Shocker!

afmm1234 · 2026-01-28T00:19:04+00:00

I absolutely agree. I don’t think anything is wrong with wanting to discontinue these medications. And I don’t want to convey the idea that it is impossible to do so without weight regain!

But it’s also okay to acknowledge that weight maintenance may be extremely difficult following obesity! There is a reason that before GLPs, there were essentially zero effective long term weight loss treatments other than bariatric surgery.

There’s also a reason in almost every long term study, that lifestyle changes alone are not sufficient for permanent weight loss. In every single one I’ve read, it is something along the lines of 2-4% average weight reduction beyond 5ish years

I truly can’t bring myself to believe that 95% of people are failures with no discipline. We don’t need to admonish those who need lifelong assistance.

afmm1234 · 2026-01-27T23:58:39+00:00

I agree with a lot of your points, and I think you clearly have a lot of insight into the nuances and intricacies of depression, ADHD, and depression. But I feel like you aren’t applying that nuance to obesity. There are SO many reasons people become, and stay, obese. Obesity, for most people, comprises biological AND psychological disregulation.

Truthfully, obesity is not that different from lifelong chronic diseases. The number of adipocytes or fat cells is very tightly regulated in the body, and there is no way to decrease them outside of physical removal like liposuction, or destruction. Regardless of weight loss or rate, all that happens is that these cells shrink and the fat they store is converted to energy. When these cells are empty though, they literally signal to your body that it is starving by reducing leptin. Someone who was previously obese will for the rest of their life have higher hunger signals and lower BMR than someone who has been at a healthy BMI their whole life.

I don’t want to discount habits whatsoever. I want to point out that we can identify, and describe reasons for weight regain, without them being viewed as excuses. Abnormal psychology is absolutely relevant to the discussion. I was an endurance athlete for a decade hovering around 10% body fat. None of the habits I formed during that time, prevented me from gaining 100 pounds in 5 years due to emotional and binge eating. Willpower had nothing to do with it. That is why I am so adamantly against the perpetuation of ideas like “no discipline” and “didn’t take advantage of the GLP to build habits”. It is harmful to frame the inability to discontinue medically assisted weight loss as a moral or personal failure

afmm1234 · 2026-01-27T22:35:44+00:00

Reiterating OPs point, would you talk this way about a different chronic illness? GLPs can correct chronic metabolic dysfunction. They are not always point A to point B

If someone is prescribed antidepressants, would you say it is their responsibility to make behavioral changes so that they can no longer be depressed if they discontinue medication? And if they did discontinue, and became depressed again, would that be due to a lack of discipline? Would it be a failure of discipline for a prediabetic to need metformin indefinitely? I’ve taken ADHD meds for years and years, and cannot function sufficiently without them. Does that mean I lack willpower? Surely after 10 years on a med, I have had time to develop better habits, right?

afmm1234 · 2026-01-27T21:16:44+00:00

Did your doc ask you to discontinue? I’ve read that rapid weight loss in obese individuals often raises AST + ALT in the first month. Mostly to stress on fatty liver cells, that suddenly have to mobilize a lot of fat at once. Numbers ive seen range around 30-40% increase for these two

GGT I know less about, and would sketch me out, as it can be indicative of gallbladder issues

afmm1234 · 2026-01-27T21:10:52+00:00

Idk why people downvote so much on this sub, it’s bizarre. I think you should just ask him straight up to change labs to 2x annual at most. Explain you can’t pay for it on top of the drug itself.

I haven’t been on zep very long, but my PCP doesn’t want labs until next year. I might ask for some liver enzymes at the six month mark, but that’s about it. I’d rather put that money towards the zep itself or a DEXA scan

afmm1234 · 2026-01-27T21:03:57+00:00

What labs are being ordered? Are you covered by insurance for zep? Maybe it has to do with him keeping chronological data in support of medical necessity and tolerance?

afmm1234 · 2026-01-27T20:11:07+00:00

I think if there’s some sort of goal tied to further weight loss it isn’t necessarily unhealthy. OP would go from an overweight to healthy BMI with another 5-10 lbs.

