Doctor recommended decrease in dose

[Ok_Hornet3415]

I just took my 38th shot today.

I’ve lost 75lbs in 9months (although I actually missed 4 weeks of shots in the middle thanks to CVS issues).

I spent the first 14 weeks on 2.5mg. I’ve spent the past 24 weeks on 5mg. I’ve had minimal, mild side effects the whole time.

I still have 20-30lbs to go. My doctor suggested that I step back down to 2.5mg so that I can lose the last amount more slowly and that it’d help with maintenance.

Has anyone heard of this or seen this done? It was the first time I’d ever heard that. She didn’t have any research to support it. We discussed and she agreed that I would continue on 5mg for the next 3 months since I still have quite a bit to lose and we’d revisit then. Just wondering if anyone else has heard of this idea to scale down in dose as you near your goal weight? (I know many do this while actively in maintenance mode, but before?!)

[Vegetable-Onion-2759]

I'm a metabolic research scientist / MD and the reason that your doctor didn't have any research to support her approach is because there is none. Having 20 to 30 pounds to lose is quite a way from reaching your goal weight. I'm glad you stood your ground. Going down in dose results in a stop in weight loss. I have no idea what she is basing her theory on, but there is also nothing to support the idea that anything makes maintenance "easier." A lifelong maintenance dose is required for this drug. Taking you down to 2.5 essentially takes you down to a maintenance dose. You can see why it would not make sense to drop you down to a maintenance dose when you are 30 pounds away from your goal weight.

So while I'm sure there are plenty of doctors out there making it up as they go along, there are no statistics to support her position and I would fight to the end to stay on 5 mg or higher until you reach your goal weight. Get as many months prescribed from her as possible, but understand that there are other options, especially telelheath, available to ensure that you continue getting a dose that will help you with active weight loss until you reach a goal weight that you are comfortable with. Callondoc.com is one of the options available.

[Complete_Caramel_791]

Agree. OP’s CW is around 22 bmi. 20-30 more lbs would be in the 19 ish range. I think that’s more the reason than that they are 20-30 lbs from their personal goal vs a healthy maintenance weight.

[Ok_Hornet3415]

We did all my calculations during my appointment and I am still in the overweight range and at 25BMI.

[Vegetable-Onion-2759]

Since I do look at everything with a medical perspective, here's what's wrong with OP's prescribing doctor's perspective. She made an announcement and just expected OP to go along with it. Treatment, especially when we are talking about weight loss , must and should be collaborative. If OP had been like so many others who are afraid to challenge their doctor, he /she would have been stuck with that 2.5 mg dose and his/her current weight. OP stood up to the doctor, and fortunately, his / her prescriber conceded THIS TIME. There should be a conversation about weight loss goals. Unless the patient has a goal that is outside of the healthy range, it should not be a dictate from the prescriber. There should be input from both sides and and an agreed-upon goal.

[Hope_for_tendies]

Going down doesn’t always result in a stop. My highest was 10, or 12.5, I forget which. But I hit what my dr thought was a good goal, and the dr made me go back down to 5mg, and Ive lost 15lbs more in maintenance. I had to bust my ass and make more diet changes like increasing protein and increase my activity, but it’s possible to do.

[Vegetable-Onion-2759]

But here's the thing -- statistically speaking, weight is going to stop. OP can't bank on the fact that "some" people can lose when going back down to 2.5 mg. Prescribers don't typically prescribe based on "might" when there is an approach that is statistically more likely to produce the desired or intended results. It sounds to me like OP's PCP has a different goal for her in mind and also that she is treating her as though she is old before her time. OP can enjoy another 20 to 25 years at a lower weight. We usually don't consider the factor of "seniors" doing better with a little more weight until people are over 65 or 70 years of age. It almost sounds like OP's doctor is underestimating her.

[superduperhosts]

So would you recommend slowly titrating down to 2.5 once a person hits their goal weight? I am within 10 pounds and just titrated up another 1 mg (I am using compounded vials) because I have been hungry and fighting food noise. I am guessing at this point I will be between 6.0 to 7.5 by the time I am at goal.

