[PREMIUM] Post-bariatric regain reversal — sema brought me back from 60-lb regain

JennaRN said:

Extending the interval and reducing the dose are pharmacologically different.

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.

pam_stl 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.

pam_stl said:

...the STEP extension data on maintenance dosing is concerning...

Let me offer a different interpretation of the same data. Yes, 2/3 of weight was regained after discontinuation. But consider:

• This is consistent with EVERY chronic disease medication ever studied
• 1/3 of patients maintained significant weight loss — who are they and why?
• The metabolic improvements partially persisted even with weight regain
• The data supports long-term treatment, not a "course" of therapy

The takeaway isn't "the drug fails when you stop" — it's "chronic diseases require ongoing treatment." We've always known this.

TirzTom said:

The regain framing needs pushing back on.

TirzTom 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.

A narrower follow-up, since the general answer is now clear:

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.