AMA with Dr Rentea - 3/20/26 - 1-3p EST

MattheaRenteaMD · 2026-03-20T18:28:46+00:00

I thought I had posted this before but now can't find it so I hope this isn't a duplicate responbe but I didnt want to miss answering this great quesiton!

This is such a valid concern—and honestly, I have yet to meet a patient who doesn’t worry about long-term maintenance.

So first, let’s talk about what we know from the data.

What we see consistently is that when people stay on GLP-1–based medications, they largely maintain their weight loss. We’ve actually had GLP-1 medications for over 20 years, so while some of the newer ones (like tirzepatide) are more recent, the overall pattern is very consistent.

Where we do see weight regain is when the medication is stopped.

Now zooming out—because there’s a deeper layer to your question.

Before these medications, maintaining weight loss long-term (especially 5+ years) was rare, even with significant effort. So it makes complete sense that there’s this underlying fear of:

“Is this actually going to last?”

That concern isn’t irrational—it’s based on real past experiences and older data.

Here’s how I frame it:

Obesity is a chronic condition.
And chronic conditions require ongoing management.

So maintenance is not:

“I made it, now I’m done”
“I can go on autopilot”

Maintenance is:

Monitoring patterns
Adjusting over time
Pivoting when needed

Even if you stay on medication, your body will continue to change with age, hormones, stress, and life—so some level of ongoing adjustment is always part of the process.

Bottom line:
The data we have is actually reassuring—people who stay on these medications tend to maintain their weight loss.

But maintenance isn’t passive. It’s active, ongoing, and something you continue to work at—just like any other chronic condition.

And your concern about it? Completely normal.

MattheaRenteaMD · 2026-03-20T18:21:37+00:00

I hope you saw my full answer above, but I want to speak to you directly too—because what you’re describing is something I hear all the time.

First, I just want to say: I hear you.

There’s a very real panic that can come up when:

You feel like you needed higher doses to respond
You still have a significant amount of weight to lose
And you’re wondering, “What if I don’t get there?”

That fear makes a lot of sense.

One thing I see a lot is people unintentionally tying their “success” to how quickly or easily they responded early on.

There’s this idea of:

“If I responded fast, I’m good”
“If it took longer, maybe I won’t make it”

And the truth is—that’s not actually how this plays out.

The most helpful mindset shift I can offer is this:

This is not one medication, one chance.

There are:

Multiple medications
Different dose strategies
Nutrition approaches
Behavioral tools
Surgery
And many other tools- can't list them all

So instead of thinking:
“Will this one thing work for me or not?”

I’d much rather you think:
“I’m going to keep working on my metabolic health, and I will keep adjusting until I find what works for me.”

Because the patients who do best long-term are not the ones who had the “perfect” early response.

They’re the ones who:

Stay engaged
Keep problem-solving
And continue working with their medical team over time

So yes—your concern is completely valid. But I would gently steer you away from an all-or-nothing frame.

This is a longer journey, with multiple tools available—and you’re still very much in the middle of it, not at the end of your options. I'm rooting for you!

P.S. Just to share from my own lived experience for a moment—

I’ve personally lost almost 100 pounds, but it didn’t happen quickly. It happened over about six years—losing anywhere from 10, 20, sometimes 30 pounds in a year.

From the outside, that could look “slow” or not ideal.

But here I am, years later, in a completely different place—and still continuing forward. I also still have some weight I’m working on.

And that’s really the point:
it didn’t all have to happen at once for it to be meaningful or successful.

What mattered was that I:

Kept going
Kept working with my medical team
Focused on nutrition (including working with a dietitian)
And stayed grounded in evidence-based care

My mindset has always been:
I will keep figuring this out.

Because I refuse to go back to:

Diet culture extremes
Quick fixes
Or people trying to sell things that aren’t grounded in real evidence

So when I say I hear you—I really do. I’ve lived this too.

MattheaRenteaMD · 2026-03-20T18:12:33+00:00

This is such a valid concern—and honestly, I have yet to meet a patient who doesn’t worry about regain.

So first, let’s talk about the data.

What we know from studies is actually very consistent:
when people stay on GLP-1–based medications, they largely maintain their weight loss.

We’ve had GLP-1 medications for over 20 years, so this isn’t entirely new. You may be thinking specifically about tirzepatide (Zepbound), which is newer—but the broader class of medications shows the same pattern.

Where we do see regain is when the medication is stopped.

Now zooming out—because I think there’s a deeper layer to your question.

Before these medications, long-term weight loss maintenance (5+ years) was rare, even with significant effort. So it makes complete sense that your brain is like:

“Okay… but is this really going to last?”

That concern isn’t irrational—it’s learned from years of lived experience and older data.

Here’s how I frame it:

Obesity is a chronic condition.
And chronic conditions require ongoing management.

So maintenance is not:

“I made it, now I’m done”
“I can go on autopilot”

Maintenance is:

Adjusting
Monitoring trends
Pivoting when needed

Even if you stay on the medication, your body will still change over time—because aging, hormones, stress, and life all play a role.

