Going up doses.

[FatsiaJaponicaInTheGarden]

I'm massively intrigued by the different recommendations of different providers here.

I think 1-2lb is the advised rate of loss...

So if you're averaging 2lb a week I assume it would make sense to stay at a dose as its working?

Yet some people seem to be going up to 7.5 from 5 even if they're averaging 2lb a week.

I know for diabetics the advice was to go up a dose each month u til they have sugar under control but isn't the advice for weight the lowest effective dose?

I'm seeing on the fb group for my provider (one of the ones that doesn't like people to go up the doses) people unhappy about not going up - yet have lost tons in their first 2 months.

I think I'm still getting my head around what's best practice (in part to inform what I do as I have a long game to play with a lot to use)

I see some providers don't like you staying on 7.5 or 12.5 as the original trial had doses at 5,10,15.

Is it the case that people on it for weight loss has only really been the last 2 years, with a lot of people choosing their own doses/buying online so beat practice isn't really established yet?

Also does it make sense to go slow up the doses so "you have somewhere to go" when you stall. Or is it likely that the higher doses just keep working until weight stabilises.

Also - you can't lose weight forever. Do people on them longterm for maintenance become underweight. Or again does it normalise?? And how does the body know what weight to stop at?

My brain loves to understand things but I really don't!!

@FatsiaJaponicaInTheGarden I wonder if your provider discourages moving up doses as you pay a set price, so they try to keep you on the cheapest doses for longer?

I stay on the lowest dose that works (currently 9mg after starting in July), so certainly don't disagree with it, just curious.

Do you know yet what happens after the initial 12 month contract? Will they let you continue at the same price for as long as MJ is appropriate?

I was on one of your original threads and so happy that you took the plunge and that it is working well for you.

No they've posted their guidance - they like people to move from 2.5 to 5 as its a titration dose but keep people on 2.5 if they have side effects.

The their current guidance says most people will do roughly 3months on 5mg,L then move up to 10 via 7.5. BUT it's tailored to the individual so each month you fill in a form and there's space to request to stay the same/move up down. They are happy to move people up if you request it due to lack of weight loss /don't have tricky symptoms but won't move up people who are regularly losing weight. So looking at the crazy fb group I'm on quite a few peoples have down a month each at 2.5/5/7.5 .

They do also seem to like people to move up from 7.5 and 12.5 as they are seen as doses to get to the next "stable dose" (which I think is silly but theyre sticking to the guidance) however again they are happy for you to stay if losing or worried about side effects.

I don't think it's a cheaper doses for longer thing. I personally wonder if they've gone full supervision rather than "buying doses" and doing the trial to get evidence in order to have it all above board in hope of winning an NHS contract when they come out. If so it's a shrewd move.

The current price is 159 for people not on the study so I imagine that's the price you'd move onto at the end of the year but they haven't said yet. I feel so incredibly lucky to have got it at 99 a month for the year. At the end of the year I guess it depends what dose I'm on as to whether I stick or shop around. If I was just maintain and on a 2.5 dose I'd go elsewhere but as it's likely I've got at least a year from now to go ill see what the prices are like then.

I could ask to go upto 7.5 next week and that would fit with what they've said but after this thread I'm now thinking about asking to stay at 5!! If it slows this next month I'll ask to go up.

They do do maintenance but I don't know their exact policy as I'm 9stone off that!!

Wow just read the SURMOUNT trial study report that Shemed repeatedly link to and it's made me really excited about these drugs all over again.

I don't understand all the medical aid of it but can read a study. This was the one carried out on non diabetics/purely for weight loss.

The drug is SO successful! I can see why the first few months are the same regardless of dose so no real need to go up the doses early on. But longer term 10/15 did outperform 5 but with little between 10 and 15.

I saw that 33% of people in the 10 condition experienced nausea. So that's definitely to be expected. And 20 something percent diahhrea and just under that for constipation.

