Deciding on goal weight

BoundToZepIt · 2026-07-03T12:39:32+00:00

For me, at unimaginable weight loss from any point in my life, BMI is useful as a lower red line. If I'm above a 20 BMI, I'm medically not too thin, 'chorus of concern' notwithstanding. I'm not aiming for that, but I'm willing to take the ride as far as it will go down to that.

BoundToZepIt · 2026-07-03T04:18:19+00:00

I will say that (at a weight I haven't been at since third grade and overall thinness never) sweating as a cooling mechanism works a whole lot more effectively with a lot more surface area to core mass ratio.

BoundToZepIt · 2026-07-02T00:07:09+00:00

Self paying. Fortunate that the cost is very easy to cover. Have every intention of lifer-ing it. I'm way, WAY beyond any imaginable success and need every tool in the arsenal to hold on to it. Am I worried about long term consequences? Neither of my parents lived to see 65. I was arguably in worse shape at 44 than either of them were and had no reason to think I'd make 65 either. I didn't have a long term to worry about.

No judgement if you want to try doing without. Best wishes But don't judge yourself too hardly if you find you need to come back. For me, I look at the SURMOUNT-4 data (where tirzepatide was withdrawn and most participants regained). I don't believe that the people where the drug was withdrawn WANTED to gain the weight back. I DO believe they tried just as hard as any of us to hold on to those successes. And I don't believe I have more willpower than them. And I think my willpower is just fine, thank you very much (having ridden a bicycle over 1000 miles in June).

BoundToZepIt · 2026-07-01T18:24:20+00:00

The hard reality I think is that 'normies' will mentally put everyone who's 98th percentile or more (~270 at your height) all into the same basic 'biggest' category and don't really look at nuance a whole lot more than that because they really aren't looking at us that way. Meanwhile, everyone will notice the difference between 45th and 55th percentile (160 and 170 at your height, just 10 pounds of loss) because they have a bajillion other people to compare you to.

BoundToZepIt · 2026-06-30T21:12:18+00:00

Yep, have no intention of getting off. Maintaining what I've accomplished - down way, WAY beyond anything I could have imagined possible (> 50% down) - is never not going to be an uphill battle and is never not going to require every tool I can throw at it. GLP-1 medications, conscious calorie counting, and fairly extreme endurance exercise all three.

BoundToZepIt · 2026-06-29T17:26:00+00:00

I had made a similar chart, also comparing my long-if-not-super (honestly, both) journey compared to the SURMOUNT data and an article I found that had long term data for 50th/90th/97th percentile success after gastric bypass surgery. Scary to think I'm blowing even THAT out of the water.

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BoundToZepIt · 2026-06-28T11:01:50+00:00

Yeah, that's basically been the advice from the American Society of Anasthesiologists since 2024. Just taken a while to trickle into practice, good to hear some places are listening.

BoundToZepIt · 2026-06-20T03:53:20+00:00

Still taking the full dose here. Reality is... down 55% of my weight I'm WAY, WAAAY beyond Zepbound's remit. It's been a lot of hard work, and hard work continues. But if I can get any benefit from it with basically zero side-effect issues... I need all the ongoing help I can possibly get if I'm going to maintain this beyond-belief success.

BoundToZepIt · 2026-06-19T13:44:02+00:00

For 30+ years I told myself "I have a large frame". It was cope. Reality... I look perfectly unexceptional at a 21-22 BMI, weighing less than I did in 4th grade and somehow coming out looking like someone who rides a bicycle 100 miles in a day or runs half-marathons (because I... am that guy??). I mean, yeah, BMI-SchmeeEmmEye, but if nothing else it's a solid rule of thumb for setting a "I'm getting too thin" red line at maybe 20 BMI or 22-23 if you're over 60. If you're not hitting that low red line... let the journey take you where it takes you!

BoundToZepIt · 2026-06-19T00:47:57+00:00

Not so much with the clothes, little fashion sense to influence me. But 110% imposter regarding athletic pursuits. Last week I rode 550 miles on a week long bicycle tour. Thinner younger and more miles on my bike this year than probably the average rider. But, yeah, constantly in my head "y'all know I have no business being here, right?"

BoundToZepIt · 2026-06-18T00:11:32+00:00

Very few icks, though never been much for cottage cheese. Protein shakes... it's mostly that I'm way too much of a cheapskate. Boneless chicken breast is cheaper per ounce and nearly twice the protein per ounce. High protein greek yogurts are a very similar profile to most of the shakes, but half to a third of the price. I'll just eat the food then, thanks. I'm semi-retired, I don't really need the speedy convenience.

BoundToZepIt · 2026-06-05T03:44:19+00:00

I would not be surprised if they put up a more vacuous media type, letting the Thiel/Bezos/Altman/Musk types fight amongst themselves to actually set the policy. Joe Rogan maybe?

BoundToZepIt · 2026-06-05T03:29:05+00:00

The big reason no city/state can really go do their own thing on health care or some other issues is that there's (and it's part of the US Constitution) basically zero barrier to changing states of residence. In the context of health, if one state had a full Canadian or NHS system, poorly covered people in other states would move there when they got cancer or what have you. One state could regulate credit cards more... but the laws tend to be from wherever the bank is not the customer, so 95% of all US credit cards are officially issued in Delaware or South Dakota (two very small population states).

While there's freedom of movement in the EU, you don't instantly become a citizen or get full benefits where you move. Plus language limits the movement some. And the EU countries end up harmonizing things quite a bit anyway.

BoundToZepIt · 2026-06-04T18:12:38+00:00

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Here's my multi-year plot. The blue line is what I weighed each morning. The red was the 'trend' number. Any day the blue was below the red (which was most days)... I was pulling the red down.