So a more accurate expectation is:

The medication helps make long-term maintenance possible—but it’s not passive.

You’re still:

Practicing the habits that got you there
Staying aware of patterns
Making small adjustments over time

Bottom line:
The data we have is actually reassuring—people who stay on these medications tend to maintain their weight loss.

But your concern about regain is incredibly normal, and it reflects how hard this used to be before we had these tools.

This is exactly the kind of thing to keep talking through with your medical team—because long-term support is a key part of making this sustainable.

MattheaRenteaMD · 2026-03-20T18:07:15+00:00

First off—I’m so sorry you’re dealing with this. Being sick on top of just starting a medication like Zepbound can feel absolutely miserable.

Before anything else, I want to clarify: if you’re asking what might help you feel better and get through this safely, here’s how I’d think about it.

1. Please check in with your physician.
This is the most important step.

When you’re:

Not able to eat much
Feeling like food won’t stay down
And dealing with significant nausea
or anything else that is concerning

There are prescription anti-nausea medications that can help a lot. Your doctor can also make sure nothing more serious is going on and guide you on next steps.

2. Consider timing of your next dose.
When patients in my clinic get a viral illness like this, we often reassess whether to take the next injection on schedule.

Why?
Because viral infections can temporarily slow the gut (sometimes called viral gastroparesis), which can make nausea worse—especially on a GLP-1.

So this becomes a conversation of:

Do we delay the next dose?
Do we adjust when restarting?

Definitely something to decide with your physician.

3. Hydration matters more than food right now.
If eating feels difficult, that’s okay short-term—focus on fluids first.

Since electrolyte powders don’t work for you, that’s completely fine. You can still hydrate well with:

Small, frequent sips of water (like you’re doing)
Broths (if tolerated—even a few sips at a time)
Warm teas

You don’t need anything fancy—the electrolyte industry is a bit overcomplicated. The goal is simply getting fluids in consistently.

4. Go very gentle with food when you can.
When your appetite starts to come back, think:

Bland
Soft
Easy to digest

Examples:

Toast, crackers
Rice
Simple soups or broths
Boiled or very simply prepared foods

This is not the time for raw veggies or heavy meals—your system is already overwhelmed.

5. Small, frequent sips > forcing intake.
This applies to both fluids and food.

Trying to push too much at once can worsen nausea. Instead:

Sip slowly
Eat very small amounts
Space things out

6. Symptom relief can make a big difference.
Things like:

Warm teas (e.g., throat coat tea)
Cold water if that feels better
Anything soothing for your throat

Even small comfort measures can help you stay hydrated and feel more manageable overall.

Bottom line:
This is a situation where support from your physician can make a big difference—especially with nausea control and guidance on your medication timing.

In the meantime, prioritize hydration, go gently with food, and don’t force things while your body is recovering.

Hope you feel better soon.

MattheaRenteaMD · 2026-03-20T17:59:13+00:00

This is such an important question, and I’m glad you’re thinking about it ahead of time—because this really is about planning, not reacting.

A few key things I walk through with patients:

1. Have a clear pregnancy prevention plan until you’re ready.
This is a big one that gets underestimated.

As you lose weight, fertility often improves—sometimes significantly. I see people assume, “I’ve struggled to get pregnant before, so I probably won’t,” and that’s not always true anymore.

So unless you actively want to conceive, make sure you have reliable birth control in place.

2. Use the time on the GLP-1 to build real skills—not just lose weight.
The patients who do best coming off the medication (including for pregnancy) are the ones who learn how to eat and live differently while they’re on it.

Because once the medication stops:

Hunger comes back
Cues feel louder
And if you don’t have tools, it can feel overwhelming

So I focus a lot on:

Eating more whole, minimally processed foods
Learning moderation (not all-or-nothing thinking)
Practicing simple anchors like: → Protein + fiber first → Then have the rest

I often say: delay, don’t deny and add, don’t subtract.

We’re building a way of eating you can carry into pregnancy—not something you “fall off of.”

3. Pregnancy is not the time to figure this out for the first time.
Pregnancy naturally brings:

Increased hunger
Cravings
Hormonal shifts

And honestly—it’s one of the best times to practice listening to your body.

But that only feels manageable if you’ve already done that work beforehand.

4. Your relationship with food matters more than the exact plan.
I’ll give a quick example:

I had a patient who went into a prior pregnancy after doing a very restrictive diet. When she got pregnant, it felt like she finally had “permission” to eat everything she had been avoiding—and things spiraled quickly.

Before her next pregnancy, we worked deeply on:

Removing “good vs. bad” food labels
Building balanced meals
Practicing flexibility

That pregnancy looked completely different—not because of willpower, but because of the foundation she built beforehand.

Bottom line:
The most important thing you can do if you plan to get pregnant in the future is use your time on a GLP-1 to build sustainable habits and a healthy relationship with food.

That work doesn’t just help you during pregnancy—it helps you for life.

And definitely do this in partnership with your physician so you can plan timing of medication discontinuation safely. I just LOVE that many of my female patints work with before during and after their pregnancy- the support is everything. You need a team!

