Why your GLP-1 might not be the problem

[Don]

One thing that keeps bothering me on these GLP-1 threads is how often people throw around random numbers and asking for help..

Someone says: "I've been on this GLP-1 for 3-4 weeks at X dose and only lost 1 kg.. whats wrong?"

The first question shouldn't be whether the GLP-1 is working miracles. The first question should be: is the primary mechanism actually working? Is appetite suppression there? Are cravings reduced? Are u eating less without constantly fighting hunger?
GLP-1s ARE NOT FATBURNERS! They don't magically melt fat off ur body. Their main benefit is helping u maintain to a calorie deficit by reducing hunger and food noise
If appetite suppression is clearly present and after several months only 1 kg is lost, then the most likely explanation is not that the GLP-1 failed. The most likely explanation is that there still isn't a consistent calorie deficit.
A lot of people are willing to inject compounds but aren't willing to spend a week tracking what they actually eat. That's often where the answer is.

And to be clear, losing 1 kg in a month is not bad at all. But when someone starts a GLP-1, especially if they're carrying a significant amount of excess body fat, most people would expect more than that. If the scale isn't moving as expected, start with the basics:

Track food intake.
Increase daily activity.
Get some regular exercise.
Focus on food quality, not just eating "less" of the junk food.

Going from 3 bags of chips every night to 2.5 bags is technically an improvement, but it's not a nutrition strategy.

Another thing I think people get wrong is chasing extreme appetite suppression. The goal shouldn't be a dose so high that u can barely eat a piece of bread. The goal is a dose that makes adherence easier while still allowing u to hit ur protein and calorie targets (don't do agressive diets and don't be scared of calories)
GLP-1s should be a tool, not the entire plan.
Long-term success comes from building eating habits that are sustainable even after the GLP-1 is gone. Replacing some fast food with better choices, learning portion control, increasing activity, and understanding ur calorie intake will always matter more than simply increasing the dose.

THAT BEING SAID!
There are hundreds of people in this community, which deserve a big amount of respect, who have been through a genuine GLP-1 journey and have checked all of these boxes along the way, some sooner, some later, but the goal remained the same. Consistency beats intensity.

This forum is here to help u to connect with these experiences. There are plenty of users here who have achieved significant weight loss and built sustainable habits. Look up their journeys, ask questions, and learn from them
Most of them are more than willing to help because they remember exactly where they started

 

[endlrls]

The general public implying that "It's cheating" is still something that pisses me off to this day. You still have to do the work for the GLP TO work.... Good Post!

 

[woundcarping]

The general public implying that "It's cheating" is still something that pisses me off to this day. You still have to do the work for the GLP TO work.... Good Post!

The only work you have to do is increase your dose until you are in a caloric deficit... let's not pretend there's some herculean effort required to lose fat.

An hour of minimum wage a week easily covers the big 3 GLP of choice, some bac, and syringes.

 

[endlrls]

The only work you have to do is increase your dose until you are in a caloric deficit... let's not pretend there's some herculean effort required to lose fat.

An hour of minimum wage a week easily covers the big 3 GLP of choice, some bac, and syringes.

True: Unfortunately for some that will include muscle loss and complete metabolic destruction along the way.... Yeah, you might be "skinnier".... healthier to a point yes... True about the sources as well... if you know where to look...

 

[Skidude]

It always interests me that these posts seem to be controversial.

Does ensuring you take your steps , even when you are tired or had a long day of work take effort?
Does eliminating sugars and fats to ensure that the minimal caloric intake has nutritional value require sacrifice?
Does monitoring macros to make sure you are getting enough protein, fiber, other nutrients require effort?

My view is it is like taking an escalator; you may not need to walk but it is quicker (beneficial) if you do.

Also.. there is such a huge range of effects that these glp1s have on different people, some get more benefit than others.

