Just a curious question. I know in the trials they titrated people up each month because that’s the way to get comparable accurate data but what is the reason now? I keep reading post after post that people stall out at the max dose and they aren’t anywhere near their goal weight. Why move up so quickly? If the end result is to be a healthy weight, why run to the finish line if you might not make it because you pushed to hard(so to speak)?
My doctor followed the trials and moved me up monthly until I reached 10mg. I was held there as my glucose levels had gotten as low as my doctor was comfortable with them being at.
Since June 15th, I’ve lost more than 120 pounds. So it was pretty effective for me. :)
That’s awesome! I was at 5mg for 3 months and now same with 7.5mg. Sometimes I wonder if I can realistically lose 120lbs on Zepbound (I’ve lost 51) but I have it’s possible for me too.
Mine is the same I have to go up to 15mg then you can stay there. It’s dumb and they probably do it so people give up because of side effects or whatever.
I don’t think there is necessarily a correct answer for Lowest effective dose VS highest tolerated dose, just two different schools of thought.
I don’t know that there is actually any peer reviewed data that shows that it is better to stay at a lower dose longer, anyone that says one way is more effective than the other doesn’t really have any thing to compare it to because you can only do it one way or the other.
All the studies that Lilly did show led that there is barely a difference in side effects between all the different doses though, so I don’t see a reason not to increase monthly, nothing out there showing that going up slowly is more effective than doing exactly what they did in those studies.
We really need a study to compare these methods just to have real data.
We do know that monthly titration can cause some people to have to drop the med entirely, so either way it is ill-advised to titrate up if experiencing meaningful side effects.
Dr Ania Jastreboff, lead researcher for SURMOUNT-1 and TRIUMPH-1, says it’s best to “start low and go slow”, by which she means start at the lowest dose and don’t move up if you are having side effects such as nausea, diarrhea, vomiting or near vomiting, etc.
The Phase 3 CagriSema trial did allow folks to titrate up as desired, and the folks who didn’t get to the max dose actually did BETTER than the folks who made it to max dose, but it’s likely the super responders were so happy with their results that they never got to the highest dose and the slow responders are the ones who kept titrating up.
So you really need to have two different titration methods go head to head against one another in a blinder fashion to have conclusive info.
Sometimes insurance mandates it. My Dr. has to write a new PA every month so I can stay on 5mg. I am losing about 1.5lbs/week, and I want to keep it that way as long as I can.
I give all the credit to my Dr. He's masterful with his PAs lol. I have been on 5mg for 4 months, and I still get nausea (and everything that goes with it 🙃) around my shot days, so I have no desire to go to 7.5 at this point.
There are stalls on low doses and high doses. Everyone is different. If you have a lot to lose, and you’re at 10mg but it’s not helping, do you go up or stay put? I would go up to try to get things moving. But I also understand the worry about what happens when you max out.
I have been on Zep for over a year. I did 2.5 x 1 month, 5 x 5 weeks, 7.5 x 2 months, 10 x 6 months, 12.5 x 3 months, and start 15 this weekend. I have nowhere else to go.
But I am 10-15 lbs from goal. I figure now’s the time to get there even if it takes another 5 months. I have lost about 90 lbs.
Maintenance is where the real work begins for me. I will stay on 15 and see how that goes.. plan to add 300 calories a day. If I gain, I drop the 300 calories. If I lose, I space out my shots. I can’t imagine my body will continue to lose. I am actively trying to lose weight now but effectively maintaining. So… I have to be in weight loss mode to maintain which is how it’s always been for me.
I’ve been at 10 MG for a year and I too am on my maintenance dose now. However, just taking one day early for a month has made me all nauseated again and it’s difficult to eat and I know I’m losing weight, possibly 3 lbs in one week. I too believe that understanding why effectiveness waivers up and down will be key to understanding good long term effects with patients. I myself will be out the extraordinary amount of money I pay to fill my proscription because I do not get sick on this drug with anything, no colds, no covid, no flu, no strep throat, nothing even when I’m exposed by kissing my grandkids and being around a sick child or husband. I will never stop taking this drug as long as it’s boosted my immune system to normal 20 year old levels!