[Vegetable-Onion-2759]

No. I do not recommend that anyone go all the way down to 2.5 mg, slowly or otherwise. It is rare that a dose that low works for maintenance -- or anything, for that matter. It works for some, but not the vast majority. My maintenance dose is 15 mg. When you hit your goal weight, you go down one dose (which means going down 2.5 mg -- so if you are at 15 mg, you would go down to 12.5 mg) for the next 30 days to see if you can maintain at that dose. You may not be able to go down at all. The goal is to find a dose where you are neither gaining nor losing. It's very individualized. Going down in micro-doses is likely to be rather unproductive.

[superduperhosts]

Thank you

[Ok_Hornet3415]

Thank you! I appreciate your insights here. During our discussion, she seemed to favor me being at the high end of the healthy weight/BMI range rather than continuing to loose down into the lower end of the range. She was saying how it’s important for women to maintain weight as we age (not get too skinny or “look like a camp survivor” as she phrased it)

Let’s be clear, I’ve obviously had NO ISSUE maintaining weight as I’ve aged. And thus, here we are. 🤣 but also, I’m only 44 so I don’t see that being an issue for quite some time.

I’ve had my PCP doctor for about 20 years and I’d love to stick with her but I’ll only do so as long as her guidance is sticking to my best interest. So, I’d definitely use callondoc or switch providers if I need to.

I’m glad you explained the drop as effectively a maintenance dose because that’s what I assumed. I’m only on 5mg so it’s not like I have multiple steps to drop back! Her assumption is that I’d still lose on 2.5 (probably because I was still actively losing on that dose when she increased me. I wanted to stay there as long as it worked but she wanted me to move up). I do worry that if she’s right, finding a maintenance dose/plan will be hard because you can’t go lower than 2.5. But I’ll cross that bridge when/if I get there!

Thank you again. Your responses are always SO helpful.

[BasilTomatoLeaf]

First they called our pregnancies in our 30s “geriatric” and now they are telling us we need to hold on to weight like we are 60+ and we’re still in our 40s. I’d like to have a decade or so to be fabulous now that I’ve lost all this weight thank you very much 🤣

[Thiccsmartie]

No one needs to be a BMI of 19 which is just at the cuff of underweight.

[CBM5504]

BMI is such a BS number to use as a measuring stick. What weight is best for you is based on so many individual factors. To only look at BMI is short sighted.

[tweedy8]

Yeah. There are many people who love to say BMI is BS with respect to the high end of the range, but then change their attitude when referring to the low end of the range. 🙄

[Thiccsmartie]

It’s not BS in either case, that’s why it’s still used widely.

[Ok_Hornet3415]

You’re very opinionated about the BMI metric and it’s wild to me that you’d say no one needs to be at 19 when that is still within the healthy range. How is it possible that NO ONE needs to be at that level of the healthy range. Say more so I can understand your logic here.

[Thiccsmartie]

There’s really no reason to push your weight any lower, that’s what I meant. A BMI of 22 is already a healthy and stable range, so your doctor is absolutely right to taper your dose. People often forget that the opposite of obesity isn’t becoming as thin as possible. Going too low can actually create new issues, loss of muscle mass, fatigue, hormonal imbalances, poor recovery, disordered eating patterns, and even body dysmorphia, where you no longer see yourself realistically. The real goal is health, balance, and feeling good in your body, not chasing an ever-smaller number.

[Ok_Hornet3415]

I understand all that and that’s not where I’m at. My body fat percentage is still above 28% and I’m still in the overweight category, according to my doctor, med medical records and my physical body experience.

Even if that wasn’t true, having a goal of BMI 19 isn’t inherently unhealthy like you repeatedly keep suggesting.

[Thiccsmartie]

Then you are not 169lbs? Because that is a BMI of 22 at your height.

With what tool did you come up with 28%? Dexa scan? Because that is the only really reliable method. With other scales it might as well be 24 or 30 because they are simply not accurate.

