So 21 lbs in 3 months? assuming 5-10 is water weight, 11-16 is real weight loss or 3.7 to 5.3 lbs a month. at 5.3 lbs is over half a kilo a week so not terrible.
It is relatively slow I guess. At that weight you must have tried to lose weight before, how did that go, was it slow?
People's responses in terms of effects on hunger and side effects are very variable, 12mg of reta caused an average of 29% weight loss in a bit over a year, but there were about 5 - 10% who lost little or no weight and a similar number who lost 40%+. At least you are not in the 5-10% who lose nothing and I am not sure you can tell how well it will work long term by how it starts off at lower doses, but you might be likely to lose a bit less than average.
How accurate is the calorie count? People in general are really very bad at calorie counting, and unless you weigh and record absolutely everything for a week it is not likely to be accurate, then you plug all that into chatgpt and get it to analyse it for calories , protein, carbs, fat etc, fairly easy apart from the weighing and recording. Given the scale of what you may be attempting , getting a few appointments with a dietician might be worthwhile but I would not take their advice on glps.
I actually think it does not matter much what the calorie count is, The aim of these drugs is to reduce appetite so you are in a calorie deficit when eating when hungry. I do not believe voluntary deliberate calorie restriction really works, or at least it can work short term , but it rarely succeeds long term, so getting the dose up to where it is working is the aim. Altering the types of food you eat rather than amounts is possibly a more viable strategy, and it should be 1.5g/kg/day of protein per kg of lean body weight to reduce muscle mass loss, and I like low calorific density high protein diets, low fat , and zero highly rewarding/high calorie/high glycemic index carb foods , and that got me from 145kg to 75 kg before I started the glp drugs. ( but I was still hungry a lot of the time )
Going up in dose slowly is designed to reduce sudden severe side effects, such as puking for a week. Going up any faster than 2mg every 4 weeks will increase the odds of that happening, so you have to judge the risks versus benefits of getting there a bit quicker. And it depends on age and other health problems, if older or sicker or diabetic, you need to be more careful and go slower.
So either you just need to be patient and slowly go up doses, ( and losing weight fast is not often a good thing , usually you will feel pretty awful ) , or go up a bit faster and risk extra side effects. If you do that look at glp plotter first. The only reasonably low risk way to increase doses faster is smaller more frequent doses, so every 2nd or 3rd day or twice a week. So at 6mg a week, add in a midweek 1mg and see what happens, if that is ok next week add in 2mg. Or start dropping some of the 6mg and adding it to the other dose. At least with smaller doses it usually does not take as long for side effects to settle if they happen. But understanding how the drug works over time is needed, that even at the same dose blood levels will keep on increasing for up to 4 weeks after a dose increase, which is the reason for increasing doses every 4 weeks. Once you start getting side effects or more appetite suppression slow the increases down a lot, usually if you are at 6mg for example and you have mild nausea, increasing the dose to 8mg , is very likely to make those side effects worse. And you need to use this to guide future increases. Once you get to your final dose just increase one dose and decrease the other slowly to get back to once a week if you prefer that.
Once you get to 12mg or to the highest dose you can tolerate without bad side effects, then you might get a better idea of how it will go longer term, but it is going to take a while given the start weight. My best guess is , given you are hoping to lose more than 50% body weight, you are very likely to have to add in extras at some point. Unfortunately there is simply zero research yet on how to do that. My approach would be to get to 12mg of reta or as close as you can, and then if the rate of weight loss is still slow consider adding in eloralintide or cagri at very low doses and increase very slowly, but if it is going ok and weight is being lost waiting till you stop losing weight on reta in a year or so is equally reasonable. unfortunately how much additional weight loss is possible from adding in elora or cagri is not yet known. If the effect is truly additive it is possible reta and elora could at least get you most of the way to 50% down, which would be as good as surgery without the surgery part. It might take some experimenting to find what works best for you.
Almost certainly there are higher known and possibly unknown risks from higher dose or combo glp therapy, but in the context, where severe obesity carries extremely high long term health risks , I think it is very unlikely the risks from the drugs is going to be anywhere near as bad as the risks of the untreated obesity.
The other issue is do not give up or stop the drugs if you get disappointed that you cannot lose enough weight to get to normal weights, in the bad old days before glp drugs dieticians or endocrinologists were very happy with 5 or 10% long term weight loss, and even that much reduced long term health risks considerably, so maintaining what losses you can achieve is almost more important than anything else.
I am currently maintaining on tirz15mg /reta 5mg/cagri0.5mg per week at 64 kg down from 145 kg or 55% down. I only started the glps after losing most of the weight to reduce the more or less permanent hunger I had trying to keep it off in the first year, and it has worked really well, now getting close to 3 years since I got to 75kg.