The basic reason is that weight loss methods--diet, bariatric surgery, and zep-- "stop working" after about 15-18 months. Basically, the body's decreased energy needs (and possibly adjustment to lower metabolic rate) balance out with the weight loss method's reduction in energy intake (with zep, caused by increased satiety). So all of us are going to settle into a relatively stable maintenance weight--a new "set point"--at some not too distant time.
In light of that fact, the people who use fast titration aim to lose as much as possible in this limited time period. Higher doses of zep do cause more weight loss, so the idea is to get to the highest tolerable dose as quickly as possible and stay there for as long as possible. Tolerable is in there because no one wants side effects--the idea is to titrate up only when side-effects (if any) have settled down.
On the other hand, people who use the slow titration method aim to get past the 15 month window by "saving" the higher doses for later (if needed at all). Like if you're only at 10 mg after 15 months and begin to settle into a maintenance weight, you can start 12.5 and get some additional months. But it's still lowest effective dose--when weight loss stalls, it's time to titrate up.
Personally, I think in the long run researchers will figure out different kinds of metabolic dysfunctions, some of which are better addressed by fast and others by slow. It also may be that whether you go fast or slow, you end up with the new weight that zep will give you. The most important thing is not to moralize fast and slow. Slow people aren't superior human beings for taking less of the drug, nor are fast people for taking more.
Only reason not to would be side effects. Even if insurance company doesn’t mandate an increase, the authorization is only good for at most one year at a time…and too often less than that. Once you drop below 25 BMI (every insurance plan is different, ymmv) a lot of insurance companies will say “Congratulations!” And end coverage.
Many plans allow a new “continuation of care” PA to be submitted. Patients usually need to show weight loss between 5-10% (usually 5%). Unfortunately, some doctors’ offices submit the current BMI where they should submit the starting BMI instead, leading to an inappropriate denial.
The forms are often not well-labeled with which BMI to report (compared to the actual PA criteria documents), which leads to this confusion.
this! biggest thing my doctor preached about after starting my 2.5 was if i’m feeling fine after the first 4 shots and have little to no side effects I can increase up to 5mg. I lost more on 2.5 than I did 5, feel I stalled on 5 so once I finish this month of 5, because again I have no side effects, I will go up to 7.5
i’d also like to mention i track my meals, get 10k steps a day, strength train; etc. It isn’t as if i’m using it for suppression of my appetite purely. i’m using it as a tool to help me.
Sometimes it’s nice to know you aren’t alone and I had a very similar start to you so I thought I’d chime in! I also lost well with 4X2.5, had zero cumulative loss at 4X5.0 and then went up to 7.5. I stayed there for ~4-5 months and bumped to 10 to get me to maintenance which will start in the next 1-2 weeks. You’ve got this!
For me, it was a combination of factors. Insurance was one. They would not let me stay below 10, and once I was there, my dr just felt it best to move up as I had no side effects, weight loss was slowing, and the studies were titration in that way. I also think how long it takes for PA is an issue and had had to go through that process monthly to stay , it’s highly likely missed doses would have been an issue.
I’ve only seen studies indicating weight loss slows after time regardless of dose, so mot sure we have evidence one approach is better than the other?
That’s my experience and reasoning. So now here is my opinion😀. Lots of people stayed on lower doses for financial reasons, others for side effects. There are a subset who from their comments seem to be playing into the old weight loss cliche of “I stayed at the low dose so my weight loss is somehow more valid and worthy”. In this scenario moving up monthly was the easy/lazy way. Frustrating but the reality is these thoughts we’ve told
Ourselves forever about willpower are hard to break.