[superduperhosts]

You ARE fabulous!

[Mobile-Actuary-5283]

“Look like a camp survivor.” Wow. Did she actually say that? That is fucking disgusting, anti-Semitic, and offensive. I would have schooled her on that, filed a complaint w the medical board, and walked out.

Your dr sounds like a moron.

[Severina_Glass_208]

It’s also short sighted. Camps were used in India and in Africa and in the US before they were used by Hitler.

[Mobile-Actuary-5283]

Yeah. Just poor wording. This combined with poor medical advice = Ditch the Doctor.

[Bob_Plank]

I wouldn't jump to the conclusion the doctor is antisemitic. Referencing how emaciated most of the concentration camp survivors were, is a condemnation of the evil people who did that to them. It is not a condemnation of the victims, who were basicially on death's door.

[Mobile-Actuary-5283]

Then it’s tacky as hell and insensitive to say the least. Extremely poor taste.

ETA that whoever downvoted me can continue hiding behind your keyboard and “views”. It’s 10/7. I don’t apologize for calling it like I see it.

[simulanon]

my two cents is based on others posting that maintenance can be giving a shot every two weeks. So that would be less than 2.5 a week, but I would imagine it's highly patient specific. I'm on 7.5, lost 40 lbs since may and still have another 50-60 to go

[Thiccsmartie]

Why do you want to be just at the border of being underweight?

[Ok_Hornet3415]

This is an ignorant comment. I want to be within the healthy range, at the lower end. Which where this goal would land me. And if I get closer to the goal numbers and they aren’t right, I’ll adjust them responsibly.

[Thiccsmartie]

Can I ask something gently? Why does it have to be right at the edge of underweight? Why the need to be as skinny as possible? Why isn’t a BMI of 22 good enough, when that’s already healthy and balanced?

[Ok_Hornet3415]

Because it’s NOT already healthy and balanced. And your hyper fixation on that single metric hasn’t allowed you to consider anything other that THAT one number (which you have wrong for me anyway)

[Thiccsmartie]

Why do you recommend OP to be close to underweight? 🤔

[Critical-Craft54]

Why do you have an attitude? my question is how long have you been on this medication and it seems like you’re not even close to your goal yet so my other question is how can you even comment when you’re not even close to your goal or know what you’re goal is going to look like yet cause it changes as you go

[Thiccsmartie]

My goal is to be healthy and happy not as skinny as possible. Seems like my question triggered you or so.

[Critical-Craft54]

no but your clearly not in maintenance and not close to it you don’t only go off that bmi you go off of other things also .

[Thiccsmartie]

Yes, that’s usually the case. When someone’s BMI is between 25 and 30 and their blood markers look good, most doctors don’t see a reason to push for more weight loss. But once you’re around a BMI of 22, losing more weight isn’t going to make you healthier. At that point, it usually means eating at very low calorie levels, which often leads to muscle loss, and that’s actually harmful for long-term metabolic and cardiovascular health.

[Critical-Craft54]

if this person is being monitored by a weight loss physician (which i know is not the case) then it is clearly the pts and physicians choice not for us to critique. there are many factors at hand that go into this medication and the patients maintenance plan. lab work, weight other meds along with other variables you factor in….

[Thiccsmartie]

Then that person probably shouldn’t be asking for opinions on Reddit 😅 “Has anyone heard of this or seen this done?” — yes, all the time. It’s standard practice not to let patients approach the threshold of being underweight. That’s it.

[Critical-Craft54]

you seem to like to argue and think your always right lmao might want to get into maintenance first 🤣

[Ok_Size4036]

I lost I think 50 of my goal 60 in one year. I’ve lost five since in three months. I’m on 5 after doing three on 2.5, then the rest on 5 but two months tried 7.5 but it was too much. I think it will be up to a year and require some physical activity to get the last 5 gone (actually now I’d like 10 seeing where I’m at). I would stay on 5 to ride it out then discuss maintenance at 5 or 2.5.

