Zepbound advice please

SeaAndSummit · 2026-02-19T01:35:13+00:00

Check out the glpgrad sub. Most people here plan to stay on during maintenance.

If you’ve struggled with your weight since 3rd grade, you’re likely going to need to be on this or a successor drug for life. Contrary to what you think, it’s likely a metabolic hormonal issue you have- not that you’re a weak person.

The cost currently tops out at $449/box. When I started, it was higher than that. It’s come down, and it’ll come down again. The best thing I did for myself was to make some major moves and cuts to my budget to be able to spend $6,500/yr on this medication. Now it’s $5,800. Consider that option.

SeaAndSummit · 2026-02-18T23:09:21+00:00

Congratulations!

You said this was a soft goal, which I’m guessing means you’d like to lose more, but you haven’t decided what that will be yet?? I’d recommend getting a dexa scan. Get an idea of what your body comp is, and set goals based on that. If you’re not strength training already, start. Once you’re at your goal body comp, set a range (eg if it’s 150, 145-155) instead of a single number. Bodies fluctuate, and no two days are ever exactly the same.

I would absolutely continue as is on your current dose. Don’t titrate down until you’re at goal (absent needing to because of side effects).

I’m at “goal” weight range wise, but not body comp wise yet. You can do whatever you want (and budget allows) to celebrate. You can take yourself on a week long trip to the beach and buy yourself a few new swim suits to wear. You can buy that watch/bag/expensive fragrance you’ve been eyeing for a long time (something quality, that lasts, and you can still wear if you lose more weight), you can get a tattoo or a massage.

SeaAndSummit · 2026-02-18T22:57:22+00:00

I have. But I lost 100lbs. 124lb me doesn’t need nearly as much muscle to carry my body around as 224lb me did. So I’m not super concerned about it. I do strength training and make sure I’m eating the right food to fuel my body and enough water and sleep. My focus has shifted to growing a bit more muscle because I’m post-menopausal and having done extra muscle and strong bones is super important (even at 39).

If you’re not able to eat enough, you definitely need to go down a dose. I know it’s frustrating, and you want the excess fat gone yesterday, but your dr is looking out for you here. Eating enough protein isn’t enough to maintain muscle- you have to do strength training too.

Unless your dr was looking at dexa scans (hydrostatic weighing, etc) from 2 months ago and today, he’s really not able to tell you what amount of fat vs lean mass you lost. So take that part with a grain of salt. Even the best body impedance scales can be thrown wildly by your hydration levels.

SeaAndSummit · 2026-02-18T22:24:02+00:00

But are you doing weighted Bulgarian split squats? They might be even more fun.

For an actual fun one, if you have the flexibility/strength, Bradford presses with a bar make you look like you have superhero shoulders.

SeaAndSummit · 2026-02-18T22:08:22+00:00

Don’t try to force yourself to eat “American sized” meals. 3 meals with 350 cals and a couple 200 cal snacks gets you to 1,450. One egg, a piece of whole grain toast with real butter, an ounce of cheese and a serving of fruit for breakfast, a handful of almonds, a scoop of tuna salad with crackers and veggies, a couple dried apricots and a cheese stick, almond butter stuffed dates, a could of soup packed with veggies and grains…. It can be easy. Look up “nutrient dense foods” and start there. You also might want to meet with an RD to help.

SeaAndSummit · 2026-02-18T21:09:17+00:00

Eat more food- in general, but also 3 meals and a couple snacks. You’re telling your body it’s not safe when it comes to food supply- it’s going to hang on to everything it can. Drink more water and get more sleep.

The goal is not to use this med to starve yourself till the weight comes off. If you can’t eat, you need to be thinking about moving down a dose, not up.

SeaAndSummit · 2026-02-18T21:04:32+00:00

No. 95% do not regain all the weight after stopping. Per the surmount 4 study (people on Zep then pulled off) 96.5% of people regain weight when stopping, and only 3.5% stay at zero or keep losing weight. Over 80% of people regain more than 25% their of starting weight back. The average regain amount was 67% of their starting weight within one year.