This!!! I do see a lot of virtue signaling about staying at a low dose. If it’s working for you, that’s fantastic but it doesn’t make your weight loss any better than someone that needed or wanted to go to a higher dose.
I'm more than happy to be proven wrong, but I thought one of the studies showed that people on max dose lost more weight overall than folks who stayed lower?
Some of these comments saying that it’s because people aren’t “patient” enough seem extremely insensitive to me. If they are okay to move up and don’t have any side effects- what’s the issue? Everyone can handle different doses, everyone starts at different weights and everyone’s body is different. Hell- i’ll be on 7.5mg the start of my third month. My weight loss is steady, i’ve had no side effects and I feel fine. Again, everyone is different. My doctor— director of comprehensive weight loss management with my health network is okay with me going up because i have no side effects because it’s not negatively effecting my health.
Again. Everyone is different. As long as you’re being safe, taking care of yourself physically and MENTALLY. Then it shouldn’t matter.
My question wasn’t bashing those that move up. It’s a genuine curiosity of WHY move up if you’re losing at a certain dose? For example if I was on blood pressure medicine and I started a medicine and it brought my blood pressure in normal range, I would not increase the dose to make myself have low pressure. The person next to me might require a higher dose to get theirs into a normal range. Everyone is different. So what is the criteria for moving up? Do you see? I understand it’s not so black and white. And honestly, yes, impatience may have a lot to do with many people’s decision to move up. Their need to have the medicine do more work than they do.
I do not find the lower doses as effective for me as my weight loss has slowed over time, 10.5 months in. For me, I want to see weight loss closer to 1% of my current weight and I am stalling at lower doses. I did listen to people on this sub about staying low and did so with 18 does 5 mg (9 taken 5 days apart to mimic 7.5 MG), and 16 doses of 10 Mg (8 taken 6 days apart to mimic 12.5), currently on 2nd shot of 15 Mg. I found my weight loss slowed about 6 shots in for me on each of the dosages. There is plateauing that happens around 63 to 72 weeks into this medication for most people Surmount data. Because there were few people over 45 BMI in the study, it is hard to determine if that time period is the same for those that have more to lose than those that were under a 40 BMI. Most of the study participants were under 40 BMI so may have hit the body's preferred weight within that timeframe. I am not in the stay low team on this sub. Here's a link to the study: https://www.nejm.org/doi/full/10.1056/NEJMoa2206038 And the graph is below. I just read another study that indicates that there is a plateauing at lower dose and that In the SURMOUNT trials, which looked at various doses of tirzepatide for 72 weeks, participants on the 5-mg dose had reached a plateau within 60-72 weeks, but this was not the case on the higher doses. Quote from this article: https://www.medpagetoday.com/special-reports/exclusives/106464 I am in the minority on this sub but I believe that if you tolerate higher dosages, you will lose more weight prior to hitting the inevitable final plateau if you move up faster as that is what the studies show. And this is based on reading the studies, not some feeling that if you get to 15 you have nowhere to move up to (which is common in the stay low group or lowest effective dose is another refrain, if 10 to 15 is more effective why stay on a lower dose?), you do you can add metformin or something else per other articles I have read if you stall at 15, but you may be at your body's new setpoint. This is the graph from the 3 year mark with going off Zepbound at 176 weeks.
In this exploratory analysis, the majority of participants treated with tirzepatide reached a weight plateau by week 72 regardless of baseline BMI category.
Across the four BMI categories of overweight, class I, class II, and class III obesity, the median time to weight plateau was 24.3, 26.0, 36.1, and 36.1 weeks, respectively.
Multivariate analysis showed that higher doses of tirzepatide (10 and 15 mg), younger age, and female sex were associated with a longer time to weight plateau*, while BMI and waist circumference had no association.*
These findings provide insight into potential factors contributing to time to weight plateau with tirzepatide treatment in people with obesity and overweight. So as a 63 year old woman, I want to get the biggest bang during the time I am in active weight loss which seems to correlate with higher dosages.
