Dr.NutriCornell said:STEP 4 is the study that answers this and it is blunt.
The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.
Ask again with the specifics and you will get a better answer than this one.
SurmountFan_IN said:Planning the end of this rather than the middle of it, which nobody around me seems to want to talk about while it is still going well.
Maintenance phase reality on maintenance dosing: reached my goal 4 months ago and now I'm in maintenance. It's a different mental game.
During weight loss, the scale going down is constant positive reinforcement. In maintenance, the scale staying the same is... just... nothing. It's anticlimactic. The dopamine hit is gone.
What keeps me going: lab improvements, physical capabilities, how I feel, fitting in clothes I love, and the knowledge that regain happens when people stop being intentional. I'm staying intentional.
mike_nyc said:The regain framing needs pushing back on.
The concept of "metabolic set point" and its relevance to maintenance dosing: the body actively defends a weight set point through hormonal feedback (leptin, ghrelin, insulin, GLP-1). After weight loss, these signals shift to promote weight regain[1].
GLP-1 agonists may work in part by resetting this set point — or at least overriding the counter-regulatory signals that drive regain. This would explain why continued treatment maintains weight loss while discontinuation leads to regain.
Understanding maintenance dosing through this lens reframes the drug from "weight loss tool" to "metabolic set point modulator."
[1] Rosenbaum M, et al. J Clin Invest. 2008;118(7):2583-2591.
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View ResultsOne thing that is still open after JessicaH_TX’s answer:
Whether there is a lowest maintenance dose with actual maintenance data behind it, or whether everything published sits at the top of the ladder?
Reporting back.
I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.