First part first - personal Specs
44 year old Male: Moderately handsome, but not dashing
Current weight: 278
Starting weight in Feb 2026: 295
Exercise: weights 3 times a week if I find the time. During my lunch break I walk approximately 2.5 miles as fast as I can. Usually in like 35 to 40 minutes.
Calories: counted via cronometer. Current at 1950 per day.
Reality:
I think I'm a slow responder. I'm currently at 12mg of reta and .75 of cag per week. My weight has been hanging around 280 for a month or so. I can still eat, although less, but still get hungry. If I drop down to 1500 calories I get HUNGRY.
So what gives? Do I increase the reta above the trial limit of 12mg or add more cag? Wait it out? Has anyone stalled at the apex of their dosing?
18 lbs in 3 months , including initial water weight loss of 5-10 lbs is not great. It is very unlikely to truly be a stall this early, more likely just fluid balance variations, but the overall rate of weight loss over 3 months on above standard doses/combo GLP's is not great, it does suggest you are not responding very well given 12mg reta plus 0.75 of cagri. Usually actually stalling takes about a year or so. If it is just slow at say 18-5lbs/3 months or 4 lbs a month and starts going down again at some point it might be fine, just slow.
Pretty sure you said minimal side effects. Do not know height so hard to know how overweight you are, generally the more overweight the faster the weight loss. I assume you did not have diabetes before you started, as that usually reduces the weight loss quite a bit.
Worth getting a different reta batch to exclude a dodgy reta just to be sure.
My guess is the calorie count is a bit off, just because people in general are very inaccurate at calorie counting, you would have to weigh absolutely everything you ate to get it accurate, but if the drugs were working as they should, it should drop your appetite so you have a calorie deficit without any special effort. I think 3 months is too early for significant metabolic adaptation.
If protein intake is not at least 1.5g/kg body weight it should be increased and consider going higher, protein is more satiating per calorie than anything else and you get a bonus 20% extra calories from the energy wasted in metabolising the protein.
Options are - more cagri is probably easiest as you are already on it, or more reta. Depends on what effect adding the cagri had when you started it , if it did not seem to do anything then maybe you are not that responsive to it as well, I can definitely tell I have taken 0.25mg of it. I have seen very few people on high doses of reta on this forum, and obviously it is not been studied medically yet, so it is harder to say for reta how risky high doses are. And the other factor is - is the obesity severe enough to justify whatever the unknown extra risks are of high dose/combo therapy? My thinking is severe obesity BMI 40+ is so bad for your health that any possible risks from experimental combinations or higher doses are almost certainly going to be lower than the risks of the obesity, but this logic breaks down a bit as the obesity gets less severe.
It actually might be worth trying to add in some tirz at not huge doses like 5mg/w, it has the strongest effect on GIP receptors of all the GLP's, and its biased agonism on glp-1 might increase the effects on that as well, given the relative lack of response to reta it might make more sense than increasing the reta dose.
Even adding in semaglutide might be worth considering , but only if tirz did not work, at least it has actually been studied at much higher doses of 7.2mg and 16mg.
What is really needed are studies on what to do if glp therapy does not work or is only marginally effective, there will get done eventually but have not been done yet.
My thinking might be a bit biased towards that combination as it works for me tirz15mg/reta5mg/cagri0.5mg per week, but i lost most of the weight before starting any of them and am using it to try to keep off 55% of my body weight, and definitely respond more to these drugs than you seem to.
You might just be really unlucky and be one of the 5-10% of people who respond poorly to GLP's, but you would need to give it at least another 2 -3 months, and higher doses/combos before deciding that.
