Maintenance phase — need advice

pete_manc_UK said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

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.

AttorneyGrant 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.

AttorneyGrant 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.

Dr.MetabolicMD said:

The regain framing needs pushing back on.

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 5 months before TTC as recommended. Was terrified of regaining weight during pregnancy.

Worked closely with my OB and MFM. Gained 22 lbs during pregnancy (within recommended range). Baby is healthy. The metabolic improvements from pre-pregnancy weight loss gave both of us a healthier pregnancy.

If you're planning pregnancy, discuss the medication discontinuation timeline with your OB. GLP-1 agonists are NOT safe during pregnancy.

One thing that is still open after jennifer_SEA’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?

OP back with an update, since a thread like this is useless without one.

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.