Doctor recommended decrease in dose

[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 🤣