Moving to 15mg

[HelpMebeok]

I have been on Mounjaro a year and lost 6 stone. Really pleased and have gone up the doses steadily and been on 12.5 for about 3 months. It's starting to lose its effect on me and I want to move up to 15mg but worried this will happen on 15mg and I'll be stuck. I still have around 4 stone to lose. looking for experiences of others.

Are you logging what you eat? Are you eating 100g protein and 30g fibre each day? Are you eating mostly wholefoods? Are you lifting weights?

Are you managing to stick to a deficit? There just isn’t enough in your post to be able to advise.

I'm not lifting weights. I've never logged food. I feel like it into my obsessive side and I don't want to go down that route of if I can help it. I've had bulimia in the past.

I usually up a dose when I feel less suppression and the food noise returning. Just nervous this time to go up to the final dose.

I'm getting plenty of protein and fibre so not worried about that.

Given the amount you still have to lose and because you have only been on it for 3 months, I’d try and increase the protein and fibre (can increase protein to 150g) first, and try and try to eliminate processed food. Weigh the protein to make sure you get 150g. That should all help you feel full.

Try and introduce some weight training. That will hopefully result in less muscle loss as you get closer to target. Ultimately you will have to learn to deal with some food noise and less suppression if you are going to maintain longer term, especially if you want to titrate down (rather than stay on 15mg long term).

Can you set out what a typical day of eating looks like?

I've been on it over a year not since January

today

I don't eat breakfast

lunch was 3 quorn sausages in a wrap

dinner was homemade lentil and sweet potato dah and a Nan bread

I had a protein yogurt as well

I have been on 18 months. 7 stone lost. 2 to go. I have stalled since Jan & been on 15 since Xmas. I get your fear as 15 is starting to lose its effectiveness for me. Ended up binging the day before & day of my recent jab. Previous binge was before I started MJ so it was upsetting. I have been in a stall since early Jan & frustrated. I need to change something up & I think exercise is the key as I have avoided it so far. Just to add I don’t track calories either. I must be eating at near a maintenance level but it doesn’t feel like it.

I can’t help with the dose but I’m not sure you’re eating enough protein.

3 quorn sausages is around 13g protein /3 sausages
wraps 8g
lentil Dahl 15-30g

Perhaps you could increase the protein to see if this helps at all? I really struggle to eat enough protein as it’s so much food!

Protein yogurt had 30g in too.

thanks for your replies. Some things to think about.

I do think rather than just up the dose you should be tracking. The medication can't do the whole job for you, you have to work with it and that means making sure you get enough protein and fibre to aid with satiety.

Quorn sausages, wrap, Nan, protein yoghurt. All UPFs. Might be worth trying to replace those with less processed foods. Tofu instead of quorn. Real sourdough instead of wrap and nan. Greek instead of yoghurt with added proteins.
Where are your vegetables? Sweet potatoe is okish, but the greens?

How would you get to 12.5mg in 3 months?

I’m in a similar situation to you 6 stones down over 20 months with 3 to go and I’ve stalled for 4 months. I aim for 150g of protein a day and I do track calories otherwise I would be eating far too much. So I’m going to need to go up to the next dose which will be 10mg for me. What I have done is join the gym I now go twice a week and do some cardio but mostly weights and strengthening exercises. I used to loose weight on 1800 calories a day but now maintain at that so to loose I have had to drop to 1500-1600 and quite frankly it’s a struggle to stay that low as I have a huge appetite. Not sure I’ve got any advice for you but reading about other people’s experiences I think what you and I are going through is a common thing. I’m just plodding on and keeping at it, my overeating and huge appetite has been a lifelong struggle for me so the solution is going to have to be a lifelong thing as well.

So I think that is nowhere near enough protein, or fibre and it’s not surprising you have food noise / are getting hungry.

I would suggest logging all food for a couple of weeks to ensure eating 120-150g protein and 30g fibre. I also think too many ultra processed food which will make it hard to keep weight off in long run.

