Reduced-Frequency GLP1 Therapy Maintains Weight, Body Composition, and Metabolic Syndrome Improvements: A Case Series
- Thread starter Chili777
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FarmgirlRebel
GLP-1 Enthusiast
Interesting. Nice to see some studies coming out on the best way to approach maintenance w/o losing other health gains.
I have been toying around with the idea of stretching out my shots to something like 10 days as I go into maintenance as the peptide would be just leaving my system at 10 days and it would boost me back up...things to ponder.
I have been toying around with the idea of stretching out my shots to something like 10 days as I go into maintenance as the peptide would be just leaving my system at 10 days and it would boost me back up...things to ponder.
lessthanhalf
GLP-1 Specialist
It is great to see some actual research on long term maintenance. I have some criticisms of this study.
I tried to find how long the patients had been on the medication before being switched over to maintenance, but could not find it. If they had been on the GLP for 18 months or so they would almost certainly be at a stable weight. Trying to work out if they were still losing weight when the swap happened as I think this is critical to interpreting this research. My logic says if the weight loss dose is maintained for maintenance and weight is stable , as is shown in basically every other study, why should a lower dose be equally as effective? By all means this should be proven by studies, but it is just an obvious conclusion from the available evidence.
All I could find was this "Patients who reported weight loss plateau (defined as less than 5% variation over a 3-month period) were invited to switch from standard once-weekly dosing to reduced-frequency dosing (every other week) at their current effective dose." , which sounds very reasonable.
But looking at the graphs of weight over time, essentially all of those patients were still losing weight when swapped to maintenance, so they were not in fact at a plateau, and most continued to lose weight with less frequent dosing, but at a slower rate. I think the problem is simply that their definition of plateau is bad. 5% weight change in 3 months is actually rapid weight loss, equivalent to 20% per year, I cannot see how that could possibly fit any useful definition of plateau. And that is what I saw in the graph. So as far as I can see the study is seriously flawed. I will go and make a heavily prompted chatgpt read it and see what it says , and will say so if I am misinterpreting it.
Changing to a maintenance dose that is lower while still losing weight is a totally different study to changing it while at a completely stable weight. The same study done after 18 months of treatment at a real plateau is very likely to give different results. So as far as I am concerned the study is not useful, only showing that if people with mostly not severe obesity are put on less frequent doses while still losing weight, they will continue to lose weight at a slower rate or stabilise weight on that less frequent dosing, which is just not useful information, kind of obvious and more or less pointless. All it says is people with mild obesity may be maintained on low or less frequent doses if they lost weight on low doses, or were still losing weight at higher doses.
Thankfully this time the image worked when I uploaded it, as it is easier to see this in the graph.
I do not know why this was not picked up by peer review? Unless I am wrong , which is possible and let me know, this is a bad study and should probably be retracted. It definitely does not demonstrate what it says it does.
I tried to find how long the patients had been on the medication before being switched over to maintenance, but could not find it. If they had been on the GLP for 18 months or so they would almost certainly be at a stable weight. Trying to work out if they were still losing weight when the swap happened as I think this is critical to interpreting this research. My logic says if the weight loss dose is maintained for maintenance and weight is stable , as is shown in basically every other study, why should a lower dose be equally as effective? By all means this should be proven by studies, but it is just an obvious conclusion from the available evidence.
All I could find was this "Patients who reported weight loss plateau (defined as less than 5% variation over a 3-month period) were invited to switch from standard once-weekly dosing to reduced-frequency dosing (every other week) at their current effective dose." , which sounds very reasonable.
But looking at the graphs of weight over time, essentially all of those patients were still losing weight when swapped to maintenance, so they were not in fact at a plateau, and most continued to lose weight with less frequent dosing, but at a slower rate. I think the problem is simply that their definition of plateau is bad. 5% weight change in 3 months is actually rapid weight loss, equivalent to 20% per year, I cannot see how that could possibly fit any useful definition of plateau. And that is what I saw in the graph. So as far as I can see the study is seriously flawed. I will go and make a heavily prompted chatgpt read it and see what it says , and will say so if I am misinterpreting it.
Changing to a maintenance dose that is lower while still losing weight is a totally different study to changing it while at a completely stable weight. The same study done after 18 months of treatment at a real plateau is very likely to give different results. So as far as I am concerned the study is not useful, only showing that if people with mostly not severe obesity are put on less frequent doses while still losing weight, they will continue to lose weight at a slower rate or stabilise weight on that less frequent dosing, which is just not useful information, kind of obvious and more or less pointless. All it says is people with mild obesity may be maintained on low or less frequent doses if they lost weight on low doses, or were still losing weight at higher doses.
