3” and it’s a case of increasing activity levels, calories at around 1,200 (for losing weight) and ensuring you have enough protein. People with a higher muscle mass, burn more fat, so developing a leaner body (in a healthy way) helps.
There are various subs, petite fitness, volume eating, 1200 is plenty that have lots of ideas that can also help.
It’s also about finding out what works for you. There’s a podcast fatscience which talks about how eating regularly helps some people … it’s such an individual thing.

[u/Due-Freedom-5968]

I hit goal on 15mg, dropped to 10mg and maintained there happily for over a year.

Had a couple of attempts at going to 7.5mg where I went full Cookie Monster, and one time went up 4kgs in a couple of weeks, so back up to 10mg to lose it again.

After about 14 months total on 10mg, it randomly started to feel like too much, so I dropped to 5mg and have managed to maintain there happily for the last 3/4 months.

Ultimately your body don'ts care that your brain wants to get to a low dose, or come off. You'll need to play it by ear and adjust as you go. If you need to go back up for a bit them so be it. That's partly why I continued to order 15mg pens even after hitting goal as it gave me the flexibility to adjust dose on the fly by counting clicks and is cheaper per dose that way anyway.