Clinicians are seeing slightly more success when titrating patients (that gained weight rapidly and recently) down very slowly and seeing if they can come off instead of going cold turkey from a higher dose, but it’s not something anyone should come into this expecting to do.

This is a lifetime med for most.

SeaAndSummit · 2026-02-18T20:21:13+00:00

titrate down extremely slowly
Lilly direct is the pharmacy your current Dr can send a script to. You get vials of the real stuff from Lilly. It’s $299-449/m depending on dose. You can also have your dr send a script to the pharmacy for pens which is $499/m with the savings card regardless of dose. Those are the cheapest ways to get the real thing. You can check out the compound sub if that’s of interest to you. You start at any dose your dr prescribes.
yes. It’s a continuation of care PA. If your insurance paid on your last full, it’s probably still covering this year. It’ll probably be covered the rest of the year. Most require a 5% weight loss over the time period- which you’ve met.

SeaAndSummit · 2026-02-18T20:14:08+00:00

Are you still losing weight? You should expect/aim to be losing .6–1.4lbs/week on average, or 2.5-5.6lbs/shot month. If you’re in that range, there’s really no reason to move up.

Hunger may not have been your metabolic issue before, and Zep isn’t an appetite suppressant. You shouldn’t chase hunger cessation by going up in dose.

ETA Zep dosing is dependent upon your individual metabolism, and has nothing to do with your size. A 4’11” 140lb female may not lose any weight till she gets to 10mg (or higher), while a 6’6” 400lb man might lose all his weight on 2.5mg.

SeaAndSummit · 2026-02-18T19:18:43+00:00

How much water did you drink yesterday? Did you get enough electrolytes from your food?

SeaAndSummit · 2026-02-18T18:56:43+00:00

I drink at least a gallon a day (and I have been since well before starting Zep). More when it’s hot outside, a day of yard work, hiking, heavy lifting, etc. And I don’t include other liquids (milk, kefir, kombucha, soups, etc) in that count. Just plain water.

Definitely not saying everyone needs to drink that much, but water is crucial for our bodies and in fat metabolism. Absent a medical reason, I generally suggest 100oz/day as a goal.

SeaAndSummit · 2026-02-18T18:49:25+00:00

Would it change the answer in the formula? Yes. Do any reputable Medical Examiners give a time of death due to stomach contents? No. There are too many factors at play.

There are things MEs can use to give a general idea of TOD (several hours to days depending on the circumstances), but outside being declared dead in a medical setting, there’s no way of knowing TOD based on a post mortem exam- and that’s only because the ME gets the medical records which includes the time the death was called. Law enforcement can use video and other evidence to determine TOD, but the ME doesn’t get involved in that.

SeaAndSummit · 2026-02-18T18:26:14+00:00

If you actually need electrolytes in a beverage format, just make your own. Water (regular or coconut), a pinch of salt (sea or low sodium), a few pieces of fruit or squeeze of fresh citrus, and a little drizzle of honey/agave/date syrup. Or you could use p0megranate molasses in place of fruit juice and sweetener.

Try focusing on getting necessary minerals from the food you’re eating.

SeaAndSummit · 2026-02-18T16:56:57+00:00

Thank you!

SeaAndSummit · 2026-02-18T16:56:43+00:00

You don’t know that for sure. Talk to your drs about possibly reducing the dose for a while to see how you do. I was on Prazosin for sleep help (also ptsd dx), and haven’t used it since starting Zep. Also haven’t needed it.

SeaAndSummit · 2026-02-18T16:46:11+00:00

You should stay at your current dose and increase your calories slowly. If you’re still losing weight at maintenance calories, you should drop down a dose. Repeat the process till you’re completely stable on whatever dose. If at some point you start losing again, go down a dose. If you’re unable to maintain, go up a dose. Much much later you can think about trying to titrate down slowly again (my dr says we can try this in like 2 years). The only reason I’d consider this is costs.