Thankfully this time the image worked when I uploaded it, as it is easier to see this in the graph.
I do not know why this was not picked up by peer review? Unless I am wrong , which is possible and let me know, this is a bad study and should probably be retracted. It definitely does not demonstrate what it says it does.
They appear to admit to deficiencies in the Conclusion and the study is presented as a Proof of Concept. Based on that, it may be somewhat above useless:
"Our findings demonstrate that many patients who initially lose weight on standard weekly GLP1 therapy maintain weight, body composition, and metabolic parameters after transitioning to reduced-frequency dosing. This study provides early proof of concept that structured de-escalation may be a viable strategy to sustain benefits while reducing treatment burden. Larger randomized controlled trials are needed to confirm these findings and may help address concerns about indefinite therapy, lower health care costs, ease supply constraints, and broaden access to GLP1 medications to improve public health."
"Our findings demonstrate that many patients who initially lose weight on standard weekly GLP1 therapy maintain weight, body composition, and metabolic parameters after transitioning to reduced-frequency dosing. This study provides early proof of concept that structured de-escalation may be a viable strategy to sustain benefits while reducing treatment burden. Larger randomized controlled trials are needed to confirm these findings and may help address concerns about indefinite therapy, lower health care costs, ease supply constraints, and broaden access to GLP1 medications to improve public health."
lessthanhalf
GLP-1 Specialist
I did get chatgpt to go through both the study and my post , and in agreement with the above post says it does not make unreasonable claims about effectiveness of less frequent dosing , and it says my statements of it being a bad study that should be retracted are excessively harsh. ( so apologies to the authors in case they read this )
It does not however disagree with my basic argument, that the definition of plateau makes no sense at all , being equivalent to the rate of weight loss from 15mg of tirzepatide over a year or about 20% which is rapid weight loss not a plateau. So its argument is fundamentally flawed. All it shows is that less frequent dosing can be used for maintenance in people with mild obesity at mostly normal BMI's, if started while they are still losing weight, which is effectively not useful new information.
It does not however disagree with my basic argument, that the definition of plateau makes no sense at all , being equivalent to the rate of weight loss from 15mg of tirzepatide over a year or about 20% which is rapid weight loss not a plateau. So its argument is fundamentally flawed. All it shows is that less frequent dosing can be used for maintenance in people with mild obesity at mostly normal BMI's, if started while they are still losing weight, which is effectively not useful new information.
I agree their use of plateau is lacking explanation and seems cherry picked as to their sample. But after 36 weeks of alternate week dosing, the results are encouraging. Maybe regardless of how the population was chosen or maybe not. More work needs to be done to prove that either way, I agree.lessthanhalf said:
lessthanhalf
GLP-1 Specialist
Please note, no criticism of any kind was intended to the poster of the study. It is an area I am actively interested in and personally relevant as I am unusually someone who only started GLP's mostly after losing the weight, so I am taking them just for maintenance, and there is so far not much specific research on maintenance, only what can be guessed at by looking at the graphs of weight from long term follow up studies of people on the drugs or people who stopped them. And to me the research strongly suggests full doses are necessary for maintenance, but on this forum I see a different picture where many people seem to be maintaining on lower doses than they used to lose the weight. So anything that helps to try to reconcile this difference is useful.
Chili777 said:
In addition to the statement in the conclusion, the authors also provide a long and extensive paragraph on the study's limitations, basically,
self-selection bias
primarily white sample
very few obese individuals
lack of some followup data
lack of control group
I would add:
the sample looks skewed towards older people
higher % of males than in most obesity studies
reduced frequency was not constant across participants
small sample size
Even still, the study appears to provide an incremental contribution to our knowledge about possible pathways for maintenance, although with some serious limitations. But Rome wasn't built in a day. Research builds on other research. Also important to note is that this journal is a top-rated journal in the obesity research community, subject to peer-review by experts in the field. Definitely not bad or useless research. Hopefully the article inspires more robust research on maintenance pathways.
CNCCurrency
GLP-1 Specialist
I believe the clearance is like 28 daysFarmgirlRebel said:
CNCCurrency
GLP-1 Specialist
A lot to dive into, thanks for postingChili777 said:
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