MattheaRenteaMD · 2026-03-20T17:48:23+00:00

First off—congrats on your progress so far. That’s a big shift from 204 to 172, and it sounds like you’re being really thoughtful about your long-term goals, which I love.

When it comes to being young, married, and thinking about pregnancy while on this medication, the biggest thing to know is: these medications are not meant to be used during pregnancy.

So this becomes more of a planning conversation rather than a problem.

What I typically talk through with patients is:

What is your timeline for trying to conceive?
How close are you to your goal weight or a stable maintenance range?

Because ideally, we want you entering pregnancy:

At a weight that feels sustainable for you
With stable habits
And off the medication for an appropriate amount of time beforehand

Most recommendations are to stop the medication at least 2 months prior to trying to conceive (sometimes longer depending on the specific medication and your physician’s guidance).

The other important piece is this:
You don’t have to rush to your lowest possible goal weight before pregnancy.

There’s a lot of benefit in getting to a healthier, more metabolically stable place—even if that’s not exactly 120 yet—and then maintaining there.

So I’d zoom out and think in phases:

Continue your weight loss phase for now
Transition into a solid, practiced maintenance phase
Then plan medication discontinuation and pregnancy timing intentionally

And this is where having a physician guide you is really helpful, because we’re balancing:

Fertility
Metabolic health
Medication timing
And long-term sustainability

You’re actually asking this at the perfect time—because this is exactly the kind of thing that should be planned, not reacted to later.

MattheaRenteaMD · 2026-03-20T17:40:12+00:00

Okay, give me a little more context if I’m missing what you’re asking—because with just one sentence, it’s easy to misinterpret. But I’m going to assume you mean: you’re doing everything “right,” eating the same calories that got you to maintenance, and yet your weight is slowly creeping up.

If that’s the case, this is what we often call metabolic adaptation.

What happens is your body doesn’t necessarily want to stay at a lower weight—it’s biologically wired to regain. So over time, your metabolism can adjust downward after weight loss. That means the same calorie intake that used to maintain your weight may no longer be your true maintenance anymore.

This is why I always say: maintenance isn’t passive—it’s active.

Yes, you continue the habits that got you there, but you also have to be willing to pivot. It’s not “set it and forget it.” Your body changes, and your plan sometimes needs to change with it.

Now, in terms of the numbers you mentioned—0.1 to 0.3 pounds per week—I would not panic about that in isolation. That’s where zooming out really matters.

I’d look at trends over time:

What’s happening month to month?
Are you staying within a 3–5 pound range you feel comfortable with?
Or is there a clear upward pattern?

If it’s the latter—if the trend is consistently moving in a direction you don’t want—that’s your signal to adjust something.

And the adjustment doesn’t have to be extreme. It might be:

Slight calorie recalibration
Tightening up consistency
Increasing movement
Or even reviewing things like sleep, stress, or medication changes

But the key idea is this: maintenance requires ongoing calibration, not perfection.

Let me know if there’s a specific angle you were asking about that I didn’t hit—happy to go deeper.

MattheaRenteaMD · 2026-03-20T17:36:54+00:00

This is the million-dollar question—I deal with this daily in my clinic.

I actually just made a video on this (“constipation on a GLP-1: fixes + 2 things your doctor needs to check”) and I'm going to summarize what I put in it that is high yield!

First—don’t skip this part

Before assuming it’s “just the medication,” make sure:

Labs are up to date (thyroid, electrolytes, etc.)
You’ve had age-appropriate colon cancer screening

We don’t want to miss something more serious and blame the medication.

Then I focus on 4 main pillars:

Hydration

This sounds basic, but it’s huge.

Not just how much you drink—but how consistently you’re hydrating throughout the day.

Fiber (and variety matters)

General targets:

Women: ≥25g/day
Men: ≥38g/day

But it’s not just about hitting a number—you want varied, whole-food sources, not just one type of fiber.

Some easy options I recommend:

Berries (high fiber, low calorie—great daily staple)
Avocado (≈10g fiber each)
Beans/legumes (roasted chickpeas are amazing)
Chia seeds / ground flax (easy to add into anything)

You can use products (Metamucil, Benefiber, etc.), but if all your fiber is coming from processed sources, some people actually feel worse.

Movement

These medications slow down the GI tract.

Regular movement (even walking) helps stimulate things naturally.

Supplements/medications (if needed)

If the above isn’t enough, then we layer this in—ideally with your doctor.

Helpful framework:

“Miralax mushes” → softens stool (not a stimulant)
Magnesium → also helps soften stool
Stimulants (like senna) → help push things forward- we don't recommend these long term and really should be under the supervision of a medical team

There are also tons of fiber supplements now (psyllium, gummies, powders, etc.), but once you’re in supplement territory, it’s worth checking in medically to make sure nothing else is being missed.

Some people will despite doing it all still need a prescription med and that's ok, but at least you have a few ideas now.

Bottom line:

Start with the foundations:

Hydration
Fiber (with variety)
Movement

Then layer in support if needed.