GOOGLE: In clinical trials, about 10% to 14% of people on semaglutide (such as Wegovy or Ozempic) are categorized as "non-responders". These individuals fail to achieve a clinically meaningful weight loss benchmark (typically a \(<5\%\) reduction in total body weight) despite full adherence to treatment.

For me, it actually helped me achieve a goal that had eluded my whole life, and I believe I was a prime candidate for this drug- and no... it is not cheating, it is healing.

Do it your way, make yourself happy don't buy into the negativity or the polarized sides.

 

[Don]

Do it your way, make yourself happy don't buy into the negativity or the polarized sides.

100%

 

[Don]

The only work you have to do is increase your dose until you are in a caloric deficit... let's not pretend there's some herculean effort required to lose fat.

An hour of minimum wage a week easily covers the big 3 GLP of choice, some bac, and syringes.

Of course it depends on the user. Is the goal complete appetite suppression, or just enough help to make staying in a deficit easier?

Those approaches can lead to very different outcomes. One person may lose 10 kg a month, another 5 kg in the same time. But the 1st one probably lost a significant amount of muscle along the way and the 2nd could have preserved most of their lean mass on the way, I'd consider the second outcome better

The scale alone doesn't tell the whole story

 

[CNCCurrency]

The only work you have to do is increase your dose until you are in a caloric deficit... let's not pretend there's some herculean effort required to lose fat.

An hour of minimum wage a week easily covers the big 3 GLP of choice, some bac, and syringes.

That's my take. Shit I am amazed at how little I put into loosing over 100lbs. I say it was stupid easy for me.

 

[woundcarping]

…The scale alone doesn't tell the whole story

Specific to me, I’ve lost 60lb in the last ~6 months and have spent thousands on labs and DEXA scans in that time.

I’ve spent ~$40 on a pair of bathroom scales.

I’ve lost ~2lb of lean mass in the last 40lb of weight loss.

 

[Don]

Specific to me, I’ve lost 60lb in the last ~6 months and have spent thousands on labs and DEXA scans in that time.

I’ve spent ~$40 on a pair of bathroom scales.

I’ve lost ~2lb of lean mass in the last 40lb of weight loss.

Told ya the slow run is the better run, thats a good ratio honestly u did great!

 

[Elgordoboy]

One thing that keeps bothering me on these GLP-1 threads is how often people throw around random numbers and asking for help..

Someone says: "I've been on this GLP-1 for 3-4 weeks at X dose and only lost 1 kg.. whats wrong?"

The first question shouldn't be whether the GLP-1 is working miracles. The first question should be: is the primary mechanism actually working? Is appetite suppression there? Are cravings reduced? Are u eating less without constantly fighting hunger?
GLP-1s ARE NOT FATBURNERS! They don't magically melt fat off ur body. Their main benefit is helping u maintain to a calorie deficit by reducing hunger and food noise
If appetite suppression is clearly present and after several months only 1 kg is lost, then the most likely explanation is not that the GLP-1 failed. The most likely explanation is that there still isn't a consistent calorie deficit.
A lot of people are willing to inject compounds but aren't willing to spend a week tracking what they actually eat. That's often where the answer is.

And to be clear, losing 1 kg in a month is not bad at all. But when someone starts a GLP-1, especially if they're carrying a significant amount of excess body fat, most people would expect more than that. If the scale isn't moving as expected, start with the basics:

Track food intake.
Increase daily activity.
Get some regular exercise.
Focus on food quality, not just eating "less" of the junk food.

Going from 3 bags of chips every night to 2.5 bags is technically an improvement, but it's not a nutrition strategy.

Another thing I think people get wrong is chasing extreme appetite suppression. The goal shouldn't be a dose so high that u can barely eat a piece of bread. The goal is a dose that makes adherence easier while still allowing u to hit ur protein and calorie targets (don't do agressive diets and don't be scared of calories)
GLP-1s should be a tool, not the entire plan.
Long-term success comes from building eating habits that are sustainable even after the GLP-1 is gone. Replacing some fast food with better choices, learning portion control, increasing activity, and understanding ur calorie intake will always matter more than simply increasing the dose.