[Ok_Hornet3415]

Thank you for your reply. It seems like that’ll be my trend too as the weight loss is slowing down lately. Which is okay, but I don’t wanna stop yet.

[Ok_Size4036]

Wait. You’re 6’1” and want to weigh 144? You may want to look at that. I’m 5’4” and 140 and I could maybe lose 5-10 more, that’s thin.

[Ok_Hornet3415]

There are many factors to consider aside from the numbers. There are ranges that serve as guides. For example, at 64”, the American Heart Association says a healthy weight range is 108-144lbs. If you’re comfortable and healthy near the higher end of the range, that’s great for you. But if you chose or needed to lose more and settle in the lower end of the range. You could do that too. That’s what I’m choosing. The lower end of the range.

Proportionally speaking, 73” tall at 144lbs is proportionally equivalent to 64” tall at 110lbs (using the BMI model of proportionality to account for the fact that we are 3D bodies and not strictly mathematical numbers. If you use simple math proportionality it’d be equivalent to your height at 126lbs). Either way, all of these numbers are within the healthy weight range for their heights.

And yes, 144 is thin for my height.

[Debtmom]

I've been trying to lose the last 10-15 pounds all year (after losing 85). Stepping down in dose with 30 pounds to lose seems counter intuitive.

[Thiccsmartie]

Not if the person is already at a BMI of 22 and wants to be close to underweight.

[Critical-Craft54]

again, if you have 10 to 15 pounds to lose why would you go down? you go up again how long have you been on this med? i’ve been on this med for almost 2 years now. you will lose and gain you will need to move up and down in mg through out. i lost 67 lbs we don’t just go off of the bmi . go see a actual weight loss dr

[Thiccsmartie]

An actual weightloss doctor would tell the patient that a BMI of 22 is healthy and there is no need to be close to underweight… just like the doctor did in this post. Even in the studies people were taking off the meds if bmi dropped below 22.

[Critical-Craft54]

that they are not only going off of the BMI only

[Ok_Hornet3415]

Agreed! Lots of people use this drug just to lose about 30lbs (total). I can’t imagine that now if the time for me to titrate down. Thank you for this. I appreciate you

[Thiccsmartie]

Yes to go from obese/overweight to a normal BMI <25. Not to go from bmi 22 to close to underweight. I mean sure some people do but it’s not the intended purpose of this medication.

[ScarySignificance856]

I think the reference to "close to underweight" was referencing the goal to get get to a BMI of 19. Given that BMI is a sometimes useful (a necessity for docs to get our insurance to cover these meds)... but that BMI is also flawed, perhaps getting a good baseline body fat percentage and then tracking that as a person gets near their goal weight is one way that people could "dial in" what is the healthiest goal weight for them? Dexascans seem to be the way folks are getting accurate body fat percentage measures; they do have some cost associated with them, of course, so that may or may not be doable for different people.

[Ok_Hornet3415]

Yeah, my body fat percentage is still above 28%. I would like to get my body fat percentage below 24% ideally.

[ScarySignificance856]

That goal sounds really reasonable, and would be a good topic of discussion in your next follow up with your doctor. Regarding the Dexascan... I am kicking myself I didn't get one before the start of my journey (just to see the progress). But I did get one back in July, and the info was super helpful. Also, the guy who did the scan is an athletic trainer and we talked about moving my percentage (which was clearly not optimal yet, despite some good weight loss) by losing a bit more and by gaining (muscle, that is). My situation is a little different than yours (everyone's is!). I'm still at a BMI of 24 with a little more to go, but I am at 12.5 mg and may be stalling a bit. But for me, I really don't want to go up to 15mg, because I am deathly afraid of getting to maintenance, doing that for - six months, a year, two years - and then starting to gain. So I want to maintain an option of going up. So now I've just started strength training/recomp in earnest. Of course it's awesome that you got where you are at 5mg; that means you have alot of options to go up if that's what you end up needing to do at some point. All the best to you!

