When to increase dose

[Blushingm]

I did a month on 2.5mg which was May and have been on 5mg ever since but the loss has slowed down to very little. I’ve lost 15.5kg

I feel full quickly, I don’t have any hunger and occasional nausea

Im not sure where I’m going wrong

So you've lost over 2 stone in 4 months? Not an expert on WLI, but from a general health perspective, that loss doesn't sound small.

How much are you losing a week? You've lost quite a good amount in 4 months - must be around a kilo a week? That's the top end of healthy loss. I work in pounds rather than kilos and 1-2lb a week is a healthy loss.

That's a good rate of loss.
I'm not sure what you're asking here?
If you're losing this much and you still have good suppression, there's no reason to increase your dose.

Have you got a lot to lose?

This is a useful wee diagram

I lost around 9kg in the first month and a half. Some weeks now I’m not losing anything at all

How much more are you trying to lose? Are you now at a healthy weight and just wanting to be slimmer? If you are getting suppression and feeling well, you need to be a bit forensic about your diet and see if you need to make tweaks there.

This is good advice. It sounds as though the medication is working so check if you’re in a calorie deficit. Going up a dose won’t necessarily make you lose weight any quicker, but it’ll likely make all the things you’re feeling now from it even stronger so even at the highest dose if you’re not eating in a deficit, you won’t lose weight.

having said that, a ‘refeed’ has helped me kickstart losses again after a month or so or no progress. Take a day, or maybe a weekend off from eating healthy and kinda have what you want - and then go back to eating well (if you don’t track calories now, it might be a good idea to do it at least for a couple of weeks).

How much have you lost over the last 4 weeks?
Are you counting your calories?

• Calorie counting. How much are you actually eating? You need to look at that. Like properly look at that. The amount of calories you need now would be less than what you needed before you lost 15kg.

• Protein. How much protein are you having? Should not be less than 1g/kg body weight. If you now weigh 70kg, you should be eating at least 70g of protein daily. Cut down on carbs, unhealthy fats and excessive fats.

• Water. Grest for digestion, keeps the bowel moving, helps with satiation and reducing false hunger pangs, keeps the body well hydrated so the body does not hold on to excess fluid. Drink at least 2 .2 - 2.5 litres of water a day

• Sleep. Are you getting good quality and quantity of sleep. At least 7-9hrs every night. Sleep helps reduce the feeling of stress on our body. Stress causes release of stress hormones especially cortisol which causes increased fat deposition in the body.

• Activity. Strength training is great, helps you build muscle. Muscle burns energy even when you are at rest. Other activities like walking (which is more cardio) help burn energy. Have you increased your activity levels?

When i stop losing weight, i go through all these and tweak stuff, the weight loss then gets moving again in the right direction.
I may have forgotten some things but maybe this helps. If you already know and do all this then ignore.
Also with lots of weight loss the body often has times of 'recalibration' adjusting it's inner workings (metabolism) to the new weight during this time weight loss ceases but later starts again when all those adjustments have been done (a very unscientific explanation).

Are you sticking to your deficit? Have you improved your diet? If the answer is yes then stick to your current dose, sounds like good weight loss since May. What’s the loss per week (averaged out). What’s your current deficit? Are you hitting protein goals and lifting weights?

I could probably eat more protein and drink more water

calories - I’m at around 1000-1200 per day

ive got around another 35 -40 kg to go to be at a healthy bmi

You need to eat more

Yeah that doesn’t sound like enough calories. Use a TDEE calculator to work out how many calories you burn daily and then knock 500 off and that should equate to 1lb a week loss as a guide. It’s 4-5 questions so it’s not a massive long questionnaire. Try eating closer to that amount (for me at 106kg starting weight I was on 1650 calories and my average loss 15 months in is 1.3lbs a week) and see if you see progress. It might seem a bit alien at first but give it a few weeks! Exercise will obviously also help burn more calories but that’s not always possible for everyone. If you are able to, then I started doing ten minute walking workouts on YouTube and gradually started doing longer ones as I felt able to.

@Blushingm , so in the following two and a half months you’ve lost a further 6.5KG, that works out at 0.65 KG per week. I’m maintaining now but during my active weight loss I lost an average overall of 0.6KG per week. In the end I had to get all the way to 15mg to achieve that. I wasn’t someone who had a big initial weight loss but neither was my weight loss steady and linear and it could be frustrating and discouraging for me at times when I felt I’d worked so hard during the week only for the scales to show I’d stayed the same or even gained.
It’s as well to approach our weight loss journeys with realistic expectations, I’m sure it’s exciting and encouraging if the weight appears to fall off initially but that will be a lot of water. Try to remember it’s not really weight we’re trying to lose but fat. Our body’s weight fluctuates in response to our hormones and what we’ve consumed because of the amount of water we’re holding onto. In the background though if we’re consistent (usually) the fat is melting away, all be it more slowly than we’d like it to.
I wish I’d tracked my weight loss on our body’s composition scales but I was so ashamed of how much I weighed and frightened my husband would see my shameful weight I didn’t. That way I could have seen a very pleasing downward trend even though that at any one time I might be feeling frustrated.
I went up a dose when my weight loss stalled and this helped me reach my goal but you’re already not eating very much and are still losing at a healthy rate so I wouldn’t suggest that time had come for you yet.
What I would strongly suggest is that you use this time to try to understand what caused you to gain weight in the first place. I am extremely fortunate because I can afford to take this medication for the rest of my life and that is what at the moment I intend to do. I’m coming back down the doses now but am stuck on 10mg, I’d really like to get to 5mg but we’ll see. The majority of people appear to expect to stop taking the medication once they reach their goal and if they haven’t worked on their diet in the interim sadly the majority of them will regain much of the weight they lost. I strongly believe and the scientific evidence supports that calories are of limited use in determining what we can consume because our body’s don’t process avocado in the same way it processes white rice for instance. If you have a diet of whole foods cooked from scratch with little to no sugar you will be able to consume more and feel more satisfied than if your diet is highly processed and you will be better nourished with a body functioning more optimally into the bargain. What’s more you’ll be creating habits that will help you maintain your weight loss.
Please also consider resistance training to maintain muscle, it’s very important. I trained all through my journey and still do and my backside is still as flat as a pancake and resembles two deflated balloons! 🥴
Good luck!