THAT BEING SAID!
There are hundreds of people in this community, which deserve a big amount of respect, who have been through a genuine GLP-1 journey and have checked all of these boxes along the way, some sooner, some later, but the goal remained the same. Consistency beats intensity.

This forum is here to help u to connect with these experiences. There are plenty of users here who have achieved significant weight loss and built sustainable habits. Look up their journeys, ask questions, and learn from them
Most of them are more than willing to help because they remember exactly where they started

Best post on here. I’d comment but it would be superfluous, this is everything

 

[BNLFL]

Specific to me, I’ve lost 60lb in the last ~6 months and have spent thousands on labs and DEXA scans in that time.

I’ve spent ~$40 on a pair of bathroom scales.

I’ve lost ~2lb of lean mass in the last 40lb of weight loss.

I'm close to my goal and should work on a maintenance dose, but I still have some dang stubborn belly fat.

 

[Jfrick11]

The only work you have to do is increase your dose until you are in a caloric deficit... let's not pretend there's some herculean effort required to lose fat.

An hour of minimum wage a week easily covers the big 3 GLP of choice, some bac, and syringes.

Hmmmm.... If the only goal is a lower number on the scale, then maybe.... . If the goal is long term health, muscle preservation, nutrition, fitness, and sustainability, there's still plenty of work involved. "Just take more until you're in a deficit" seems like a surprisingly fad diet way of looking at it.

 

[lessthanhalf]

One thing that keeps bothering me on these GLP-1 threads is how often people throw around random numbers and asking for help..

Someone says: "I've been on this GLP-1 for 3-4 weeks at X dose and only lost 1 kg.. whats wrong?"

The first question shouldn't be whether the GLP-1 is working miracles. The first question should be: is the primary mechanism actually working? Is appetite suppression there? Are cravings reduced? Are u eating less without constantly fighting hunger?
GLP-1s ARE NOT FATBURNERS! They don't magically melt fat off ur body. Their main benefit is helping u maintain to a calorie deficit by reducing hunger and food noise
If appetite suppression is clearly present and after several months only 1 kg is lost, then the most likely explanation is not that the GLP-1 failed. The most likely explanation is that there still isn't a consistent calorie deficit.
A lot of people are willing to inject compounds but aren't willing to spend a week tracking what they actually eat. That's often where the answer is.

And to be clear, losing 1 kg in a month is not bad at all. But when someone starts a GLP-1, especially if they're carrying a significant amount of excess body fat, most people would expect more than that. If the scale isn't moving as expected, start with the basics:

Track food intake.
Increase daily activity.
Get some regular exercise.
Focus on food quality, not just eating "less" of the junk food.

Going from 3 bags of chips every night to 2.5 bags is technically an improvement, but it's not a nutrition strategy.

Another thing I think people get wrong is chasing extreme appetite suppression. The goal shouldn't be a dose so high that u can barely eat a piece of bread. The goal is a dose that makes adherence easier while still allowing u to hit ur protein and calorie targets (don't do agressive diets and don't be scared of calories)
GLP-1s should be a tool, not the entire plan.
Long-term success comes from building eating habits that are sustainable even after the GLP-1 is gone. Replacing some fast food with better choices, learning portion control, increasing activity, and understanding ur calorie intake will always matter more than simply increasing the dose.

THAT BEING SAID!
There are hundreds of people in this community, which deserve a big amount of respect, who have been through a genuine GLP-1 journey and have checked all of these boxes along the way, some sooner, some later, but the goal remained the same. Consistency beats intensity.

This forum is here to help u to connect with these experiences. There are plenty of users here who have achieved significant weight loss and built sustainable habits. Look up their journeys, ask questions, and learn from them
Most of them are more than willing to help because they remember exactly where they started

What you are saying here is not wrong , but I do have a different perspective on it.

