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Comment by toomuchtodo | Hacker News Reader

That might be okay! I'm on the lowest dose of Zepbound (tirzepatide), 2.5mg, and I'm losing 5lbs a week, which is almost too much. It will be helpful to switch to something perhaps not as good in pill form (versus my weekly injections) once I reach my target weight. For those who need pill form and the effectiveness available, it's a slam dunk imho. Orforglipron [1] (small molecule by Lilly vs a peptide) will be potentially available shortly for those needing more effectiveness. We're making incremental improvements in this system rapidly.

HN Search: orforglipron - https://hn.algolia.com/?dateRange=all&page=0&prefix=false&qu...

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Could also be great for maintenance dosing. I'm reaching the end of my ~weight loss journey~, and it's not a sure thing that the insurance company will continue paying for the injections once I'm no longer overweight.

I'm definitely willing to keep taking it. If insurance won't pay for it, I could pay for the pill out of pocket if I had to, which would be cost prohibitive for the injections.

5 lbs a week is crazy? Are you expecting asymptotic approach to healthy weight? I'm 185 and would prefer to be more like 170, but 3 weeks seems too fast.

I started at 170lbs and my target is 135lbs (early 40s male). My blood panel looks good per my PCP, and as long as I'm not losing weight so fast I have excess skin or I experience liver, kidney, or pancreas failures of any degree, that meets my success criteria. I am trying to shed as much unhealthy visceral fat as possible while using the pharma intervention to dissuade me from unhealthy consumption habits.

At $300/month cash pay through https://lilly.com, I find the ROI to be exceptional.

135lbs seems very low for an adult male. How tall are you? Why is that your target?

While I think BMI is fairly suboptimal and would defer to a DEXA scan, that weight puts me right in the middle of a healthy BMI for a human of my gender, height, and age. As mentioned, I lift weights, three days per week. This also increases my metabolism and daily caloric budget (beyond basal and resting metabolic rates).

My goal is to drop fat, gain muscle, and be strong with good cardio performance, and a GLP-1 turns off the part of my brain that made me carry excess unhealthy fat and eat the foods that made that fat. GLP-1s also promote thermogenesis, so it is turning on the switch to tell your body to burn fat that you would have to fast or get into ketosis via a ketogenic diet otherwise to get into (by first depleting your glycogen reserves). I do not get any fatigue such that I would when fasting or on a keto diet needed to encourage thermogenesis and burning up fat reserves, which is awesome imho.

My brain says "you are fine" instead "you must eat, feel hungry, and get hangry, even though you already have all of this fat." A bug has been patched.

https://pubmed.ncbi.nlm.nih.gov/?term=glp-1+thermogenesis

(think like a hacker, the body is just another system to hack)

Interesting. I also do weightlifting 3x/week and my weight is in the 190s (male, 60yrs old, 6' tall). I am definitely carrying some excess fat but think my ideal would be somwhere around 175-180. Have never done any BMI tests.

> 135lbs seems very low for an adult male

Impossible to characterize without height.

Well, that's why I asked how tall he was...

He said "right in the middle of a healthy BMI" which would make him 5'2" or 5'3".

That's starvation level weight loss. A normal regime would be more like 1-2lbs per week via a moderate calorie deficit.

> 5 lbs a week is crazy?

https://www.nutrition.gov/topics/healthy-living-and-weight/s...

"A reasonable rate of weight loss is 1 to 2 pounds per week."

Going too fast has downsides.

https://health.clevelandclinic.org/risks-of-losing-weight-to...

Even if you water fasted, you would not lose 5 lbs a week sustained. It was probably your first week and mostly water weight

It depends on your starting weight. If you weigh north of 300lbs than this is very much possible for several month.

2.5kg per week? Wow.

Indeed, I have to make a conscious effort to remember to eat, and consume 800 calories (two servings) of Creamy Chocolate Soylent (premade, liquid bottles) daily, along with fiber gummies to keep everything moving in my digestive track. I do strength training to preserve muscle mass. Desire to eat anything sweet or alcohol has gone to zero (RIP my craft beer desires and my sweet tooth).

How long did those effects take to come into effect? I have been on 2.5 for a week and haven't noticed a change in my appetite, though I have lost 2 pounds.

First week. You might need a higher dose, check with your prescriber. My partner needed to go to 5mg to see improved results, but dropped back down due to side effects (which I did not have).

You are consuming only 800 calories a day? From a starting weight of 170ish?

Was this plan made with your doctor?

My doctor does not approve or reject my actions, they simply make recommendations and provide guidance. I work with people who understand my risk appetite, which is aggressive. If you are not aggressive as a practitioner, I will work with someone who is. Unsophisticated humans need protection, which I understand and appreciate, but I need coaches and subject matter experts who will push me to my limits.

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