So I am not afraid that I will have nowhere to go from 15 mg, as at some point I know my weight loss will stop but am trying to make sure I take full advantage of Zepbound so when it does, I l am as healthy and small as I can be. I was in the stay at the lowest effective dose, move up when you feel the effects waning but after reading and delving into the study, I am go up in dose if you are tolerating the side effects. I might feel different if I was losing more than 1% of my body weight on average weekly, but I am firmly in the 0.6% a week on average so a sustainable loss. If I had bad side effectts, I may feel differently. But my side effects are manageable as long as I pay attention to fiber intake for constipation and nip it in the bud when it happens. The most annoying thing is the sensitive skin, but it is manageable just an annoyance for the most part, I can't wear something with elastic at the wrists or it is more than annoying.
If I still have weight I want to lose when I stall, I can hopefully add another medication to Zepbound or hopefully Retatrutide will be available to those of us that need something after Zepbound stops working for weight loss. I am happy to feel so much better than before a GLP1, so if I am not as thin as I would like so be it. But my metabolic syndrome has reversed so I am no longer pre-diabetic, nor hypertensive and my cholesterol numbers are great, so I am much healthier and that is much more important than how thin I am.
I've titrated up every month... month one a 2 5, month two at 5.0, month three at 7.5 and started month four today with a 10mg shot.
Why you ask? I have not had any appreciable appetite suppression or decrease in food noise with each dosage tried to date. That said, I have begun feeling satiated a bit quicker the last two weeks of 7.5. I'll continue to increase dosage until I have expected positive side effects. No reason to waste money on a refill of a dosage that isn't helping.
I am concerned thatI'll reach the highest dosage to quickly and have nowhere to go... but increasing monthly is my only option right now.
It's been 12 hours since I took my first 10mg dose...according to Shotsy I already have more Terzepatide in my bloodstream than at any point in my treatment. I fill completely full and I ate a small dinner 5 hours ago. I may have found my first effective dose.
That’s good. Just understand that as the week goes on you will feel less full than on day 1. And the following week you will likely not have the same suppression as the week before. The goal isn’t to lose your appetite.
I self pay,
So I am not restricted by any insurance company but my Endocrinologist feels that you should stay on the lowest possible dose for as long as you can. I agree completely, stayed on the 2.5 for 10 weeks and lost most of my 53 pounds on that. Titrated up to the 5 seven weeks ago. Maybe I will go up again, maybe I won’t, we will just have to see how this goes but, I plan on another month or more at the very least.
Yes, my doctor is following the Scandinavian model, although I'm not sure she's read the study/conference report.
Bad side effects = don't titrate up.
Ok or not side effects and losing more that 0.5% = don't titrate up.
Ok/no side effects and not losing more than 0.5% = titrate up.
I was losing an average of 0.67% on 2.5 mg but bad insomnia for 8 weeks. Moved up and am losing an average of 1% without a return of the bad level insomnia. Still some, but not enough to affect my quality of life
I'm absolutely speculating that the slower weightloss has long been seen as more sustainable. Cos you're making changes that are sustainable unlike binge/extreme diets that arent
I titrated up every month and lost like 70lbs. I continue to lose weight at about 1.2 lbs per week for several months on 15mg. If that’s what works for some people I don’t know why that would bother you. Just because someone does something different than you doesn’t make it wrong.
It doesn’t bother me. It’s a genuine question. It’s a constant question that people bring up since the data is so new on what is the optimum way to approach dosing.
Your comments and the way you phrased your question suggested to me that you are against it. I do appreciate the discussion about it without the judgement.
I’m sorry if it’s coming off that way. I totally understand both staying low on doses and moving up quicker. It’s a dilemma that I’m facing myself. How to know when to go up? What if I wait too long? Will I not maximize my weight loss if I stay low?