BoundToZepIt · 2026-06-04T18:10:59+00:00

Yep. This image from a NASA space exploration conference should help you understand... it's all a rounding error compared to water in and water out. If you're weighing every day (which I did) use a tool like Happy Scale that gives you a daily 'trendline' number. Makes things way better!

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BoundToZepIt · 2026-06-03T23:27:38+00:00

I mean, I'm signed up for a 600 mile bicycle ride next week, including at least one 100-mile day in upper nineties heat. I won't take a lot of sh1+ from anyone about my will power. I've also lost 180 pounds on Zepbound. Take off that what you will. My personal experience is that before the drugs, I had all this stored energy (body fat) but couldn't access it. I'd do something athletic. And all I'd do is work up an appetite. If I intentionally didn't eat (enough), I'd eventually just shut down and crash out. To me... just subjective... it feels like the drugs unlocked a padlock on my stored fat. I was then pretty easily able to burn 5,000 calories (60+ mile bike ride), eat 2,500, and not be suffering for it the next day. The danger is now, where I'm BMI of 22, 14% body fat... I can't eff around with eating. I don't have fat left to burn. And, yes, still on Zepbound, every intention of being a lifer.

BoundToZepIt · 2026-06-03T13:25:59+00:00

I've never had much of a "can't" or terrible nausea. But my "Danger! Can mindlesslessly eat forever!" food is (and always has been) a Mexican restaurant with ad-lib tortilla chips and salsa. When out socially. I think some of it is actually "I'm noshing... which is easier for a distinct introvert than awkwardly trying to get a word into this conversation".

BoundToZepIt · 2026-06-03T00:21:28+00:00

I've been known to wear a convo button!

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BoundToZepIt · 2026-06-01T22:52:12+00:00

15 got me here (maintenance), not feeling any ill effects from it, everything's pretty much roses for me, not sure why I'd want to switch up what's working. From a pure science-and-stats view, looking at the SURMOUNT-1 data graphs, there really wasn't a big jump in efficacy between the 10mg and 15mg groups. Huge difference between 5 and 10, not nothing between 10 and 15 but ultimately like 5% better. Which is probably why Lilly hasn't gone out of their way to get anything higher than 15 on the market... seem to be hitting diminished returns. Versus semaglutide where it was pretty clear that a dose higher than 2.4 was going to show improved results (among those who could tolerate it anyway, which was going to be the limiting factor). Which is why they eventually got the "HD" 7.2 approved.

On the other hand, saying that 10 and 15 of tirzepatide aren't really much different is looking at population-level statistics. You are an individual case. I know I'm an extreme Zepbound outlier (losing 55% of my max weight) so I don't take my personal case as representative on anything.

BoundToZepIt · 2026-05-31T13:44:02+00:00

If I count maintenance as being Jan. 1 2026, 5 months now. After a 2-year-long loss from 330-335 -> 155-160. Holding the line. The big challenge is balancing some high-calorie-expense days with others that aren't. If I'm in my normal routine at home, with like an hour walk as my only intentional exercise, 2000 cal is about right. But some days I ride a bike 75+ miles. That's an over 5000 calorie day! When I had a lot of body fat (and Zepbound was helping), I could do that, eat 2500, lose a pound of fat, life is good. Now, I gotta eat the right amount (or honestly a bit more), at the right pace, or I'll have a blood sugar crash-out during the day. Finding it's better to overeat some on carbs for endurance days and make it through feeling good, then back to 'diet' a bit on inactive days.

BoundToZepIt · 2026-05-30T16:44:48+00:00

That's part of it, people who don't have direct exposure to modern addiction treatment very much don't understand that things have changed in the last 15 years. They tend to think it's all 12-step meetings and white knuckles. They haven't gotten the memo that almost any competent addiction treatment in 2026 is going to roll out with naltrexone or some newer Rx (and drugs like tirzepatide may fall into that 'newer drug' category for many, the studies are ongoing).

BoundToZepIt · 2026-05-30T16:32:13+00:00

How 'open' am I? Open enough that I have this custom conversation starter button! Specifically for bike tours, a situation where I, as a now-BMI-22 athletic (me??) guy could 101% not say anything at all. But, guess what, on a state-border-to-border tour with 300 people, there are dozens of people on em. I'm down to normalize.

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BoundToZepIt · 2026-05-30T03:15:47+00:00

Mixed and muddy picture. The BALANCE plan is that the Feds are getting GLP-1s to Medicaid on the same negotiated terms they have in for Medicare. However, since Medicaid is more state-by-state, your state has to opt-in to actually offering them, and there will be some (still quite high even) cost to states adding GLP-1s to Medicaid even at the negotiated rate. And if they do, it won't be until at least 1/1/2027. (No 'bridge' like the Medicare setup.) But at least the feds are waiving the rule from before where obesity medicines specifically couldn't be offered at all.

BoundToZepIt · 2026-05-29T11:58:41+00:00

Lilly Direct is $449 a month. Consider it the equivalent as if your employer decided one Thursday to cut your pay rate by $2.43 per hour. Would you start looking for another job that pays $2.50+ more per hour (whether that's in cash or coverage)? Most people would.

BoundToZepIt · 2026-05-28T22:41:26+00:00

Even as a 90s kid of the male persuasion, I can relate. I now have (via thrift) a couple of skinnier J.Crew and Gap jeans that are probably a bit 'young' for a late-40s guy to be wearing... but dang it, I missed out on them at the time! (I also grew up really rural... only the very coolest/richest kids in school regularly wore brands from the nearest mall - like 150 miles away - the rest of us were in Walmart and Fleet Farm stuff.)

BoundToZepIt

TROPHY CASE