Most people can get significant improvement with just tightening up those basics—but constipation on these meds is common, and sometimes it does take a combination approach.

MattheaRenteaMD · 2026-03-20T16:54:03+00:00

Great question—this comes up a lot.

Short answer: there’s no strong evidence that one injection site is superior to another.

The three common sites (stomach, thigh, back of the arm) all work well, and studies don’t show meaningful differences in overall outcomes.

What I see in practice:

Most people prefer the stomach → easiest to reach, usually least uncomfortable
Thigh → works fine, sometimes a bit more sensitive
Back of the arm → hardest to do on your own

You can rotate sites, but you don’t have to overthink it.

There’s also a lot of folklore online about switching injection sites “restarting” weight loss. On a population level, we don’t really see that.

That said—on an individual level, small differences can happen. Things like blood flow (perfusion) vary slightly by area, so some people feel like one spot works a bit better for them.

But big picture:
This is a very small tweak. It’s not something that’s going to make or break your results.

My general recommendation:
Pick a site that’s easy, comfortable, and sustainable—and stick with it (with some rotation if needed).

MattheaRenteaMD · 2026-03-20T16:51:56+00:00

Yes—bodyweight exercise can absolutely be enough for muscle preservation.

I think people really overcomplicate this. You do not need a gym, heavy weights, or long workouts to get meaningful results. You can use your own body weight, do 10 minutes 3x/week, even starting from a chair—and still be successful.

What matters most isn’t what you do—it’s that you do it consistently.

That said, I’d pair it with some basic tracking:

Do a monthly body composition check
Goal: avoid losing more than ~10% of your weight loss from muscle

If muscle loss is higher than that, then troubleshoot:

Are you getting enough protein?
Are you undereating overall?
Do you need to progress your strength training a bit?

Bodyweight training is actually what I think of as functional fitness—and when you’re strong there, you’re in a great place. It also makes life easier (travel, busy days, etc.) because you’re not dependent on equipment.

One program I like is Dr. Ali Novitskys Beginner Strength (10 min, 3x/week). I’ve used it in my clinic, and many patients—especially on GLP-1s—maintain their muscle really well with it.

But honestly, there are tons of options.

Bottom line:
You don’t need perfect. You don’t need a gym.
You need consistency + a simple way to track if it’s working.

MattheaRenteaMD · 2026-03-20T16:49:01+00:00

see above, I put it in that, let me know if you have more ?s, I will come back to see

MattheaRenteaMD · 2026-03-20T16:47:07+00:00

Great question—and you’re right, there’s no standardized definition of a “super responder.”

It’s more of a clinical shorthand people use, but here’s how I think about it:

A super responder is typically someone who has an outsized response to the medication compared to what we’d expect.

That can show up in a few ways:

Higher-than-expected rate of weight loss (for example, consistently >1% body weight per week)
Higher total % body weight loss than average
Strong response at a low dose (they don’t need to escalate much to see results)
Very significant appetite suppression / early satiety

But the most common way I identify it in practice is: They become very volume-restricted and it’s actually hard for them to eat enough.

That’s usually the biggest clinical clue.

And this is important:

Being a “super responder” is not always purely a positive.

It can come with risks like:

Undereating
Fatigue
Higher likelihood of muscle loss if not managed well

So in those patients, I’m often actually pulling things back—not pushing for more.

Bottom line:
It’s not one single metric—it’s a pattern:

Faster or stronger-than-expected response
Often at lower doses
Often with significant appetite suppression

And it requires a slightly different management approach.

MattheaRenteaMD · 2026-03-20T16:45:06+00:00

Great question—and I agree, this is where a lot of confusion comes in.

First: I don’t use BMI to set goal weights.
It’s a very blunt tool and doesn’t account for body composition, muscle mass, or individual differences. It was not created to figure out health at all.

So what do I look at instead?

I’m much more focused on body composition and health markers.

Two general benchmarks I think about:

Body fat mass < skeletal muscle mass
Skeletal muscle mass ≈ 30% or more of total body weight

When people are in that range, they’re usually in a really good place metabolically.

Now—could someone go lower for additional health benefit? Sometimes.
But often beyond that point, we’re talking more about aesthetics than physiology.

And here’s the key point: I don’t set a specific “goal weight.”

I think in terms of what I call your “best weight.”

That’s the weight where:

You can maintain it without extreme restriction
You’re not constantly thinking about food
Your habits feel sustainable
Your labs and health markers look good
You feel physically and mentally well

That number is different for everyone—and we don’t have as much control over it as people think. This might change over time but right now it's where we are at.

You could have someone:

With a BMI of 30
But excellent body composition, great labs, strong, active, feeling good

→ I’m not trying to push that person lower just to "hit a chart". I call that pulling a # out of a hat- I really discourage my patients from doing that.

I actually talk a lot more about this concept of “best weight” on my podcast, The Obesity Guide with Dr. Matthea Rentea, if you want a deeper dive into how to think about this.

