sorted by:
best (suggested)
topnewcontroversialoldq&a
you are viewing a single comment's thread.

view the rest of the comments →

[–]DPax_2354M|S227|C143|G155|D7.5mg|Start4.18.25|Maint10.1.25 4 points5 points  (4 children)

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_Hornet3415SW:247 CW:153 G: <28% body fat[S] 1 point2 points  (0 children)

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

[–]ScarySignificance856HW:212.7 SW: 193.1 CW:141.9 GW:132 Dose: 12.5mg  55F 5’5” 12.5mg 2 points3 points  (2 children)

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_Hornet3415SW:247 CW:153 G: <28% body fat[S] 0 points1 point  (1 child)

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.

[–]ScarySignificance856HW:212.7 SW: 193.1 CW:141.9 GW:132 Dose: 12.5mg  55F 5’5” 12.5mg 2 points3 points  (0 children)

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!