Does staying on a low dose and losing slowly make maintenance and keeping the weight off easier?

[Saturnista]

Just that really, a question from the “low and slow” thread. Most of us are either staying on a low dose and going up doses v slowly in 0.25-0.5 mg due to unpleasant side effects or because we are “super responders”. It does seem to result in a slower weight loss of o.5. -1 lb a week so our journeys will be longer but we were wondering if that has a benefit longer term in terms of maintenance and keeping the weight off easier. People’s actual experience would be great to hear, thank you.

I was "low" never going above MJ 3.75mg, but not "slow" as lost over 9st in 18 months (it was a long time, but also a lot of weight). Maintaining BMI 24-25 fairly easily for 6-7 months now.

I think it is too complex to reduce to one "low and slow" cliché, and likely to disappoint many. Some of those complexities may include -

• Starting BMI,age, weight and underlying health/metabolic health
• Response to the medication which varies enormously
• Expectation from medication also varies greatly - some need stronger suppression others can work with it taking the edge off their appetite
• Whether side effects/finances limit dose or, if someone requires a higher dose to be effective
• Food choices and quality, not just eating less
• Protein intake and resistance exercise to help preserve muscle mass
• Sleep,stress, and other lifestyle factors that influence us
• The "right dose" is the lowest dose that works for you, not the lowest dose possible for everyone
• Maintaining weight is very different from losing it, ome people may need ongoing treatment while others may be able to maintain without it

A rigid focus on "low and slow" risks turning what should be an individual treatment into another inflexible diet. For many people, it isn't rigid plans that lead to longterm success but learning to respond to how their own body reacts.

Whether it was strict calorie counting, WW, SW, keto, fasting, or an insistence to stay on the lowest possible dose if it is not effective, the common thing that failed us with all of them is the belief that there's one "right" way for everyone where in the real world it is far more nuanced.

The most sustainable approach is one that is flexible enough to evolve as you listen to how your body responds and you decide how you can best manage it, rather than a predetermined plan or slogan.

No it’s not that simple. There is no correlation, 80 percent of people regain the weight from dieting alone, and often that’s slow.

even if someone loses rapidly. Ie 3-4 lbs a week they’ve as much chance of maintaining as a slow loser. It’s simply about what you consume in maintenance.

Thanks for your feedback. How’s your maintenance been, have you come off completely or are you still on a low dose?
From my own perspective, I have had no choice but to stay on a low dose as the side effects have been pretty bad and only after 5 months can I tolerate more than 2.5 mg. So, it wasn’t a question about the approach of “low and slow” as, like you said, it simply suits me although the slow weight loss of 0.5 lbs a week isn't comparable to a lot of other people. Just wanted to ask whether it made any difference to people’s maintenance plans.
Serious congrats on your weight loss and maintenance of it!

Thanks @Wickedlittledancerfor your feedback. What’s your experience in maintenance been?

@Saturnista I am maintaining at 2.5mg, it has been fairly straightforward, albeit boring, so far.

In maintenance I have stuck to the way of eating I found in my 18 months of weight loss, through trial and error, worked for me both for weight loss and healthier foods I enjoy. I eat much more fish than I ever did before, and simple grilled chicken with spices (instead of complex sauces) and so much veg and salad and minimal pasta/rice. It is more relaxed than when I first started Mounjaro and I still eat out / have takeaways, but the foods I eat day to day are simple protein and veg but I enjoy them.

I would say use your "slow" time to find foods that work for you, that your body finds satisfying, staves off hunger, and you do enjoy. For me I was determined that this was going to have to be a way of eating forever and I couldn't return to my old "normal" so I had to find foods I found satisfying and enjoyable.

This is what I did, and it's been a piece of piss, but it's probably a chicken and egg situation. Low dose is just what happened to work for me, and continues to do so at maintenance.

Have a look at the maintainers threads @Saturnista . There is just about every type of WLI loser on there. Some went all the way up to the highest dose, others stayed on the lowest, some lost the weight fast, others it took ages, some lost only a few stone, others lost almost half their body weight. Literally every type of loser.

There is also every type of experience in maintenance too and it honestly doesn't seem to have a huge amount to do with how slowly the weight was lost.

Obviously, I'm not charting it scientifically, but from the many anecdotes shared, I would say that in the main it is to do with how much control can be maintained over calorie intake post reaching goal. Everyone has differing degrees of success and some can just cold turkey off WLI and crack on with no issues, whereas others have to taper down slowly, raise their dose a bit, maybe come off and go back on, some microdose, others tinker around with how many calories they can actually eat or how much exercise they need to do to offset the food intake etc.

Everyone has so many different physiological and psychological food pathways that as far as I can tell, you can't really correlate much. Other than keeping the weight off will always boil down to whether or not you are consuming more than you are using.

No one really knows because the trials were not done this way.

I started at bmi 26 and have stayed low and pretty slow. I hope that only being overweight not obese might mean I won't struggle with coming off them - kind of makes sense, body not so badly affected in the first place etc? But who knows.

The clinics who prescribe microdose of wli to normal bmi people probably have enough data by now but they dint have to publish it.

I lost 5st in 5 months on 2.5mg. I lost consistently throughout. To maintain, my dose has crept up to 4-5mg which I adjust depending on how I'm feeling.

Just curious-if you reach your target weight with a BMI of about 23, will you still be prescribed MJ?
I’ve lost a stone with about 1.5 stone still to go but feel that I might want to micro dose to maintain.