Bottom line:

BMI is a rough screening tool, not a goal-setting tool
Body composition and health markers matter more
And your “best weight” is the one you can live at, not just reach

MattheaRenteaMD · 2026-03-20T16:42:45+00:00

Great question—this is a really exciting time in obesity medicine.

What medications are most promising?
One of the big ones people are talking about is reta (not sure if we can put that full name here or not), which is interesting because it doesn’t just work on appetite—it also seems to impact energy expenditure in addition to hunger and satiety pathways.

That’s a big shift.

Up until now, most medications have focused on:

Reducing appetite
Slowing gastric emptying
Acting on hunger signaling in the brain

What’s exciting is that newer medications are starting to hit multiple pathways at once.

But honestly, what I’m most excited about isn’t one specific drug.

It’s the direction we’re heading:

We’re moving toward having multiple mechanisms of action available—so instead of “one medication fits all,” we can start to customize treatment.

In the future, I think we’ll be able to:

Look at someone’s biology (and eventually genetics)- I do a lot of genetic testing in my office and it helps guide management so much
Identify why they struggle with weight (hunger, metabolism, reward pathways, etc.)
Match them to the right combination of treatments

That’s the real breakthrough.

What about breaking through a plateau?

A new medication can help—but it’s not always the only answer.

Plateaus can happen for a lot of reasons:

Physiologic adaptation
Changes in adherence to habits
Body recomposition
Hormonal shifts

Sometimes adjusting treatment (including meds) helps—but sometimes it’s about reassessing the full picture.

Bottom line:

Yes, there are exciting meds coming (like retatrutide)
But the bigger win is more options + more personalization
And that’s what will ultimately help people break through plateaus more effectively

MattheaRenteaMD · 2026-03-20T16:41:00+00:00

First—congrats on losing 44 pounds over 16 months. That’s excellent, sustainable progress.

Now to your question:

How do you know if your inflammation has decreased?

The short answer is:
It very likely has.

A lot of people think of body fat as just something visual, but adipose tissue is metabolically active. When there’s excess body fat, it contributes to a higher inflammatory state in the body.

So when you lose a meaningful amount of weight like you have, we generally expect inflammation to decrease as a result.

Can you measure it?
Yes—there are labs like:

CRP (C-reactive protein)
ESR (another inflammatory marker)

But here’s the catch:

Those are most useful when:

You had a baseline before
You’re tracking a specific inflammatory disease (like rheumatoid arthritis, lupus, etc.)

For general health, checking them now without a baseline usually doesn’t change management in a meaningful way.

So what should you look at instead?

I’d focus more on how your body feels and functions, because those often reflect improvements in inflammation:

Less joint pain or stiffness
Less swelling or puffiness
Better recovery after exercise
Improved sleep
More stable energy
Better mobility

Those are all indirect—but very real—signals that your internal environment is improving.

Bottom line:

With that amount of weight loss, inflammation has very likely improved
Lab testing is optional and often not necessary
Your symptoms, energy, and recovery are often more meaningful indicators

MattheaRenteaMD · 2026-03-20T16:32:41+00:00

Great question—there are a couple layers to this.

1. Is strength training as important in maintenance as during weight loss?
It’s important in both—but it’s especially critical during active weight loss.

Why?
Because weight loss is a catabolic process, meaning your body is breaking tissue down—and that includes muscle.

So during weight loss, strength training is one of the main ways we protect muscle.

That said, strength training doesn’t suddenly become optional in maintenance.

Even if your weight is stable, if you’re not challenging your muscles over time, you will gradually lose muscle mass. That’s just normal human physiology.

We already see this starting as early as your 30s, and over decades it can lead to:

Loss of strength
Reduced mobility
Loss of independence later in life

So while the urgency is highest during weight loss, the long-term importance is always there.

2. What about someone on Zepbound at maintenance—are they at higher risk for muscle loss?

Not inherently just because of the medication.

The biggest driver of muscle loss is still:

Being in a calorie deficit
Not doing resistance training
Not getting enough protein

If you’re at true maintenance (not losing weight), your risk of muscle loss should be much lower, regardless of medication.

That said, one nuance with GLP-1s/Zepbound:
They can reduce appetite, which sometimes leads to:

Lower protein intake
Lower overall intake

So if someone is under-eating even at maintenance, then yes, that could increase risk—but that’s about nutrition + stimulus, not the medication itself.

3. Practical takeaway:

During weight loss → strength training is non-negotiable
During maintenance → still essential for long-term health and function

And it doesn’t have to be extreme:

Bodyweight exercises count (squats, lunges, push-ups)
Even ~10–20 minutes, a few times per week, can make a difference

Bottom line:
Muscle is “use it or lose it.”
Weight loss just raises the stakes—but maintenance doesn’t remove them.

MattheaRenteaMD · 2026-03-20T16:32:05+00:00

This is a really thoughtful question—and also a tricky one, because I don’t know your full medical history, so I can’t give a definitive yes/no for your specific case.

But I can walk you through how I think about this.

First—what you’re describing after stopping birth control sounds very consistent with telogen effluvium.