For reference I might eat in a day:
breakfast Kefir bioful yoghurt with chia seeds and berries 30g protein
Lunch tin tuna 30g protein with massive salad
Mid afternoon protein shake 30g protein
Dinner chicken breast with loads of veg (think like a whole brocolli head!) 40g protein.

re: the three months I thought she said she’d only been taking current dose for 3 months.

It might stop working eventually but you won’t know unless you try and if 12.5mg has stopped having a strong effect you need to move up.

Even if 15mg only helps for a while that is still longer to lose weight until you no longer feel suppression.

I had a similar experience as each dose eventually became tolerated to the degree that I didn’t have the initial suppression and so moved up over a year to 15mg.

At the moment 15mg is still giving me suppression.

That said, I have never had the enormous effect some people report though and although mounjaro has been a definite help I have always been able to overeat enough to not lose any weight and have still needed to make a determined effort not to do so.

You might as well just move up to 15mg because what exactly is the downside?

Slightly more expensive but that’s all and there is no point paying for 12.5 mg if it isn’t working and a higher dose is available.

I do think that in general, not aiming this at you OP, we need to remember that mounjaro is said to reduce a percentage of bodyweight and does not necessarily mean that those of us with the higher body weights will therefore lose all our unwanted weight.

I have a slightly different view.

MJ is a tool to help with weight loss. It reduces hunger, food noise etc. but it’s still just a tool. It will also likely stop working as the body gets used to it so the most important thing is to use the time it works well for to introduce good new habits that will enable long term weight maintenance ideally on a lower maintenance dose (as 15mg is expensive!!)
OP, you are clearly eating in a deficit which is why you have lost so much weight, but it’s only filling enough due to the MJ.

i think it would be good to use this time to move towards sustainable eating which (I believe) includes: 100g minimum - 150g protein to help feel full and with muscle maintenance, 30g fibre (ie volume eating of veg), cutting back on UPFs and also working out maintenance calories / weight loss calories - for me I lost on 1,200 and I maintain on around 1,800.

I would also recommend resistance training to mitigate muscle loss.

If you do move up to 15mg now you’ll have the same question in 3-6 months time. And what is longer term plan? Do you want to stay on 15mg forever?

The downside is that the body will likely start to tolerate 15mg the way it has tolerated all the lower doses and then she has nowhere to go, and is stuck at the highest and most expensive dose. Before going up to 15 it is sensible to try other approaches to make 12.5mg work better for her. I'm saying this from the perspective of someone who did it exactly the way OP did for the first 6 months and went all the way to 15 before I started tracking and making sure I hit my macros. I wish I had done that earlier and not relied on the drug to do all the work. I'm now maintaining and trying to titrate down but it's challenging.

Yes this is what I was trying to say. It’s just a tool, as the food noise does eventually come back. I also think having a think about what you want longer term is good. I’m sure I will take for life, but a low dose. In order to achieve that (currently taking 2mg every 10 days) I need to weigh myself daily, track macros, avoid UPFs, lift weights.

I don't always eat ultra processed foods. That was one day's food intake. I don't think I'm generally in much of a deficit. I ate around 1200 cal a day I think although I'll try not to think too much about calories.

I do appreciate everyone's viewpoints and advice, so will give it some thought

I totally see why you wouldnt want to count calories, I have a similar history to you, however I have counted calories since I started MJ, have lost 2st9lb in just over 3 months. The reason I count calories is to ensure my macros are a good balance every day plus to ensure I eat enough calories. It hasnt caused an obsession for me but has given me the tools to help me eat well and eat the things that fill me up and give me the nutrition I need.

I regularly recalculate my TDEE to check I am in a big enough deficit.

It must be frustrating coming to the point where you stall, i am expecting this soon, but in reality you need to make sure you are in a deficit and eating the right things. There is a lot of scientific evidence to show why it is important what you eat within your calorie allowance.