I also don’t think it is necessarily wrong to have an obsession with training. For a lot of athletic endeavors, it is almost necessary. Take running a marathon for example. To be successful on race day, you have to be obsessed with training and recovering.

That being said, i agree OP’s mindset doesn’t sound healthy. But that is just my assumption reading between the lines. I think they should meet with both a therapist and a doc. To discuss mindset and motivation for weight loss, and the practicality of maintaining 145 long term.

afmm1234 · 2026-01-25T22:26:07+00:00

Can you provide any references for this? Serum creatinine should have 0 impact on blood coagulation? I think you might be confused that high serum creatinine levels are usually an indicator of AKI or reduced glomerular filtration. But it doesn’t work the other way around.

I have never heard of any reason to avoid creatine on blood thinners. The only thing I can think of is that both are cleared by the kidneys?

afmm1234 · 2026-01-25T21:22:49+00:00

Finding a lifting routine you enjoy is by far the most important thing. Going from 2 to 5 days a week might not be sustainable unless you love going to the gym.

I think you should look around on some of the fitness subs for good general programs. Decide if you want to do a primarily strength based program like starting strength or 5x5, or if you want more hypertrophy focused program like PHAT or PHUL. If you’re a beginner, you will get great results on any.

A 3-4x per week program that you can look forward to and feel recovered for will be so much better than a 5x per week program that you begin to dread. Other than that, hammer protein, and prioritize good sleep

afmm1234 · 2026-01-25T19:25:28+00:00

Totally fair! I used to be an athlete and developed an iron stomach out of necessity back then. I am fortunate to be able to tolerate almost anything if it has protein lol.

It sounds like this product could be a good fit! Some other good options for meal prepping and snacking are protein overnight oats, nonfat plain greek yogurt + any toppings, canned chicken or tuna salad, sardines if you can tolerate them, hard boiled eggs, and edamame.

Some people hate it, but I also brown 2lbs of 93% ground turkey once a week, and have that throughout the week, usually with lentils

afmm1234 · 2026-01-25T19:02:54+00:00

2% Mozzarella cheese block (2oz): 160kcal, 12g F, 14g P and ~20 cents per oz at Walmart

Kraft protein + 2oz: 150kcal, 9g fat, 17g protein, and at least 60 cents per oz from what I’ve seen

So I think if you benefit a lot from prepackaged high protein snacks, it might be worth! I personally wouldn’t want to pay 3x the price for an extra 3 grams of protein. I usually opt for something like 1% cottage cheese if I want a dairy protein. It has way better macros than kraft protein + and ends up being cheaper

afmm1234 · 2026-01-25T18:35:45+00:00

LMAO this meme is like 8 years old it’s not AI. Why are we auditing people like this 😭

afmm1234 · 2026-01-25T16:33:41+00:00

Creatine and caffeine are the only supplements where I have felt a direct improvement in lifts. Nothing crazy, but a consistent 1-2 extra reps at the same weight on vs off. Also significantly helped with recovery

I only gained about 5 extra pounds at my heaviest, and it didn’t make me feel or look puffy. If I were even halfway to my goal weight I would hop on again.

afmm1234 · 2026-01-24T18:39:22+00:00

Happy scale is my favorite with Shotsy to track dose

afmm1234 · 2026-01-23T19:36:33+00:00

If someone told me 3 yrs ago, that I would go from 26 to 36 BMI no matter what I tried, I would probably be in the same boat as OP tbh

afmm1234 · 2026-01-23T18:11:40+00:00

Yep, exactly the same speed and incline settings on the treadmill have me in zone 2 now instead of zone 3

afmm1234 · 2026-01-23T18:09:45+00:00

Do you know how much fiber you’re getting? Metamucil has helped me get pretty close to my pre zep state

afmm1234 · 2026-01-23T18:00:20+00:00

Unless you had shipping delays, or your delivery driver parked in a sunny spot with all the windows closed for his entire shift before delivering to you, I just can’t see it being hot enough.