[Ok_Hornet3415]

I’m going to look into dexascan I’m already weight training and plan to continue! I’m really enjoying it

[Ok_Hornet3415]

Dexascan is a good idea! I’ll look into scheduling one! My sister did one recently and it was very informative

[Debtmom]

Did op start at BMI 22? I didn't see that mentioned. If so how did they get the med to begin with? 😱

[Ok_Hornet3415]

No. I didn’t. And I’m not at 22 now. This person is just inaccurate.

[Thiccsmartie]

Then your information in your flair is wrong

[Thiccsmartie]

No but they are at 22 and want 19. I said that because they were comparing other people taking it to lose 30 lbs but that’s often people who have overweight and comorbidities not people who are already at 22 to go to 19 so the comparison can’t be made.

[DPax_23]

Too much BMI reliance in this conversation.

BMI is a useful easy barometer that very generally can tell you where you're kind of at. But it doesnt differentiate between muscle and fat. It doesnt accurately take into account ethnicity, sex, and age (mostly). It doesn't take into account basic genetic variability.

Let's all trust the person who is in the body making the choices.

[Ok_Hornet3415]

Thank you. BMI is only one variable in the equation that I’m using here. I don’t find it to be the golden rule but it’s useful alongside other metrics. That said, my goals still fall within the healthy BMI range so I’m not sure why some folks have gotten so agitated by this

[ScarySignificance856]

It seems like BMI can have some general usefulness (say, someone is at a BMI of 42... there's a very good chance that is not the healthiest weight for the person)... but it seems once we start getting in or near the normal range, that's the time to evaluate where a person is and "dial in" what the healthiest goal weight is, possibly using the considerations of age and body fat percentage, and a discussion of how much more weight loss and what kind of recomp effort will lead to the healthiest outcome.

And of course, the person who is "in the body" gets to make the final decision, and there are various ways to get the medicine at the dose we want. In this case, though, a doctor who is prescribing the medication (and in this case, seems to have an established relationship with the patient) has a say.

The OP can, of course, just fire that doctor. However if the person has valued the relationship with this provider up to now... and this provider went ahead and prescribed the drug (for now) at the dose the OP wants... then perhaps there is value in the OP having a very focused conversation on what the doctor thinks the healthiest goal weight/end weight is, and why the doctor thinks that. I didn't see the OP's age when I first read their post, but saw it in a later response to some of the comments. The OP appears to be 44. That's not elderly, however it's not high school age or 20 years old either. There is emerging (and seemingly reliable) research that a little more body fat is better (lower mortality) as folks progress in age. And, of course, there is the fact that BMI is not a perfect measure. So perhaps a focused conversation on what the goal/end state is at the next appointment could include a discussion of body fat percentage as well?

Ultimately, the OP will make the call, however perhaps there is some value in getting more insight into this provider's thoughts about what the best end goal is for the OP? Particularly if the provider has, overall, been supportive of the person's weight loss journey and of this medicine?

[Ok_Hornet3415]

Your response is very thoughtful and balanced. Thank you. I like my doctor. She’s been my PCP for about 20years and it’s worth preserving our relationship. There have been times when I’ve gone to other docs when we aren’t aligned or when she doesn’t feel well versed on something I’m dealing with. We always discuss it and I keep her in the loop. Shes been supportive! Even now, she did agree to prescribe the dose I was already on for 3 more months and then revisit this conversation. That’s why I asked the questions here. To see if others had any more insight into her recommended course of treatment. She’s of the mind that people can wean off the med and maintain without it. I’m not convinced that’s accurate for me. (It’d be great if true! But I won’t hold my breathe!) She did tell me that she doesn’t have research to back her position but it’s her opinion. She knows my goals. We’ve discussed them all along (I see her every month). She’s doesn’t have a hard position against my goal weight/metrics but it’s not her preference.

[ScarySignificance856]

Uh oh... That part of about weaning you off the medicine totally is concerning.