The two extreme approaches are just use the GLP drug and do nothing different versus use a very small dose and then apply standard diet and exercise strategies to try to lose weight, in which case the diet and exercise bit is doing the work, and the GLP maybe doing not much or reducing appetite slightly.

I also think the approach may need to be a bit different depending on the degree of obesity, where lifestyle changes might be more useful in people with overweight as opposed to those with BMI's of 40+ and those with significant chronic illness

I think from my reading and personal experience that long term weight loss maintenance from diet and exercise is pretty much really poor, a few percent can sustain massive weight loss through diet and exercise, but most regain the weight sooner or later.

One of the things about eating is that people like to believe it is under conscious control, and to some extent especially in the short term it is definitely controllable, but I am not at all sure the conscious mind has control over food intake in the longer term. The built in mechanisms controlling appetite, hunger and eating behaviour are insanely complex convoluted and from deep evolutionary time, and are very hard to interfere with, which is why it has taken so long to get anti obesity drugs that actually work without killing you. I think it matters because deliberate conscious control of food intake types and quantities takes mental effort, and in the long term this is not an unlimited resource, so that cognitive control of eating long term usually fails, as external or internal stressors override its importance and control slips back into earlier less deliberate and less conscious eating patterns. Exercise is pretty similar , if it takes effort and cognitive control to do it or it is aversive, it is not sustained long term.

This is my basic logic for seeing losing weight with GLP drugs as mainly about diet and exercise as a possible set up for long term failure, as those strategies without the glp drugs do not work well.

If you start a GLP drug with no special changes, then it reduces appetite, and improves metabolic state, the reduced appetite causes a calorie deficit and weight loss occurs. Eventually after dose increases a new balance point is reached where lower energy expenditure plus the added hunger from weight loss balance out the GLP effect, and a plateau is reached at a lower weight and no further weight loss will occur. Interestingly peoples food choices and buying choices improve towards healthier options on GLP therapy without conscious input. And most importantly the weight loss state is maintained long term if glp therapy is continued.

I am absolutely in favour of eating healthier foods and exercising. I saw a study recently where overweight fit people were 3 x less likely to get cardiovascular disease than unfit skinny people, with worse odds for overweight and unfit. But I do not really agree that exercise or diet is a long term weight control strategy, they are a good idea for overall health, but for weight loss the effectiveness except in the short term is more debateable.

So I see GLP drugs as the treatment for obesity, nothing before has ever come close, ( except surgery but long term is not great and has a lot of adverse effects ) and they keep the weight of long term, while reducing chances of cardiovascular disease, stroke, many cancers, possibly drastically improve survival if you have cancer, prevent and treat diabetes, high blood pressure , high lipids , etc etc

As far as I know there is more or less no real research on GLP non reponders, so to argue that in that case calorie counting and deliberate food restriction might work in that group or that glp failure in those patients is due to food choices that are worse than responders , does not really have any solid support. I think if those strategies worked , they would work, but I see no evidence that long term weight loss is achieved by diet , other than small amounts with intensive effort and support and a few rare people who achieve large weight loss long term.

I see a lot of evidence that people taking GLP drugs improve their food choices, I would argue that a fair bit of this is not mediated via conscious thought, they make you less hungry, and full more easily, so the types of foods you feel like eating change, and there are direct aversive effects on desire for extra high calorie foods as well, and the overall reduction in hedonic desire for food goes along with a general reduction in overall thinking about food and hunger. This is the bit that happens unconsciously, adding in deliberate improvements is a good idea, but, I do not think that conscious food choices work as a long term weight loss method, but are still a good idea for overall health and wellbeing. It is possible that restricting types of food is more sustainable than amounts, such as low calorific density or keto, mainly as it requires less ongoing conscious effort.

 

[Skidude]

I think it is possible to like Coke and Pepsi and it does not need to be a polarizing choice.

