Would you titrate up?

[Stace_wow]

Would you titrate up? I did. I’m curious what others would have done in this case.

Weight 264
Average daily calories last week were just under 1300 and from last week I lost .4 pounds hahahhahahaaa fuk

I’m seeing about 1 pound a week loss, and in my opinion and for the calories and my weight, it’s not sufficient.

 

[spanky2026]

Average expected weight loss is anywhere between .5 and 2 pounds a week, 1 a week is solid. I don't titrate up unless I've not lost anything for multiple weeks and my food noise is coming back.

Everyone is different, but I will say 7.5 was not a great dose for me, better up at 10. But again, you're losing a pound a week, I'd hang in a bit longer, see if the smaller loss last week was a fluke or the beginning of a trend.

 

[cloratheshadow]

There was about a 3-4 week period where I maintained early on. I have lost 33 lbs in 3 1/2 months. Sometimes you won’t lose. Unless you have lost less than a lb a week for a month, I would ride it out.

Also are you weighing your food or guessing? You’d be surprised how many people underestimate the calories they are eating. Very unlikely that 1300 would cause such small weight loss!

 

[headward]

Average expected weight loss is anywhere between .5 and 2 pounds a week, 1 a week is solid.

☝️This.

Nothing at all wrong with titrating up to max dose on the normal trial schedule if aligned with your goals. Are you taking reta or tirz? Either way, fine to get to max dose. The good thing is elora is available now so if you reach max dose on either and plateau, then just start stacking elora (won't need much; it's strong) to reach goal weight.

 

[Stace_wow]

There was about a 3-4 week period where I maintained early on. I have lost 33 lbs in 3 1/2 months. Sometimes you won’t lose. Unless you have lost less than a lb a week for a month, I would ride it out.

Also are you weighing your food or guessing? You’d be surprised how many people underestimate the calories they are eating. Very unlikely that 1300 would cause such small weight loss!

I weight and measure all my food, I have 2 digital food scales, one for home and one for work, and even track my vegetables and fruit and supplements. 10 cal energy drinks are tracked. If it goes in my mouth, I track it.

 

[Stace_wow]

I take Tirzepatide, sorry I left that out 🤪 😆

 

[headward]

I take Tirzepatide, sorry I left that out 🤪 😆

Then maybe you even have a third option if you need to switch to reta if you plateau. But tirz + elora should be enough, if you even need that later.

 

[eidos]

You've just started at 10 mg; wait until you've taken four doses at that level and reached a steady state before making a decision.

Tirz didn't have much effect (glycemia and weight) for me until I reached 10 mg. Between 800 and 1,200 kCal, my weight stayed the same. My basal metabolic rate was in "famine mode" because of all the restrictions. That really changed with the Reta.

And remember that you really need to drink plenty of water. You should urinate about once an hour, and your urine should be a “light straw-yellow” color. That's a sign that it's the right balance.

Don't get fixated on the numbers, or you'll drive yourself crazy. Get a scale with an app that plots a graph. We don't focus on the numbers when driving, so why do it for weight? Look at the heading.

 

[Stace_wow]

I agree cause this is making me crazy! I just looked back, and I weigh the same today as I did May 4th 😂😂😂😂 holy crap. It’s been like losing and gaining the same 5 fricking pounds for the last 7 weeks! I am a hydrated gal….I pee frequently, and the color is on point!

I should stop weighing myself everyday, that maybe my biggest mind mess but I like the data 😂 and it keeps me accountable to my calorie tracking app.

 

[Sasquatch]

Welcome to my World!
I've weighed the same since May 10th.
I've gone thru a vacation, two sicknesses, a rodeo, and a buzzard fuck.
Just now getting over food poisoning. Did you know with gastric slowing, suffering food poisoning is extended? Joyful words cannot express this! 🤬

 

[domin8brix]

IF you titrate up, do it with the smallest amount you can do at a time--so like if you take 25 units now, go up to 27 or 28 units and see how that goes.

 

[Skidude]

I only weighed in once a week, same time.
I only titrated when needed, even after gaining in a week.
here is my titration to goal:



1 lb a week is not bad, if you are losing you are winning!!

I would suggest adding steps or other resistance prior to more GLPs as you are doing fine and will get to your goal with what you are doing.

My only regret is not paying more attention to muscle loss, I have since added 4-6lbs with resistance and high protein.

 

[HARLEYV2]

I only weighed in once a week, same time.
I only titrated when needed, even after gaining in a week.
here is my titration to goal:
View attachment 28267


1 lb a week is not bad, if you are losing you are winning!!