Yes look at monj.co.uk for maintence pharmacies most prescribe down to bmi 22 and some 19.

So you're on a Higher dose for maintenance than for active WL?
Is that because you aren’t controlling your food as strictly and relying on the suppression long term?

My provider will allow it down to bmi 19, which would be terribly skinny for me.

I will microdose if needed. I'm on wegovy and have very little appetite suppression but can eat more on wli than I can without and still lose weight - I assume it's fixing an Insulin resistance or inflammation issue.

I’ve been at goal about 18 months or so. Lost 6 and a half stone, bmi 32 to 20. Dress size 18 to 8.

i was at 10mg as my optimal dose. When I hit goal I reverse dieted, so did an extra month at 10, whilst upping my cals by 100 or so a week. I then did a month of 7.5 whilst doing the same till my weight stabilised and I knew I was at maintwqnce cals and then moved to 5 as my maintwnce dose. As such the increase in cals off set any increase in hunger as I dropped the dose.

my weight has been completely stable for the full time. I go up and down 2lbs on average

I tend to eat less during the week to allow for weekends, I maintain on about 2000 cals.

when I go on long holidays, I obviously eat and drink a lot more, I then just either nudge up the meds when I come back to knock the few pounds off, last time was 4 lbs, or just get right back into it. I find when I have consumed more sugar etc the meds work less well so takes me a few days to get back into giving it no thought.

overall I find it very easy, there is little to no thought now behind my weight or eating. I was at a friends bbq at rhe weekend, had burger, cake, chocolate, crisps , booze etc, was 3lbs up when I came back on Sunday and back to normal weight today just from back to normal eating. So I would say I eat clean and healthy 80- 90 percent of the time, but if I fancy something I have it, I’m fully in control.

That's interesting. I lost most of my weight on 2.5 and 3.75 mg. I moved up to 5 mg for the last few pounds.

Since goal I've found "bad habits" that disappeared for all my weightloss journey returning. I've started eating crisps, chocolate and cakes that I hadn't even thought about for many months. I wonder whether I'll have to increase my dose too. I'd anticipated reducing not increasing it for maintenance.

That’s a good question. I’m more relaxed with food choices but still generally stick my calories. I snack occasionally and have the odd glass of wine which I didn’t do whilst loosing weight. My desire to snack unconsciously has caught me out a few times and I find slightly higher MJ helps me maintain control. MJ definitely stops me overindulging when I take my eye off the ball which was my main issue prior to MJ.

It is weird right. I initially worried I’d be going up to 15mg if MJ stopped being effective but after 18 months it’s not increased substantially. I took 4mg last week and so far feel good.

I’d be interested in the research when all this is established! Like, set point theory. Does your body find it easier to remain at 9 stone when it’s been 9 stone for, say, ten years?

It obvs doesn’t stop working, as otherwise it would not be prescribed for things like diabetes and shortly cardio vascular health, it would be too dangerous.

i think what happens is diet fatigue sets in and also any placebo effect goes. In addition you can usually push through unless the meds make you unwell. There is a mental health element associated with weight maintenance. And that’s what starts to come into play.

I think it is difficult to extrapolate from individual experiences.

It took me six months to lose 3.5 stone which seems quite quick to me. I never went above 5mg and lost most of my weight on 2.5. I’ve been maintaining since September. Been on 1.25mg since Xmas and recently experimenting with 1.25 every two weeks so I am probably in microdose territory now.

I’m on the maintenance thread and I can see that in some respects I’ve found maintaining ‘easier’ than others in that I’ve had no problems with regain thus far and the financial burden of my tiny dose is negligible. But I would also say that I work hard at maintaining. I’ve changed my whole diet. I excercise a lot and I think constantly about when and what I’m going to eat. I weigh myself every day and am constantly waiting to wake up fat again.

I don’t have any suppression but the urge to binge is much less than off MJ. I am often hungry and 90% of the time I eat clean non UPF food. I have never counted calories. Sometimes I fantasise about taking a bigger dose and just obliterating the urge to eat entirely but I do want to come off one day so I guess I feel like I’m in training for that.

Lost 3 stones in 6 months, with a month at a max of 3.5mg (mostly 2.5mg).
For maintenance, my sweet spot is 1.75mg. Any less than this and im opening the cupboards every 5 mins and it shows on the scales…

This is the exact approach people have to take for maintenance, for the rest of their lives. I don’t think most understand. With WLI or not. Every day is resisting temptation, missing out, thinking about calories, control. It’s not a temporary period of time. But being slim and healthy is worth it.

Yes I think it is worth it but it is definitely not without sacrifice. Sometimes I think how nice it would be just to not think about the nutritional content of everything that passes my lips. But I love the way I look and how strong and capable my body is now.

Absolutely, me too. I let myself have 1 binge day a month to get it out of my system 😂

I'm on a low dose (nearly a year on 2.5mg). I've lost about four stone.

Like others have said, there are so many individual processes that will influence maintenance, and food intake versus energy output will be the biggest one. But where I do think that having stayed on a low dose might be helpful in the long term, is that a lot of the weight loss has occurred without very much suppression in many cases. Certainly for me, I do get very hungry and feel like I could easily eat more than I allow myself, so I do need a fair bit of willpower, which I hope will help me in the long run. I think though, that if people titrate down slowly, and get used to the increased hunger in steadily managed increments, that could also have the same benefit. The hardest thing must surely be if people go cold turkey, particularly after taking a higher dose.