There are certainly benefits to just taking the drug, with no added support from diet exercise, and the number of "non-responders" is small, even smaller if you add tirz and reta to the math.

We do know that people respond on a spectrum and the studies suggest there is reason to believe that the medicine has it's limits.
Also, if you stop using them, many regain unless they have developed better strategies.

I think the truth is we are all trying our best to do better, and that means we cannot be "cheating", and whichever strategy we choose is a result of effort, time, and dedication.
I like the Coke and the Pepsi!

As for conscience choices on what to eat and how much.
Here is a great video on how your gut might make some for you and what you feed it has a lot to do with what you crave, it is short and entertaining:

 

[Don]

What you are saying here is not wrong , but I do have a different perspective on it.

The two extreme approaches are just use the GLP drug and do nothing different versus use a very small dose and then apply standard diet and exercise strategies to try to lose weight, in which case the diet and exercise bit is doing the work, and the GLP maybe doing not much or reducing appetite slightly.

I also think the approach may need to be a bit different depending on the degree of obesity, where lifestyle changes might be more useful in people with overweight as opposed to those with BMI's of 40+ and those with significant chronic illness

I think from my reading and personal experience that long term weight loss maintenance from diet and exercise is pretty much really poor, a few percent can sustain massive weight loss through diet and exercise, but most regain the weight sooner or later.

One of the things about eating is that people like to believe it is under conscious control, and to some extent especially in the short term it is definitely controllable, but I am not at all sure the conscious mind has control over food intake in the longer term. The built in mechanisms controlling appetite, hunger and eating behaviour are insanely complex convoluted and from deep evolutionary time, and are very hard to interfere with, which is why it has taken so long to get anti obesity drugs that actually work without killing you. I think it matters because deliberate conscious control of food intake types and quantities takes mental effort, and in the long term this is not an unlimited resource, so that cognitive control of eating long term usually fails, as external or internal stressors override its importance and control slips back into earlier less deliberate and less conscious eating patterns. Exercise is pretty similar , if it takes effort and cognitive control to do it or it is aversive, it is not sustained long term.

This is my basic logic for seeing losing weight with GLP drugs as mainly about diet and exercise as a possible set up for long term failure, as those strategies without the glp drugs do not work well.

If you start a GLP drug with no special changes, then it reduces appetite, and improves metabolic state, the reduced appetite causes a calorie deficit and weight loss occurs. Eventually after dose increases a new balance point is reached where lower energy expenditure plus the added hunger from weight loss balance out the GLP effect, and a plateau is reached at a lower weight and no further weight loss will occur. Interestingly peoples food choices and buying choices improve towards healthier options on GLP therapy without conscious input. And most importantly the weight loss state is maintained long term if glp therapy is continued.

I am absolutely in favour of eating healthier foods and exercising. I saw a study recently where overweight fit people were 3 x less likely to get cardiovascular disease than unfit skinny people, with worse odds for overweight and unfit. But I do not really agree that exercise or diet is a long term weight control strategy, they are a good idea for overall health, but for weight loss the effectiveness except in the short term is more debateable.

So I see GLP drugs as the treatment for obesity, nothing before has ever come close, ( except surgery but long term is not great and has a lot of adverse effects ) and they keep the weight of long term, while reducing chances of cardiovascular disease, stroke, many cancers, possibly drastically improve survival if you have cancer, prevent and treat diabetes, high blood pressure , high lipids , etc etc

As far as I know there is more or less no real research on GLP non reponders, so to argue that in that case calorie counting and deliberate food restriction might work in that group or that glp failure in those patients is due to food choices that are worse than responders , does not really have any solid support. I think if those strategies worked , they would work, but I see no evidence that long term weight loss is achieved by diet , other than small amounts with intensive effort and support and a few rare people who achieve large weight loss long term.

