Mounjaro stalled. Now what?

Hi everyone,

New to this forum. I've been on Mounjaro for around 3 years, and on the highest dose (15mg) for about a year. I initially lost about 40lbs, but I've been stuck at 260lbs for a while now.

My blood sugar is well-managed, and I eat a fairly low-carb diet without overeating. I think I'm consuming around 2000 calories daily, give or take. I'm trying to exercise more, but it's a work in progress.

I'm not sure what to do. My endocrinologist is pleased with my A1c, but doesn't have any suggestions for my weight. Any advice?

Aside from the other health benefits, these meds aren't a magic weight loss button. You'll only drop pounds if they help you eat less.

If you're really eating ~2000 calories and tracking everything correctly (including drinks, sauces, etc), that might just be too much for your current activity level if you want to continue losing weight.

You could try reducing your calorie intake and/or increase your physical activity. Ideally, you'd do both.

Basically, you're eating too much food for how active you are. Eat less and move more!

Gotta be the calories. Track them super carefully, and weigh everything you eat for a week. It'll be an eye-opener! Just guessing at calories won't cut it if you want to lose weight.

Okay, long story incoming...

I had gastric bypass way back in '94, and didn't lose much weight even eating tiny portions. Had a revision in '98, still didn't lose weight. Lap band in 2014, no weight loss. It got infected and ate through my stomach in 2015, and I had emergency surgery to create a new stomach. I was on TPN for 11 weeks (no food or water by mouth) and somehow gained five pounds.

Now, I've been on Mounjaro for about 8 months and I've lost 70 pounds, but it's been a huge struggle. I track every single bite, and rarely eat more than 750 calories a day. Before the Mounjaro, it took a year to lose 60 pounds, so the med has helped my metabolism somewhat. However I traveled last week, ate closer to 800 calories, and gained 4 pounds. I don't know why, and my doctors don't either. I've consulted dozens of nutrition specialists over the years, and nobody knows why I don't lose weight easily. For some of us, a calorie deficit that most would consider unhealthy is the only way to lose weight.

I'm not suggesting you eat 750 calories, but I will say that it's the only thing that's ever worked for ME to get to a 'normal' weight. Calorie deficits are real, but the needed size varies greatly. You must find your individual balance between calories and weight goals.

I wish I had better news. You just haven't found your specific calorie needs yet. If you're not losing, you're consuming too much for your body. It sucks that others can eat more and lose weight, but that's how it is. If I ate 2000 calories a day, I'd be enormous. If you're healthy and feel good where you are, maybe you should stay at your current weight?

On Mounjaro for 16 weeks at this point. My A1C went from 7.5 down to 6.2, putting me just outside the diabetic threshold. Pretty thrilled about the trajectory.

Use a TDEE calculator to find your calorie deficit. You can find one online. Then, measure and weigh EVERYTHING that goes into your mouth. A cheap food scale from Amazon will do the trick (around $10). Track it all in MyFitnessPal. You'll get the hang of it quickly. Focus on protein-rich meals and snacks. A calorie deficit is the only path to success. Healthier eating is a good start, but you need to dial in the calorie count and burn more. Exercise comes in many forms. Even a little walking can help, and work your way up. There are chair exercises and stretchy bands for seated workouts. Light weights while seated help too! Good luck!

Track EVERYTHING you consume. Coffee? Log it. Cream in your coffee? Log it. I see so many people say they're 'around' 2000 calories, but they don't account for sauces, dressings, etc. I use Lose It, and it automatically calculates my calorie goals. It takes effort to weigh and measure everything, but that's what helped me lose weight. Also, I don't add back exercise calories. I stick to my base calorie budget. All exercise is just extra calories burned each week.

Same here. But I know why. I think I'm eating small portions, but I'm still eating too much. And despite trying to eat 'lower carb', I still have too many carbs. It's the same for you. That's why we're not losing weight.

As you slim down, your body needs less energy to move around. So, you're no longer in a calorie deficit at 2000. When I was 238, my TDEE was about 2300. Now that I'm at 140, it's about 1750. To lose weight, I aimed for 1400-1600. Use a TDEE calculator for guidance. Also, use a food scale to track your intake precisely.

I agree with @SnackRN. It's easy to underestimate how much your calorie needs change as you lose weight. A TDEE calculator can be really helpful to re-evaluate your needs.

Have you thought about body composition?

True-Fam said:

Have you thought about body composition?

Click to expand...

That's a great point! It could be that you're building muscle while losing fat, which can stall the scale even if you're still losing inches. Getting your body fat percentage checked could give you a better picture of what's going on.

I've been thinking about that too, @GastricEmpty, thanks for the suggestion! Maybe I'll look into getting a body composition analysis done. It's just frustrating seeing the scale not budge!

Also, are you drinking enough water? I find my weight loss really slows down if I don't drink enough H2O!

Yeah, and what kind of food are you eating? A thousand calories of junk food is gonna have a way different effect than a thousand calories of healthy stuff.

Cirrhosis diagnosis blocking access sucks. Have you looked at alternatives or talked to your doctor about medical options?

Cirrhosis restricts some access pathways but not all - a direct hepatologist conversation about GLP-1 options is worth having.