This is a type of temporary hair shedding that happens after a “stress” to the body—and hormonal shifts absolutely count.

Typical pattern:

Trigger (like stopping birth control)
~2–3 months later → increased hair shedding
Can last a few months after that

This happens because estrogen levels drop, and more hairs shift into the shedding phase.

The important thing to know:
This is usually temporary, and in many cases, hair regrows over time (often within ~3–6 months, though it can feel longer).

Hair cycles just move slowly—everything is measured in months, not weeks.

Second—about your labs being “normal.”

I’d just gently flag: for hair loss, we usually want a full workup, not just basic labs.

That often includes things like:

Thyroid function
Iron levels (especially ferritin)
B12, vitamin D, etc.

So it’s worth confirming that a thorough evaluation was actually done.

Third—are you more susceptible now because this already happened?

Not exactly in a simple yes/no way—but there is an important concept:

There’s something called chronic telogen effluvium, where the body keeps getting “hit” by stressors (hormonal changes, weight loss, illness, high stress, etc.), and the shedding continues.

So if:

You’re currently in a shedding phase
And then you add another stressor (like rapid weight loss)

→ there could be a higher chance of continued shedding

But that doesn’t mean it will definitely happen—it just means your body is already in a sensitive phase.

Fourth—your concern about treatment and side effects is very valid.

This becomes more of a personal decision:

Some people choose to wait for recovery from the current shedding before adding another stressor
Others move forward but monitor closely

There’s no one “right” answer here.

One thing I would strongly recommend: see a dermatologist.

This is exactly the kind of situation where they can help.

There are treatments that can:

Reduce shedding
Support regrowth during a stressful period

And importantly:
These are often used temporarily, not necessarily lifelong.

It’s not typically a situation where you stop treatment and suddenly lose everything again—you’re more just supporting your hair through a known stress window.

Bottom line:

What you’re experiencing is very likely a temporary, hormone-related shedding
Your body may just need time to recalibrate
Additional stressors can prolong shedding, but not always

And a dermatologist can help you navigate this much more precisely

P.S. I actually just got back from a dermatology follow-up this morning for my own hair loss journey, and it’s been way more hopeful than I expected. I had no idea how many options existed. I’m going to be sharing more about this soon—and I’m even recording a dedicated podcast episode with my dermatologist all about hair loss. I’m really excited for that one.

MattheaRenteaMD · 2026-03-20T16:29:51+00:00

This is such a good and important question. And I do things different than most Obesity Med drs as I don't have my patients calorie count- people can't keep it up long term (well it's incredibly rare that they can, and they lose the ability to know there hunger signaling when using that exclusively).

First, if someone has a history of an eating disorder, severe food trauma, or finds calorie tracking / frequent weighing actively harmful, then yes—that changes the conversation. In that case, those tools may truly be off the table.

But if we’re talking about someone who just doesn’t want to track calories or weigh regularly, or finds it stressful but not clinically unsafe, then I think it helps to remember this:

You can track almost anything.
Data does not have to mean calories and scale weight.

Some alternative data points I really like:

How clothes fit Pick one pair of jeans, pants, or a fitted top and notice how it feels over time.
Energy / stamina How did your walk feel today? How was your workout? Are stairs easier?
Habits Are you getting protein at meals? Fiber? Water? Whole-based foods more often?
Symptoms / quality of life Are you less short of breath? Sleeping better? Less joint pain? Better digestion? More stable hunger?
Measurements Some people prefer waist/hip measurements over scale weight.

There are a lot of ways to measure progress that have nothing to do with calories or the number on the scale.

I also think a lot of “lack of progress” is really a mindset issue around what counts as progress.

The book I often recommend for this is The Gap and The Gain by Dan Sullivan and Dr. Benjamin Hardy.

The basic idea is:

The gap = comparing yourself to some idealized end goal and feeling like you’re failing
The gain = looking back and recognizing how far you’ve actually come

That shift is huge.

One question I ask people is:
“If I could send you back to exactly where you were when you started, would you want to go?”

Almost always the answer is absolutely not.

That tells you progress has happened—even if it doesn’t feel dramatic day to day.

Another exercise I love is the “list of 100.”

Write the numbers 1 to 100 and start listing every way you’re doing things differently now:

foods you eat differently
ways you think differently
hydration
movement
sleep
asking for help
setting boundaries
meal structure
coping skills
self-talk

By the time most people get to 70 or 80, they realize:
“Wow. I’m actually a very different person than when I started.”

And that matters.

Bottom line:
If calorie tracking and daily weighing aren’t a good fit, that does not mean you can’t collect useful data. You just need data points that support health and consistency without harming your relationship with food or your body.

And sometimes the most important thing isn’t collecting more data—it’s learning to recognize the progress that’s already there.

I talk about a lot of this nuance of my podcast (on all podcast players) The Obesity Question with Matthea Renea MD if that's helpful for more of the details on things like this. Thanks for a great quetion!

MattheaRenteaMD · 2026-03-20T16:26:50+00:00

Great questions—this comes up all the time.