I see a lot of evidence that people taking GLP drugs improve their food choices, I would argue that a fair bit of this is not mediated via conscious thought, they make you less hungry, and full more easily, so the types of foods you feel like eating change, and there are direct aversive effects on desire for extra high calorie foods as well, and the overall reduction in hedonic desire for food goes along with a general reduction in overall thinking about food and hunger. This is the bit that happens unconsciously, adding in deliberate improvements is a good idea, but, I do not think that conscious food choices work as a long term weight loss method, but are still a good idea for overall health and wellbeing. It is possible that restricting types of food is more sustainable than amounts, such as low calorific density or keto, mainly as it requires less ongoing conscious effort.

I think we're talking past each other a little bit here.

My point was never that people should use a tiny dose and rely mostly on willpower, nor did I suggest that obesity can be solved by diet and exercise alone. I didn't mention a specific dose at all for that reason.

What I was referring to is a threshold of effect, not a specific dose. The optimal level of appetite suppression will be different from person to person. Some people may need much stronger appetite reduction than others depending on their relationship with food, eating behaviours, mental health, and the severity of their obesity.

My argument is simply that there is a middle ground between "white-knuckling a diet" and "being so suppressed that you can barely eat enough to meet your nutritional needs."

For example, if someone weighs 120 kg and has been consuming 5000–6000+ calories per day for years, I don't think the ideal outcome is suddenly eating 1000 calories per day simply because their appetite has been completely shut down. That's not what I mean by support.

To me, the goal is that GLP-1s reduce food noise, cravings, binge tendencies, and the constant mental battle around food, while still allowing someone to eat enough protein, micronutrients, and calories to support their body and preserve lean mass during weight loss.

I completely agree that obesity is heavily biological and that GLP-1s are the most effective obesity treatment we've had so far. Where I differ slightly is that I don't think the objective should automatically be maximum appetite suppression or just a 5% supression. I think the objective should be enough appetite suppression to make adherence sustainable while maintaining adequate nutrition and a healthy rate of weight loss. This range can vary from person to person, some would need 20% supression, others maybe 50%, but going for 95% is not the way and is overdoing it.

So I think part of ur reply is addressing a position that I don't actually hold and I still respect that, since we sometimes just read over big text and be like "OH HE'S SAYING ITS BLACK AND WHITE BUT ITS GREY TOO!"

 

[tendency]

The general public implying that "It's cheating" is still something that pisses me off to this day. You still have to do the work for the GLP TO work.... Good Post!

Actually, not always I'd argue. For many people taking a GLP does everything - there is no work required to modify, pay attention to, track etc. food or lifestyle changes. Well, I take that back - they may have to work to eat something! 😀 So, I can see how the impression this is a shortcut or cheat can take hold in some people's thinking.

 

[endlrls]

Actually, not always I'd argue. For many people taking a GLP does everything - there is no work required to modify, pay attention to, track etc. food or lifestyle changes. Well, I take that back - they may have to work to eat something! 😀 So, I can see how the impression this is a shortcut or cheat can take hold in some people's thinking.

I suppose to a point if "pharmacological starvation" is the way to do it 😆... I'm so afraid to lose muscle mass I'm debating actually going down in dose again....

 

[dancs]

I think it is possible to like Coke and Pepsi and it does not need to be a polarizing choice.

There are certainly benefits to just taking the drug, with no added support from diet exercise, and the number of "non-responders" is small, even smaller if you add tirz and reta to the math.

We do know that people respond on a spectrum and the studies suggest there is reason to believe that the medicine has it's limits.
Also, if you stop using them, many regain unless they have developed better strategies.

I think the truth is we are all trying our best to do better, and that means we cannot be "cheating", and whichever strategy we choose is a result of effort, time, and dedication.
I like the Coke and the Pepsi!

As for conscience choices on what to eat and how much.
Here is a great video on how your gut might make some for you and what you feed it has a lot to do with what you crave, it is short and entertaining:

Pepsi is trash.

 

[Powerslide]

Pepsi is trash.

wife would agree. Dr Pepper 4life