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.
The narrow version of the question is whether there is a lowest maintenance dose with actual maintenance data behind it, or whether everything published sits at the top of the ladder.
Happy to be told the question itself is wrong.
This one has a reasonably settled answer, so here it is. One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are. That subgroup is the most interesting unanswered question in the field and it is routinely flattened into the two-thirds headline.
PharmacoVig_BOS said:One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.
Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.
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Shop Reference StandardsDr.Martinez 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.
Same position here, arrived at the long way round. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.
Clinical perspective, offered as context rather than as advice.
Dr.Martinez said:...I stopped maintenance dosing and regained all the weight...
This is a really important data point and I appreciate your honesty. The STEP 1 extension data showed ~2/3 of weight regain within 12 months of discontinuation.
This doesn't mean the drug "doesn't work" — it means obesity is a chronic disease requiring ongoing treatment, just like hypertension or diabetes. We don't criticize blood pressure meds for "not working" when BP rises after stopping them.
The framing matters. maintenance dosing is a treatment, not a cure. And that's okay.