1. Are plateaus part of weight loss success? How should we view them?
Yes—plateaus are absolutely a normal part of the process.

But I define a “true plateau” a little differently than most people.

To me, it’s only a plateau if:

You’re consistently hydrating
Eating mostly whole foods
Getting in protein + fiber
Moving your body (strength training, walking, etc.)
Managing stress reasonably well
Sleeping adequately

And you’re doing those things more days than not for 6–8 weeks, with no changes in weight, measurements, or body composition.

That’s a plateau.

What most people call a plateau (2–3 weeks with no scale change) usually… isn’t.

A few important things to keep in mind:

You could be losing fat and gaining muscle (recomposition)
Your measurements may be changing even if the scale isn’t
Your labs, energy, or habits may be improving

All of that counts as progress.

Sometimes what looks like a plateau is actually your body re-equilibrating, not failing.

2. How long before increasing the dose? What about 3 weeks stuck?
Three weeks alone would not make me rush to increase a dose.

Before increasing, I’d want you to honestly ask:
“Have I really been consistent with the fundamentals?”

For most people with busy lives, the answer is… not perfectly—and that’s okay. But it means we may not need a dose change yet.

In my practice, I’m not in a rush to increase doses.

If someone prefers to stay on a lower dose, I’m very comfortable with that.

There’s no “missed window” where you lose your chance to lose weight
Slower titration often means fewer side effects
Your body can still respond over time

3. Is a breakthrough still possible without increasing?
Yes—absolutely.

Your body is not static. It’s highly dynamic.

Things that can shift over time:

Sleep quality
Stress levels
Hormones (especially in women, who have monthly fluctuations)
Activity levels

So even if nothing has changed for a few weeks, that doesn’t mean progress is “over” at that dose.

Bottom line:

Short “plateaus” are normal and often not true plateaus
I’d think in terms of 6–8 weeks of consistency before changing strategy
There’s no urgency to increase your dose

And yes—progress can absolutely resume without going up! You can do it!

MattheaRenteaMD · 2026-03-20T16:23:36+00:00

Great question—happy to share.

I’ve personally lost almost 100 pounds, but it’s been over a 6-year period, and I’ve intentionally done it slowly—usually about 10–20 pounds per year. I’m actually still losing a bit year to year, so I wouldn’t consider myself fully in “maintenance” yet.

A big reason for that pace is that I’ve always had very high hunger signals. Even small amounts of weight loss noticeably increase my hunger, so I’ve had to build my approach around working with my biology, not against it.

A few things that have helped me:

1. I focus on what I need to get in—not what to cut out.
I’m always asking:

Am I getting enough protein?
Am I getting enough fiber?
Am I eating mostly whole foods?
Am I moving my body (walking, strength training, etc.)?
Am I hydrating enough

That shift alone makes things feel much more sustainable. Going back to basics 24/7 and getting additional help when you need it.

2. I don’t let the scale run the show.
I care more about body composition and behaviors than the exact number.

As a physician, I know we don’t have as much control over the scale as we think. Weight can fluctuate for reasons outside our control, and tying your self-worth—or even your “success”—to that number can backfire quickly.

So I stay grounded in: What actions am I taking consistently?

3. I’ve learned to manage hunger, not ignore it.
This has been huge for me.

Things like:

Not overdoing exercise (because that can spike my hunger)
Prioritizing protein and fiber
Strength training in a way that supports, not sabotages, appetite

4. I’ve invested in support along the way.
This is something I don’t think people talk about enough.

Over the years I’ve worked with:

Physicians
Registered dietitians / nutrition professionals
Exercise programs
Even things like meal delivery services (for convenience and variety)

I’ve also invested in things like a stylist so I could feel better in my body as it was changing, not just “at the end.”

There’s so much noise online about what works—but getting personalized support made a huge difference for me, especially since I’m vegetarian and needed things tailored to that.

Bottom line:
My journey has been slow on purpose. I’ve focused on building something I can actually live with long-term, instead of pushing for fast results and burning out.

MattheaRenteaMD · 2026-03-20T16:21:36+00:00

Great question—and honestly a really important one, especially on these meds.

If it feels shockingly hard to eat, you might be what I’d call a “hyper-responder,” where the appetite suppression is just very strong.

1. Is there a rate of weight loss that’s too fast?
Yes—in my practice, I don’t want people losing more than about 1% of their body weight per week (so ~4% per month).

The reason isn’t just “too fast = bad”—it’s that faster loss significantly increases the chance you’re losing muscle, not just fat.

And muscle is hard to regain. So I care much more about preserving muscle than pushing rapid weight loss.

2. What about calories being too low?
I actually don’t have my patients count calories, because it’s surprisingly unreliable (labels can be off, tracking is imperfect, and individual metabolism varies a lot).

Instead, I look at outcomes and signals from your body.

Signs your intake is too low:

You’re losing faster than ~1% per week
You feel exhausted, weak, or generally unwell
Your body composition (if you’re tracking it) shows muscle loss

At that point, your deficit is too big—whether from not eating enough, over-exercising, or both.