I would suggest adding steps or other resistance prior to more GLPs as you are doing fine and will get to your goal with what you are doing.
ld
My only regret is not paying more attention to muscle loss, I have since added 4-6lbs with resistance and high protein.

You're Killing it! I started at 220 on Easter Monday down to 194 now would kill to hit 160's like you. Especially with Football season coming up. It's my Nemesis!

 

[Skidude]

You're Killing it! I started at 220 on Easter Monday down to 194 now would kill to hit 160's like you. Especially with Football season coming up. It's my Nemesis!

It sounds like you are on the right track!

My goal was going to be 185, had not been below for 35+ years.. but when this stuff works and you work it; it feels like a miracle!

Good luck!

 

[HARLEYV2]

It sounds like you are on the right track!

My goal was going to be 185, had not been below for 35+ years.. but when this stuff works and you work it; it feels like a miracle!

Good luck!

You're old like me then .

 

[DrPEPr]

Weight 264
Average daily calories last week were just under 1300.

1300 at that weight is way too low.
Your body thinks it's starving.

You're actively sabotaging your weightloss by downregulating your metabolism.
Measure your maintenance intake (I guess it'll be around 2600ish), subtract 500kcal max. and just keep that up for the next 3-4 months.

#TrustmeBro

 

[DaisyRN]

Welcome to my World!
I've weighed the same since May 10th.
I've gone thru a vacation, two sicknesses, a rodeo, and a buzzard fuck.
Just now getting over food poisoning. Did you know with gastric slowing, suffering food poisoning is extended? Joyful words cannot express this! 🤬

Oh! As an ER nurse, I love hearing these tidbits of info (although, I’m very sorry you have to go thru that)! Outside of surgical delays, I have never considered extended GI tract symptoms with GLPs for patients with GI illnesses (esp food poisoning) but this makes SO much sense.
On a positive note, at least your “real life” suffering will be shared with my ER patients so they can know what to expect!
Joyful words indeed! 🤣

 

[Stace_wow]

#TrustmeBro

No, for real! When I wasn't using a GLP my goal was 2200 cals....but that was 40 pounds ago. I am with you on that! My lower calorie consumption was caused, in part, by a soft foods diet the last few weeks (gut issues) and having to restructure my eating times.....but I am noticing the same trend now....1300 is where I am eating, but I know I need more, I do NOT wanna mess up my body under eating. Id like to be around 2000 cals. TDEE reports as 2200, but I know these websites are often on the very LOW end.

Thanks for your comment....

 

[DrPEPr]

No, for real! When I wasn't using a GLP my goal was 2200 cals....but that was 40 pounds ago. I am with you on that! My lower calorie consumption was caused, in part, by a soft foods diet the last few weeks (gut issues) and having to restructure my eating times.....but I am noticing the same trend now....1300 is where I am eating, but I know I need more, I do NOT wanna mess up my body under eating. Id like to be around 2000 cals. TDEE reports as 2200, but I know these websites are often on the very LOW end.

Thanks for your comment....

These websites guess (at best an educated one).
Measure your maintenance. Just start at a slightly higher number (e.g. 2400) and see what the scale does for 2-3 weeks. (measure every day).
If you see a trend up, cut cals by 200-250 and repeat. from then on you KNOW where you're at.

 

[HouseCat]

Fam! I too weigh the same as I did a month ago. It is beyond frustrating!! (I just titrated up 2 weeks ago so fingers crossed!) Also, I wanna say your calorie tracking is diligent AF! Way to go with that!

Looks like you just started 10mg...I'd stay there for another 3 weeks before determining whether you should titrate up, but I defs think you made the right decision to titrate up shot day (mine is also Saturdays - cheers!)

The titrate up guideline I like the most is in the pic below, which asks if your weight is at least 2% less than it was 4 weeks ago. You can also replace that phrase with "Is my current weight at least 1% lower than 2 weeks ago?" Hope you lose soon, and your vibe on is great BTW!

 

[Stace_wow]

Thank you!

 

[HouseCat]

OMG of course! I got it from Reddit and I think it's a nice clear graphic that takes the emotion out of the decision. (Big ups on your profile for two of my favorite things: cats and Vegas - Red Rock Canyon is one of my favorite places in the WORLD!)

 

[Stace_wow]

Red Rock is pretty spectacular... One of my fav places around here 🙂 <3

 

[Mood]

1300 at that weight is way too low.
Your body thinks it's starving.

