traveltech_sara said:One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.
This is exactly what I could not find anywhere else.
Adding the clinical framing, because it changes how the question reads.
The concept of "metabolic set point" and its relevance to maintenance dosing: the body actively defends a weight set point through hormonal feedback (leptin, ghrelin, insulin, GLP-1). After weight loss, these signals shift to promote weight regain[1].
GLP-1 agonists may work in part by resetting this set point — or at least overriding the counter-regulatory signals that drive regain. This would explain why continued treatment maintains weight loss while discontinuation leads to regain.
Understanding maintenance dosing through this lens reframes the drug from "weight loss tool" to "metabolic set point modulator."
sophie_paris said:josh_phd_bmore said: ...the STEP extension data on maintenance dosing is concerning...
Maintenance phase reality on maintenance dosing: reached my goal 5 months ago and now I'm in maintenance. It's a different mental game.
During weight loss, the scale going down is constant positive reinforcement. In maintenance, the scale staying the same is... just... nothing. It's anticlimactic. The dopamine hit is gone.
What keeps me going: lab improvements, physical capabilities, how I feel, fitting in clothes I love, and the knowledge that regain happens when people stop being intentional. I'm staying intentional.
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View ResultsDr.ObesityMed said:Extending the interval and reducing the dose are pharmacologically different.
Dr.ObesityMed 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.
Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Carry on.