I think for myself if there's good reason not to lose weight above the 1-2lb per week recommended ( I originally wanted to lose faster!) then as long as I'm closer to the 2 I'll stick but with the expectation if it slows I may want to move up.

I'm so hopeful this can work. Their trial was 72 weeks and that's around how long I think it will take me to get to goal which is also very exciting!

The SURMOUNT study

https://www.nejm.org/doi/10.1056/NEJMoa2206038?fbclid=IwY2xjawJoliRleHRuA2FlbQIxMQABHsPmerCbmK5Zb3pq1nDdI3yxM8OaFce8XDwCEkud2JGF3gh9eOjzckLVkqXaem8HxUsG3RQq4qVvjlPphVIA

Absolutely. I was so happy to be in the 13s (stones). I'm 13.2 now and when I hit the 12s, I'll probably not believe it 😂 I am very happy averaging 2lbs ish a week!!

I'm a very long way from 12! But will similarly be excited when I get there 😁. My next current goal in my head is to lose the "morbid" and if I keep at this rate that should be early July. It is finally seeming that I have something that works.

I've just moved up to 7.5mg. I was with a provider who doesn't like moving up the doses. I put on every week I was on the 2nd 5mg dose. Unfortunately some of us do need the higher doses, so it should be an option. Great the lower is working for you, but I'm know I'm not alone struggling on the lower dose.

I moved up as was seeing no progress or suppression or even side effects really with 2.5/5mg. I’m now on 7.5mg and starting to be able to feel suppression and now I’m loosing a bit more weight. For context 3rd pen 10lbs down, as you can imagine it’s been disheartening, if you take it as total loss I’m averaging 1lb a week however 4lb of that has been on 7.5mg (2lb a week)

@Simi90 Oh I absolutely get moving up if not losing. Sorry if I gave the impression otherwise. I hope the 7.5 works better for you and I will join you if mine slows (which looking at the studies I'm thinking it might!).

@autumn1610 compeltely agree if not losing go up! I'm glad 7.5 is working for you.

On my chart I do sometimes have a few weeks it stays the same/is under 1lb but then I get a bigger leap and it's averaged to 2lb so I think okay overall. I think early on I was just impatient as I have so much to lose... And I want it all gone now 😂.

From the study - it does look like all the doses were pretty similar in terms of results before 3 months.

Yet from 4 months-72weeks the 10/15mg dose outperformed 5mg.

I think I will have to bear that in mind as mine like to move to 10 eventually because of this. (But we're all different etc and mine is currently working..!)

I've not had nausea on any dose other than first few days of 2 weeks on 7.5mg really when i struggled to eat but this was before I increased my water intake and since then all fine, I must be lucky, I'm on 10mg now and no side effects with full suppression all week. Was going to go up to 12.5mg as 2 weeks left of my 2nd 10mg pen but I might stay on it if it continues. Past experience the 7 5mg wore off after 7 weeks for me.
Slower loss per week is better especially for muscle loss, my muscle rate after 2 stone 1lb loss after 6 months is 47.5% which is still normal, when I started I was at 50% so I've not lost that much and still have curves in the right places and have strength to lift heavy equipment etc

Yay for low side effects! It's so exciting to read everyone's experiences.

We're all at different levels, different times, different weights - so we'll done you! Have you set a mini goal?

The thing is, it does come off. I've said before, I could lose 2lb in a week, but, at my age and things going on, it would never be sustainable. It is now!

It's really life changing. I know at 50 full meno, and quit smoking at the same time that my weight was going to go up, and my health suffer. Quite the opposite. Weight down, blood pressure down. I was walking in to type 2 diabetes. I don't feel that anymore. I feel almost healthy 🤣
Nearly there!

You'll get there too. Little by little... Weight comes down. I've had ups and downs, everyone does. We're dealing with either constipation or as women - water retention due to, who knows? Hormones, salty foods, it being a Wednesday... It still drops off on the end.

Good luck @FatsiaJaponicaInTheGarden You'll be fine!