You're actively sabotaging your weightloss by downregulating your metabolism.
Measure your maintenance intake (I guess it'll be around 2600ish), subtract 500kcal max. and just keep that up for the next 3-4 months.

#TrustmeBro

This ☝️
1300 is way too low. Sounds like you are trying to eat more but are having a hard time reaching closer to the 2000 calories you should be eating? Titrating up is the wrong choice (imo) because that is likely to just cause you to eat less. It is very common for people to not lose weigh and think the answer is to increase the dose, but in this case you may actually be making it worse.

You mentioned you were having gut issues; does that correlate to a prior increase in dose or something else unrelated? Personally, I would look for calorie dense food to add to increase your calories and see how things go when you get closer to that 2000 number. If you like chicken, try going with thighs instead of breasts (thighs have about 25% more calories per oz than breasts). Try adding a couple protein shakes for some extra protein and calories. Protein is your friend and a shake is an easy way to add 25 grams and 100 calories to your day. It also won't necessarily fill you up as long as something more solid.

In all honesty, if you've been struggling to eat and/or if the gut issues started around a prior dose increase, you may want to consider backing down the dose a little bit. You said you are gaining/losing the same 5lbs over the last 7 weeks? That could be your body trying to tell you that it is not happy and its holding on. Remember, this is a marathon not a sprint. No one gained all their weight in a couple months, so its not reasonable to think you are going to lose it all in a couple months. (Not saying you are, but its a common mindset people have and end up sabotaging themselves).

Are you exercising? People tend to focus on the number on the scale, but if you are exercising and gaining muscle, then you may want to take note of things like whether your cloths fit better, has your face thinned out, etc. My weight stayed the same for several weeks, but I went down a belt notch (almost 2) in that same time. So the number didn't change but I was losing weight where it counted, gaining muscle, etc.

 

[anhydrous]

If you've been stalled for a month or so I think that is the appropriate time to up the dosage a bit. It recently happened to me. I was stuck around 220-225 from May 14 until mid June. Upped the dose and my interest in food is completely crushed for now.

 

[Stace_wow]

Thanks for your reply!

My gut issues are about 2 decades old. My issue was...I like to fast in the morning and eat 2 larger meals and a snack later in the day. This was not working well for me due to gerds and delayed gastric emptying.. I have no issue eating, even now. I had a diverticulitis flare that required me to eat softer foods to let my sigmoid colon rest (I eat lots of raw veggies and fruit, so I switched up my eating to eat smaller meals more frequently, stopping around 4-5pm (I'm up early) I am a night snacker, so after like....years of saving calories for the evening, and just switching it up, I'm still working out how to lay my calories out with eating more frequently and earlier to help my gut. Protein shakes are a great idea, and I use them, but maybe adding in some peanut butter would aid the calorie intake....and its delish. I have been on this lean protein high fiber kick for a while, adding in higher calorie meats is a great idea.

I just added in some walking....I have been walking here and there, but I'm interested in increasing my activity level without increasing my hunger so walking is perfect imo. I will add in some lifting again when I'm leaner (Injury prone) around 240....my body holds a lot of lean muscle naturally.

I hit 260.6 this morning, so whatever stall my body was holding on to, its let it go (thank goodness) and I def plan to ride out 10 as long as its effective for me, even at a smaller loss (.5-1 pound a week)

 

[Mood]

Thanks for your reply!

My gut issues are about 2 decades old. My issue was...I like to fast in the morning and eat 2 larger meals and a snack later in the day. This was not working well for me due to gerds and delayed gastric emptying.. I have no issue eating, even now. I had a diverticulitis flare that required me to eat softer foods to let my sigmoid colon rest (I eat lots of raw veggies and fruit, so I switched up my eating to eat smaller meals more frequently, stopping around 4-5pm (I'm up early) I am a night snacker, so after like....years of saving calories for the evening, and just switching it up, I'm still working out how to lay my calories out with eating more frequently and earlier to help my gut. Protein shakes are a great idea, and I use them, but maybe adding in some peanut butter would aid the calorie intake....and its delish. I have been on this lean protein high fiber kick for a while, adding in higher calorie meats is a great idea.

I just added in some walking....I have been walking here and there, but I'm interested in increasing my activity level without increasing my hunger so walking is perfect imo. I will add in some lifting again when I'm leaner (Injury prone) around 240....my body holds a lot of lean muscle naturally.

