Creatine loading vs maintenance on GLP-1 — need advice

Short answer first, then the reasoning. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.

Dr.ObesityLA said:

Extending the interval and reducing the dose are pharmacologically different.

Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.

DebRD_ATL 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.

Can confirm the pattern DebRD_ATL describes. STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

Adding the clinical framing, because it changes how the question reads.

DebRD_ATL 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.