the food noise going quiet is the part nobody warned me about
Thinking out loud about this: the food noise going quiet is the part nobody warned me about.
On the "everybody ends up at 2.4" claim, which comes up every few weeks.
The escalation schedule in the trials was designed to get people to a fixed study dose. Real use is not a trial. The dose that keeps your appetite quiet with side effects you can live with is the dose, and for a lot of people on this board that has been 1.0mg for a very long time.
The counter-argument, which is fair: some people genuinely do need the top of the range, and staying low out of caution costs them months. That is a conversation with someone who knows your history, not with us.
Steady state after a dose change takes four to five half-lives, so the fair judgement point on a new step is about a month, not four days.
The escalation schedule in the trials existed to keep people on the drug. It is a tolerability ramp, and it is why the label reads the way it does.
Happy to answer the boring questions. Those are usually the ones worth asking.
best — the order this archive was captured in
Weight change and appetite change are different endpoints on different timescales. Conflating them is where most of the confusion on this board starts.
Retitled to match the body. The original promised a comparison the post does not make.
The weekly interval comes out of the half-life — roughly a week — so you are on a smooth curve rather than a series of spikes. That is also why moving your day slightly does very little.
Cosigning. The appetite change and the scale change ran about three weeks apart for me too.
Cosigning.
Right, and the timescale is the bit that keeps getting lost. Judge a step at a month, not at a weekend.
Right, and the timescale is the bit that keeps getting lost.
Disagree with this specific line. A pause at 1.0mg is not evidence that 1.0mg has stopped working.
What dose and how many weeks at it before this started?
Genuine question — is the appetite effect still there, or is it just the scale that has paused?
Disagree. 2.4 is the top of the label, not the goal, and "everyone ends up there" is just survivorship in the posts you read.
Yes — and the honest version is that most of the "it stopped working" posts turn out to be a normal fortnight of water weight.
This matches me almost exactly, right down to the reflux showing up on the second day and being gone by the fourth.
Careful. A four-week stall is inside normal variation and treating it as failure is how people escalate for no reason.
Correct, and worth adding: the trial average is an average. Half the people in it did worse than 15% and were still on the drug.
STEP-1 ran 68 weeks and landed just under 15% mean body weight change on 2.4mg. It is an average of a wide distribution, not a target you have missed.
- 1The weekly interval comes out of the half-life — roughly a week — so you are…9 comments in this branch · started by u/rafael_ostergaard