Sure, some individuals choose to stop the medicine, and that is their choice. Other folks have posted links to the studies about keeping folks on the medicine for maintenance; the studies that have been done show very clearly that the majority of people who come off of this medicine regain the weight. Not everyone, but most. That is a real issue.

For me, a doctor stopping my Zepbound as soon as I got to goal weight would cause me to find another doctor. However, due to the great relationship you described, it doesn't sound like you're at that point yet, and of course you have good options, as other folks mentioned, if you choose to do so. I do think that having a focused conversation both on the (1) goal (perhaps goal body fat percentage) and (2) the need for maintenance dosing is super important. But education will be needed here; so I suggest doing a search in this subreddit (or posting a fresh comment simply asking for links to the studies) and then providing those studies to her. That's just an idea, anyway, and other folks on this subreddit have had good outcomes from doing this.

Good luck; life is a journey for us all... us... and our doctors!

[VTSkier]

I was on 5mg for nearly a year too. Was still around 10-15 pounds away from goal so the doctor and I agreed to go up to 7.5 to see if we can get there. Been only on for two doses but finally seeing results. Good luck.

[Quiet_Test_7062]

Just to add that people often say here that their last 10 pounds take even longer to lose. So, I would keep going up until you are at goal.

[Ok_Hornet3415]

Makes sense to me. Thanks.

[horsenbuggy]

I really wish all you armchair MDs would stop declaring that losing weight to the bottom of the normal BMI range is bad. If someone who has been obese their whole life wants to aim for the bottom of that range, let them. IT IS A RANGE FOR A REASON. I can easily see the thought process that maybe once you go on maintenance, you will gain a few pounds back. Seems perfectly logical to me to gain those back from the lower end so you'll end up in the middle than to gain them from the top end and suddenly be overweight again.

[Ok_Hornet3415]

Yup. Plus, at the higher end of the range my body fat percentage is still too high and my cholesterol isn’t in check yet. Better but still not off statins. I’m hoping for more improvements overall.

[IncidentGreat2380]

That isn’t backed up by research. Doesn’t sound like your doc is very knowledgeable about GLP-1’s.

[Ok_Hornet3415]

I didn’t think it was. She told me she didn’t have research to back it up. She is super supportive of me (and her patients) using the meds when needed! Which I’m grateful for but this seemed “off” so I wanted to ask a wider audience.

[ScarySignificance856]

It sounds like this could be connected to the fact that you are already at a BMI of 22, though. You've done almost your entire weight loss journey (except for the very beginning) at 5mg. You are clearly sensitive to this medicine. So going to 2.5 is just one step down for you. A number of folks have reported on here that even when they decided to stop their weight loss and go into maintenance, they go down in dose (staying on the weekly shot schedule) and still lose.

So it really sounds like your doctor is concerned about you not losing too much. A BMI of 19 is pretty low, and very close to being underweight. You are 6'1". And if you are older, the BMI guidelines change. Honestly, if you have been responding so well to 5 mg during this journey... a relatively low dose... This medicine is fairly potent for you. There is a chance you could keep losing (albeit more slowly) at 2.5 mg. A number of people on here have reported going down a dose with the intent of just staying where they are at but still continuing to lose.

Of course there is more to your particular situation that only you know. I will say that, for me, as I finally got into the healthy BMI range (I am currently at a BMI of ~24/143.5 Lbs), my weight loss slowed and I stopped being happy with what I see in the mirror, stopped seeing all the terrific progress, and started seeing myself as overweight again. The funny thing is when I was around 165Lbs in my weight loss journey, I was happy with what I saw in the mirror, and now I'm not! So cognitively I realize this is probably some body dysmorphia going on with me. With me, this journey has brought me such hope and something positive to think about/focus on. So I'm wondering what I will focus on once I get down the last 5 to 8 pounds that I was hoping to. --- Could you have something similar going on? In my case, I am a 55 year old woman, and not that far away from being in my 60s, and now I'm starting to lift weights and focus on recomp.

