The doctor wanted real progress toward goals, so started at a small amount for four weeks before moving to the next level. Lost sixty pounds over the following year. Currently on the highest pen amount now. Been on a mood medication the entire time, keeps things calm but joy wasn't really part of the picture. Once this medication kicked in, that sense of joy came back. Still another sixty pounds to go given how much weight there was to begin with, so genuinely excited for what's ahead this year.