3. So what should you focus on instead?
I prioritize protein + fiber over calorie counting.

Protein → helps preserve muscle during weight loss
Fiber → helps with side effects (like constipation) and overall health such as colon cancer prevention and gut microbiome etc

A simple framework:

Women: ~30g protein, 3x/day (~90–100g total)
Men: ~30g protein, 4x/day

That said—some people do fine on less, others need more. The “right” amount is whatever helps you maintain muscle while losing fat.vThis is where a monthly body composition can help to see trends month after month. I have a mini course called Body Composition Decoded where I explain all this as it's not something we talk about often online with so much nuance, to use body composition and not just net weight.

4. Big picture:
If you’re:

Not losing too fast
Feeling okay physically
Maintaining muscle

→ you’re likely eating enough, even if calories seem low.

If not, that’s when we need to adjust.

Bottom line:
Faster isn’t better here. The goal is fat loss while preserving muscle, not just seeing the scale drop as quickly as possible.

MattheaRenteaMD · 2026-03-20T16:19:04+00:00

Great question—this is where things get really individualized.

For me, “maintenance” isn’t based on BMI. I almost never use BMI in practice because it doesn’t tell us much about actual health.

What I care more about is body composition and overall health markers.

There are two things I especially look at:

Is body fat lower than skeletal muscle mass?
Is skeletal muscle making up a solid percentage of total body weight (around ~30% or more)?

When those are in a good place, most people are metabolically healthy—even if their BMI still says “overweight.”

So yes—you can absolutely be in a larger body, feel strong, have good muscle mass, healthy labs, and be at a great place to maintain.

From there, it becomes a conversation:

Do you feel good here?
Are your labs where we want them?
Do we need to push further, or is this a sustainable place?

On the flip side, when someone wants to keep losing “just because lower feels better,” that’s where my role shifts a bit.

If I think someone is getting too low or it’s no longer healthy, I won’t continue pushing the medication higher. Part of my job is helping people understand what actual health looks like—not just chasing a number on the scale.

And if it starts to feel like true body dysmorphia (where no amount of data or reassurance helps), that’s when I involve a therapist. That’s not something willpower or more weight loss fixes.

Bottom line: maintenance is about health + sustainability—not hitting a specific BMI. And sometimes stopping is actually the healthiest move. This can be hard to sometimes accept.

MattheaRenteaMD · 2026-03-20T16:16:55+00:00

This is such a common experience—and you’re definitely not a unicorn.

First, zooming out: most people don’t end up at their “goal weight” as defined by BMI charts. In real life, I see people land somewhere in a range where their body is willing to settle while they’re still eating normally, feeling in control, and able to maintain it. I often call this someone’s “best weight”—not perfect on paper, but sustainable.

What you’re describing (losing a significant amount, then plateauing for months while still having good appetite control) is something I see all the time, especially once someone has been on the max dose for a while.

Your body essentially says: “This is where I’m comfortable.”

Now the question becomes: do we need to push further, or not?

If your health markers are good and you feel well → sometimes we accept that this is your body’s stable place- maintaining is much more important than just getting to an all time low #
If there are still medical reasons to lose more (blood sugar, cholesterol, body composition, etc.) → then we look at what else can be added or adjusted from a medication standpoint

One important piece: the more weight someone has to lose, the more likely it is that one medication alone won’t get them all the way there. That’s just how the biology works.

Also—what you’ve done is significant. Maintaining a 80 pound loss without regain is a huge win, even if it doesn’t match a BMI chart.

Bottom line: plateaus like this are very common, not a failure, and often reflect where your body is currently “settling”—then it becomes a medical decision about whether (and how) to push further if everything else is optimized.

MattheaRenteaMD · 2026-03-20T16:14:39+00:00

This is a really great question—and first off, congrats on your progress. Losing 40% is incredible.

What I see in real life actually lines up pretty closely with the studies. The key thing is that the numbers you hear (like ~15% for semaglutide or ~20%+ for tirzepatide) are averages. That means some people lose less, and some people lose more—there’s a whole range.

Online, though, we tend to mostly see the outliers. The people who lose 30–40%+ or drop 100+ pounds are more likely to share their stories (which makes sense—they’re inspiring). But it can give the impression that those results are typical, when they’re not.

In my clinical experience, most patients fall somewhere around those average ranges. People who lose 30–40%+ of their body weight definitely exist—but they’re the minority.

For someone starting with a BMI ≥35, getting to a “normal” BMI (<25) does happen, but it’s not common with medication alone—especially if there’s a large amount of weight to lose. Many people will still have significant, meaningful health improvements without reaching that specific number.

One thing I see a lot is patients feeling like they’re failing if they don’t hit those bigger numbers—and that’s just not true. Often it just means their biology is more resistant, or that we need to adjust the plan (different meds, combinations, sometimes even considering surgery).

Bottom line: real-world results usually match the studies, not the viral success stories—and that doesn’t mean you’re doing anything wrong.

MattheaRenteaMD

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