I hit 260.6 this morning, so whatever stall my body was holding on to, its let it go (thank goodness) and I def plan to ride out 10 as long as its effective for me, even at a smaller loss (.5-1 pound a week)

Good news that the stall seems to be passing. I always fasted and ate a few large meals as well, but had to switch to more frequent smaller meals since I fill up faster than I used to.

Protein shakes are a great way to get some calories and protein in after a walk. Fuel those muscles. That's how I usually start my day; take the dog on a walk and drink a protein shake when I get back.

 

[Stace_wow]

The liquid calories help for sure! I appreciate your response and insight 🙂

 

[lessthanhalf]

Would you titrate up? I did. I’m curious what others would have done in this case.

Weight 264
Average daily calories last week were just under 1300 and from last week I lost .4 pounds hahahhahahaaa fuk

I’m seeing about 1 pound a week loss, and in my opinion and for the calories and my weight, it’s not sufficient.

View attachment 28052View attachment 28051

I do not see a height anywhere or an age, which would help.

Assuming side effects are ok, then I would advise increasing with the aim of getting to 15mg a week if that is tolerated ok. Just going on the weight of 260 lbs plus 40 already lost, without knowing height, it still sounds like pretty significant obesity.

This forum always emphasises as low a dose as possible for as long as possible, and if overweight or a bit obese may be good advice, but in more severe long term obesity, the odds are you are going to need the highest dose anyway and those doses are the ones proven to improve long term health outcomes the best. I am not recommending increasing doses when weight loss is already rapid or side effects are a problem, but it does not sound like that is the case here anyway.

Over the longer term fluctuations in fluid balance are going to cause ups and downs in weight. If you are eating the same number of calories that has caused weight loss before, the odds are it is still happening, even if the scales do not move, weighing less often can help, or you can measure waist circumference instead. Over the very long term, above 6 months to a year or more weight loss is likely to slow down as you reduce energy expenditure from having less cells using energy and from metabolic adaptation to long term low calorie input. I do not subscribe to the theory that increasing calorie intake helps with this. Real world energy expenditure rarely has a lot to do with what EE calculators create especially in severe obesity and even less so after weight loss. The only reasonably accurate way to determine caloric deficit is to calculate it based on weight loss, where each kg of weight loss is 7700 kcal.

Once you get to a true stall that will usually take about a year or a year once on max doses, then you can work out where to go from there, Do not know BMI so hard to guess, but if of average height, there is a fair chance you might need to consider higher than standard doses or adding in cagri or elora at that point, depending on if you get less or more than average amounts of weight loss.

 

[Stace_wow]

I do not see a height anywhere or an age, which would help.

Assuming side effects are ok, then I would advise increasing with the aim of getting to 15mg a week if that is tolerated ok. Just going on the weight of 260 lbs plus 40 already lost, without knowing height, it still sounds like pretty significant obesity.

This forum always emphasises as low a dose as possible for as long as possible, and if overweight or a bit obese may be good advice, but in more severe long term obesity, the odds are you are going to need the highest dose anyway and those doses are the ones proven to improve long term health outcomes the best. I am not recommending increasing doses when weight loss is already rapid or side effects are a problem, but it does not sound like that is the case here anyway.

Over the longer term fluctuations in fluid balance are going to cause ups and downs in weight. If you are eating the same number of calories that has caused weight loss before, the odds are it is still happening, even if the scales do not move, weighing less often can help, or you can measure waist circumference instead. Over the very long term, above 6 months to a year or more weight loss is likely to slow down as you reduce energy expenditure from having less cells using energy and from metabolic adaptation to long term low calorie input. I do not subscribe to the theory that increasing calorie intake helps with this. Real world energy expenditure rarely has a lot to do with what EE calculators create especially in severe obesity and even less so after weight loss. The only reasonably accurate way to determine caloric deficit is to calculate it based on weight loss, where each kg of weight loss is 7700 kcal.

Once you get to a true stall that will usually take about a year or a year once on max doses, then you can work out where to go from there, Do not know BMI so hard to guess, but if of average height, there is a fair chance you might need to consider higher than standard doses or adding in cagri or elora at that point, depending on if you get less or more than average amounts of weight loss.

45 yo Female
5’6
BMI 42.3
GLP start weight was 285 on 3/27/26 (first 20 pounds lost in weeks 1-2) with a HW of 400 pounds (115 lost naturally through diet and exercise)
No sides (even after titration to 10mg Tirz)
This reasoning is why I titrated up….
I did increase my calories to 1750 yesterday, and still lost, 10mg titration was the right move.

Thank you for your comment and insight 😊