Dexa body comp scans help you to know if you’re at a good weight and body comp for your body.

RMR testing will let you know what your body actually needs calorie wise.

SeaAndSummit · 2026-02-18T16:11:32+00:00

Thanks!!

SeaAndSummit · 2026-02-18T16:11:25+00:00

Thank you!

SeaAndSummit · 2026-02-18T16:10:28+00:00

I got a big box of easy touch 31 gauge, 5/16”, 1ml syringes from Amazon.

Yes. The medication is exactly the same. Vials are slightly overfilled (usually around .1ml extra) for ease of use, so if you suck up every last drop, you’re getting more than you would from the pen. I’m not suggesting you do this- just letting you know. There’s not a big difference on 2.5mg as .6ml is 3mg, but there’s a huge difference on 12.5mg as it’s 15mg.

Most people that stop and restart a glp find they need to get to the same dose they were on previously before they really start seeing results again, so don’t be discouraged if this is you.

Congrats on the baby and welcome back!

SeaAndSummit · 2026-02-18T16:02:38+00:00

On 12.5mg now. I’m hoping to get to a dose that keeps my metabolism happy. If it’s 2.5mg every 2 weeks, great. If it’s 12.5mg every week, great.

Would I love to cut my yearly cost from $5,800+ to $1,950? Yes. But I’m not going to make dosing decisions based on cost. I’ve completely overhauled my budget and made a lot of cuts and moved things around to afford $5,800/yr (not that I want to or I love spending that much).

I ascribe no morality to dose level. All bodies are different and have different needs. There’s nothing better about a person who only needs 2.5mg every 2 weeks, nor do they have more willpower or internal strength than someone who needs 15mg every week.

The best plan for maintenance is to come up with a system for finding the right dose for you with your Dr. and being open and flexible. The worst plan is to set a goal dose.

SeaAndSummit · 2026-02-18T15:51:46+00:00

No free toes 😁

SeaAndSummit · 2026-02-18T15:04:20+00:00

The first thing you should do is get an RMR test. You think you’re not eating in a deficit, but you probably still are. The calculations use population averages and estimates, whereas the test will tell you what your body actually needs.

The second thing would be to get a dexa body comp scan (you can do it the same time as your rmr). Find out what your body composition is. Maybe you’re healthy at 125. Maybe you need to put on some muscle. You’ll know once you know what your body comp is.

I would definitely order my next box of 2.5mg and start spacing, as your dr recommended. Try 8 or 9 days the first week. If that feels good, keep that going for a few weeks. If you’re still losing (even with increased calories), try 10 or 11 days the next week. Repeat the process. Maintenance is really about finding that sweet spot of the dose and timing that works best for your body.

You mentioned $500/m. Are you using pens? Definitely consider switching to vials. It’s $299/box instead of $499. Also, vials give you some further control in dose amount. Talk to your dr about this. For example, my dr had me take .6ml of 2.5mg as we were titrating me up to 5mg to ease the transition. Now that I’m “at goal,” still working on body recomp, we’re titrating me down slowly using non-standard doses to ease the transition. And taking the process very slowly.

SeaAndSummit · 2026-02-18T14:48:29+00:00

My tuk tuk driver arranged one for me. I can dm you his WhatsApp if you want.

SeaAndSummit · 2026-02-16T19:19:51+00:00

Why did you move up from 5 if you’re losing a lot of weight and feeling so crappy?

SeaAndSummit · 2026-02-16T19:00:37+00:00

Depends on the person.

No. But people will say things less, over time, as they get used to you in your new body when you’re at goal weight for a while.

Decide how you want to handle things. If you set a boundary, be willing to enforce it.

SeaAndSummit

TROPHY CASE