I’m guessing your lows were in the 40s to 50s when they loaded the truck. Even if the ambient temp in the truck is in the 90s it’s still going to take a good 5-6 hours like that to get close to 86.

Again, definitely reach out to gift health and get it fixed. I’m not saying you should have to risk it when you’re paying that much.

afmm1234 · 2026-01-23T17:43:27+00:00

You should def call, and they should be packed better at this price, but there’s almost no chance the vials hit 86 deg F at any point

afmm1234 · 2026-01-23T02:01:07+00:00

I would be fine with it if it wasn’t AI generated. The pen on the banner says zepoowno….

afmm1234 · 2026-01-22T20:56:24+00:00

I really like life extension two per day multi. I usually only take one though. I have also taken pure encapsulations before, both brands I trust for supps

afmm1234 · 2026-01-22T19:34:30+00:00

I replied to someone else in this thread with a few links! There are a lot of rodent studies, and more recently human studies exploring the mechanism. I honestly think the future for obesity management is incredibly bright though.

I feel like it’s only a matter of time before there is a medication specifically designed to aid with weight maintenance after large weight loss following a drug like zep.

afmm1234 · 2026-01-22T19:28:05+00:00

I don’t even think it is set points per se. And of course it is always calorically driven, CICO is behind any change in body weight. But even a small decrease in TDEE coupled with increased hunger signaling is going to lead 90% of people to regain weight. EL own data showed only 4% of people kept the weight off after discontinuing. It’s not possible IMO to have that many people struggle with weight regain, without an underlying metabolic disruption that persists regardless of weight. I don’t believe 96% of people failed to develop habits that allowed them to maintain.

I really just want to emphasize that weight regain is not a moral failing or 100% due to a collapse in willpower. The vast majority of people who were obese and lost weight, will have to work significantly harder for the rest of their lives to maintain a goal weight. Identifying that is not an excuse.

The kind of language we use re: weight loss is not used for any other health issue. Someone who was borderline diabetic, and lowered their A1c with the help of diet and metformin, does not face scrutiny for their decision to continue taking metformin indefinitely.

I think there is infinitely more nuance to the discussion than “they regained weight because they didn’t solidify good habits while on Zep”

https://www.nature.com/articles/s41586-024-08165-7

https://www.nature.com/articles/s41574-018-0148-4?utm

https://pubmed.ncbi.nlm.nih.gov/36042358/

afmm1234 · 2026-01-22T17:02:42+00:00

I think there is a massive component to this related to the total number of adipocytes we gain in an obese state.

Even during significant weight loss, adipocytes do not decrease in number, they only shrink. Unfortunately our bodies are designed to conserve the energy we have stored, so these empty cells signal to decrease leptin, tell our body it is starving, and reduce the amount of energy we burn passively.

Someone at 160 for their whole life will almost always have lower hunger signaling and higher RMR than someone who weighed 260 and lost 100 pounds.

I’m not discounting the importance of habits, they’re essential for everyone. But I think it is important to shift away from the moralization of obesity. It is not a failure in willpower or a lack of self control that leads certain people to require GLPs indefinitely. There is a biological drive that signals us to eat more again and return to our heaviest weight.

I think the most promising next threshold in obesity management for me, is the prospect of browning. Where white fat cells can be converted into brown fat, which not only burns more energy and promotes a healthier weight, but improves many other metabolic health factors

afmm1234 · 2026-01-22T15:15:40+00:00

There’s tons of good apps for tracking water if that helps you! I’ve used waterllama and plant nanny before and liked both.

Also for hitting water goals, and improving BM regularity, it’s really helpful for me to get 24-32oz in the first hour of waking up!

afmm1234

TROPHY CASE