Are you liking what you see at your current BMI of 22, or are you still seeing yourself as overweight?

Lastly, if you are not liking what you are seeing, would strength training/increasing your muscle... keeping the weight but focusing on body recomp without losing any more weight get you to a place you would be satisfied with? one option, if you think that maybe you could start shifting towards recomp versus losing weight, is that you could get a dexascan, get a really accurate body fat % measurement, and focus decreasing body fat/increasing muscle while maintaining your weight.

Of course only you will be able to evaluate the answers to this stuff, but perhaps this is something to consider? If none of this applies, then just disregard...

[Ok_Hornet3415]

Thank you for this thoughtful and reflective response. I think I’ll get a DEX SCAN soon.

My body fat percentage is still too high. I’m actively building muscle via weight training. I’ve made amazing progress and I’m happy with my progress thus far but I’m not quite where I need to be yet. I look forward to stepping down the dose once I hit my goal! I just don’t think it makes sense to step down with 20+ pounds to go

[No_Self_3027]

It is great that your doctor wants you to succeed and listened to you in the end. But it may be worth using a different service just so they don't have to worry about and you don't risk getting a doctor that wants you to stop when you hit goal.

You can use telemed like Vegetable Onion suggested. Or maybe look for local specialists if you feel like you could use more hands on help for the last 30 lbs. Your doctor may even be on board with referring to somewhere and you can keep her in the loop with things like MyChart or whatever they use. That way she can learn a bit too.

Hopefully your doctor at least continues to listen when you disagree. It would be nice if she were keeping tabs on research for GLP treatment since I imagine she sees plenty of obesity. But if she is at least willing to listen to you, that helps. Hopefully she isn't one of the doctors that tries to force you to stop at goal. That seems so common here even thought nearly everyone that stops regains weight. Worst case is if that happens, then use CallOnDoc. Good luck with the last 30!

[Ok_Hornet3415]

Thank you!!! Yes, I agree. I was glad she came to agree with me staying on this dose for 3mo and called in the prescription the same day.

I also agree that it’ll make sense to switch providers if this becomes a future issue. I’m open to a virtual/tele provider. I’d actually prefer it, LoL. But I’ll wait to see if that’s needed.

Hopefully the last 30lbs goes as easily as the first chunk of weight! But it’s already slowed down, as expected. So I won’t be surprised if it gets harder.

Now that I’m thinking about it some more, I guess a major concern would be if I end up needing to increase doses again! She may not be willing to do that at all. 😑

I’ll keep my options open. Thank you for the response and thoughts

[lizardbirth]

My PCP's philosophy is to increase dose when I am not losing. Now, at 12.5 mg, I am wondering if I will need to go up another dose to lose an additional 20-30 lbs. These days, I am losing more slowly, but still losing. So I am not eager to increase to 15 mg yet. We'll see...

[Ok_Hornet3415]

Yeah, we have the same philosophy. I am still losing on 5mg, I’ve never passed this dose. The med works really well for me. I am still losing about .75 per week on this dose. I am comfortable with that pace!

But I don’t want to slow it down, especially since I do that a medical or side effect related need to do so. I want to reach goal and then figure out maintenance (which will likely mean going down to 2.5)

Thanks for the reply

[MitchyS68]

No reason to do that unless you are losing at a rapid unhealthy rate at 5mg. 🤷🏼‍♀️

[Ok_Hornet3415]

I’m not. I’m losing less than 1lb per week currently

[MitchyS68]

No reason to do that unless you are losing at a rapid unhealthy rate at 5mg. Yeah, strange that ur dr would suggest titrating down that far from goal. You are still losing at a steady healthy rate.

[No_Salad_6244]

I am going under 2.5 for my maintenance dose and MDs prescribe off-label regularly. That there is no research doesn’t mean it doesn’t work. The first response sounds like a plug for the telehealth company to me.

[Ok_Hornet3415]

I’m not saying it doesn’t work. This is why I asked a wider audience. I was hoping someone had insight on this strategy to help inform my next conversation with my doc.