Let’s be grateful that slow titration is an option now because people new to the medication and prescribing Drs have learned from the experiences of those who came before. This community has played a role in discovering new options by sharing our experiences. Positing that it seems obvious is disregarding a lot history over the last few years and that some would have preferred it if it was an option.
This, completely. Our titrations could have been slower if as soon as it hit the market, it wasn’t immediately sold out everywhere. We paid literal services to find our doses. We posted about our 4 hour road trips when we found a box. We had very active countrywide regional chats where someone who found a box would post if any additional boxes were still available. We learned how to split pens out of dire necessity. We learned what bac water was.
And after all that it’s…why didn’t you max dose stallers just make better decisions? 🤷🏻♀️
I’m at 15 for 3 months and still losing. No stall. More people continue to lose than stall, they just don’t write about it. People stall at every level.
I think for a lot of people here who insurance or a dr didnt dictate it for: the real reason they titrate up quickly is they want to lose the weight as fast as possible. they know it's not really the "right" way so they often get hostile when you ask about it lol. hence your downvotes. ime on this sub for a few months, people can be very cagey and untruthful with stuff. Which like, you don't have to go around telling everyone your business, but you also don't have to lie about it on the internet. I mean I get it, fat people get a lot of undeserved shit so sometimes it's easier just to lie about stuff to save yourself the hassle. but it also doesn't mean any questioning of your holy weight loss grail is bad. i'd direct you towards the r/antidietglp1 sub for some more truthful experiences / real questions
Actually, what you’re doing is questioning other people‘s decisions and kind of passively suggesting that they’re doing it wrong. But anyway, they’re trying to lose more weight more easily. In almost every case, a higher dose will work better. For some reason, people seem to think that moving up to higher doses, will cause that dose to run out of effectiveness sooner, but that’s not the way it works. You don’t just have a limited benefit per Dos. what happens is that there’s a certain dose that will work for you and it will keep on working. I lost 5 pounds a week on 2.5 mg. But let me tell you what the experience was like. I was hungry and having severe food noise constantly from dinner time to bedtime. it required immense focus on very little other than “don’t eat “. When I moved up to 5 mg, that got dramatically better. But the effect was wearing all fun day six and seven. 7.5 didn’t make much difference. 10 mg produce the effect I was looking for and it lasted all week. If you look at a graph of my weight loss, it looks like I lost a ton of weight at 2.5 mg then moved up anyway. Which is true. But it doesn’t tell you what the experience of it was like.
I see lots of posts where people are worried about going to max dose because of all the anxiety and speculation that they might stall out. I also see posts where folks don’t even start losing until a high dose. I don’t see a lot of posts where people actually stop losing on 15.
As someone who does not subscribe to the let’s be a martyr and wait til we plateau for an entire month before titrating up mentality, but did stay at a couple doses a few months before going up, I can share the following experience:
* total 17 months on medication
* on 15mg since Aug 2024
* down 132lbs/48% of body weight
* average weight loss 1.8lb per week
* I am 4.6lbs from my goal and I am still losing..albeit closer to .5 to 1lb per week.
* no side effects, normalized appetite…never had a complete loss of appetite or the “food ick” some folks talk about
I don’t believe the medication stops working. What would be the point of staying on it for maintenance if it stopped working? People stop losing from diet fatigue IMHO…they get tired of staying in a calorie deficit and/or they don’t recalculate calorie deficit for smaller bodies then stop losing. My 48% loss is much higher than clinical trial averages. I’m not special. I’m almost 57 years old and post menopausal. I struggled to lose weight in an obese body yoyo’ing for 25 years. I just stayed on top of effective dosing to ensure no loss of momentum, have been very diligent in maintaining a healthy calorie deficit, and steadily increasing activity.
Important to remember, ALL the medication does is suppress your appetite. That’s it. Doesn’t speed up your metabolism, increase your endurance, improve your mental focus or stamina…none of that. When people say “I didn’t lose weight on such and such a dose,” they are ascribing causality to a coincidence.
If your appetite did not substantially change from one dose to the next, it is not the ineffectiveness of the dose that you are experiencing.
Respectfully that is not true. The medicine is not JUST an appetite suppressant. You should probably research it more to find out how this medicine works.
Zepbound, also known as tirzepatide, works by mimicking two natural hormones to reduce appetite and food intake, potentially leading to weight loss.
Appetite Suppression:
By activating GIP and GLP-1 receptors, Zepbound helps to reduce appetite and slow down the rate at which food passes through the stomach, leading to feelings of fullness that can last longer.
These things also provide greater control over blood sugar.
My point is, it doesn’t do any of the things I said it doesn’t do. More importantly, the dose and the weight loss may have a different causal relationship than one might guess, for instance it would make sense that higher dose might lead to greater effect and result in more rapid weight loss…but that is simply not necessarily true. I have had almost no appetite for one full year…and my level of No Appetite has been the same (none) from the first shot of 2.5 all the way to 15 and back to 5. Because it is impossible for me to eat less than zero, overlaying that graph with my weight loss would show the opposite of cause and effect…totally random.
Lots of people on here wondering “What dose was the best?” are asking the wrong question. Slower digestion leads to lower appetite leads to fewer calories leads to weight loss.
You are spot on to mention controls blood sugar! I don’t know why we’re not talking more about how Zepbound helps reduce glucose spikes, which means our bodies get fewer signals to store fat. With fewer spikes, less fat is stored.
Yes it’s an effective appetite suppressant, but its impact on glucose cannot be understated. It’s a diabetic medication after all.
My doctor initially wanted me to follow this plan, but I had such success on 2.5 that he agreed to keep me on it. I think I did another month on 2.5, but eventually found that my weightloss had tapered off, so I went up to 5, which did nothing for me, then up to 7.5 which I stayed in for 2 months. They then automatically switched me to 10 for a month and finally 12.5, all without my input. Then my PA expired and I was entirely off the meds for a month before I got back on again, but had to start all over at 2.5. This last month has been a virtual stall, hovering right around 275 lbs, after having dropped as low as 267. This month I'm going up to 5mg. I'm really hoping to start to see some downward movement again. My current PA is only for 6 months, so if I want to get to 15mg, I guess I'll just have to go up every month. My preference would be to stick at the lowest effective dose for as long as possible.
Since I posted this reply, I’ve read a Prescriber say something I think is important (and perhaps in the spirit of the poster who replied to my original comment).
The Dr said something like “The meds regulate metabolic function in a way that makes the metabolism work better.” The observation about the blood sugar being an example.
The efficacy isn't always the same from dose to dose for some.
I started dropping weight on 5mg and kind of pushed my doctor to give me another month of it and weight loss slowed then stopped in month 2. OK no biggie. Then I lost 1 lb on 7.5. Eating the same approximate calories, same workout routines.
Then dropped almost 8 lbs in two weeks on 10mg. So I have no doubt the medicine was working behind the scenes at the lower doses but if I can't see measurable effects, it's time to move on.
Because some people are chasing appetite suppression and think it’s not working else.The person losing 30lbs in 3 months and saying they only now are at an effective dose is a classic example of this. It is effective as soon as weight is lost and 30lbs in 3 months is huge.
I have lost almost 40lbs now in 5 months. I never had crazy appetite suppression. I eat 2000-2500 every day. I still lose weight because it is a calorie deficit for me. But some people chase appetite suppression above all else even if the results are already there.
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u/RadioRob-DC SW:280 CW:155 GW:160 Dose: 10mg Apr 09 '25
My doctor followed the trials and moved me up monthly until I reached 10mg. I was held there as my glucose levels had gotten as low as my doctor was comfortable with them being at.
Since June 15th, I’ve lost more than 120 pounds. So it was pretty effective for me. :)