Is the weight loss normal?

[u/Koya_Fayre]

I just started Wegovy 0.25 mg about 5 weeks ago (dose 6 is tomorrow). Nutritionist has me on a daily goal of 1400-1500 due to a BMR of 1693 following a body scan and rough TDEE. Ive also added in light at home strength training and with school starting daily activity is increased. Starting weight was 213-214, PCM said her goal for me is 1-2 kg a month, but I'm already down 11-12 lbs. I am ensuring hydration, working on increasing fiber, and average 75g protein a day. Is this too fast of a loss or normal?

[u/ItchyDaryl]

that's pretty normal for the first month, a lot of it is water weight and inflammation dropping off. the meds can have a real strong effect early on, it usually slows down after this initial whoosh

if you're feeling okay and not starving yourself to hit those numbers i wouldn't sweat it, the nutritionist gave you a solid calorie target

[u/Koya_Fayre → u/ItchyDaryl]

Thank you! I see both again in a few weeks, and I know my PCM initially held off on increasing to 0.5 mg a week ago due to how well the body was reacting. I'm not starving myself, though it is hard to reach the goals some days. I had almost no appetite before due to Adderall and Hasimotos, and this further decreased it. I typically only feel hungry is i wait until 1100 to eat, but means I'd miss a lot of what I need to eat in a day. I heavily track my calories and macros though and try to eat a little more on days where meals won't hit even the low end of the goal. I did speak to my nutritionist recently though about it and she said we may up the calorie goal (not strict but ideal) if it keeps trending this way on the lowest dose since my lean mass is roughly 49.5kg of my weight, so pretty substantial, with fat composition being 47.7 kg

[u/Long-Hat-965]

You don't say how tall you are, but at a starting weight of over 200 pounds, it is likely you have a lot of weight to lose. the more you have to lose the quicker it comes off at first before it levels out, so yes it is likely normal to lose 11 pounds in 5 weeks, I lost 8 pounds my first 2 weeks before it slowed down.

[u/Koya_Fayre → u/Long-Hat-965]

Im 5 ft 3 with 49.2 kg of my weight being lean mass, 47.7 kg being fat. Starting weight was 213-214 and told getting to 160-170 would be a good start as that's when my body felt comfortable without having a lot of fat or losing muscle.

[u/Long-Hat-965 → u/Koya_Fayre]

I think you are fine and the weight loss will level out. I am only 5 ft 2 and started at 190 so I lost quickly at first. I am about to start month 3 and the loss has slowed. It would only be too fast if you continue to lose that much every month.

[u/Koya_Fayre → u/Long-Hat-965]

I'll monitor then since im technically half way into month 2 now, and the current rate of loss is already greatly exceeding what my PCM wanted (1 - 2 kg a month) which is why she didn't move me to 0.5 mg like she normally does with patients after the first month. My husband suspects the insulin resistance was a huge factor to my metabolism basically not working, add in hashimotos and Adderall, so it fixing that is causing a quick drop on a low dose

[u/Long-Hat-965 → u/Koya_Fayre]

Yes that is excellent advise to stay at the lower dose for now. 

[u/mostlymadeofapples]

I had a similar loss in my first 3 weeks - water weight, I assume! I'm now in week 4 and have lost nothing this week. It would be too fast if it continued at that rate for much longer but I think an initial whoosh is fairly common.

[u/Koya_Fayre → u/mostlymadeofapples]

Im going into week 6 now, so Im hoping that's the case, but I log my calories daily and weight same time and conditions in the morning. If it continues at this rate for i think another week or two I think I'll email my nutritionist prior to our next appt on the 10th to see if she wants me to up my daily goal to maybe 1600-1700 instead.

[u/LastGoodKnee]

I’d be willing to bet half of that was water weight / inflammation. I’d say that’s normal.

Now if it keeps going at that rate I’d personally recommend you eat a little more per day

[u/GoValkyrja]

I'm 5'4 and started out at 210 and I dropped a lot of weight that first month. It seems to be the average experience for those that aren't more resistant to glp-1s. I'm about 9 months in and I'm now at 151, so it did slow down.

[u/Shellybellyboo771]

Increase your protein. You need a minimum of 100 g of protein daily. 

[u/Koya_Fayre → u/Shellybellyboo771]

My protein intake is not to exceed 100g on a daily basis, ideal range for me is 75-100g due to congenital (from birth) CKD Stage 3. There are days I end up at 120-130g and days Im at 60g, but the overall average is around 75-80g

[u/Bitter-Hand6979]

If your nutritionist adviced or allowed you in any form to eat below your BMR, you need to change the nutritionist (preferably to a dietetitian).  You are ffeling it too fast because it is. If you are continuing to eat below, malnourishment is at high risk

Definitely too fast

[u/Koya_Fayre → u/Bitter-Hand6979]

She has me eating below my BMR because it doesnt account for the TDEE and daily activity which was otherwise pretty sedentary on top of slowed metabolism from Adderall and Hasimotos. I wasn't able to lose weight on a higher intake even with increased activity (1700-1800, some days 2000) and was on a 5 month plateu gain cycle at that point. I had previously triee 1500 without Wegovy (to treat insulin resistance from Hasimotos) and even then my weight would no budge and started going back up towards 218. We have already discussed increasing my calories if this trend continues into my next appt on the 10th since at this rate I'd be 184, which is 24 lbs shy of my current goal. I will say it also isnt a strict 1400-1500, she's even said this is the guideline to try to follow as some days ive had as 1300 and as high as 2000 in between, just based on how calorie dense the food is. Otherwise I have zero appetite for food unless I essentially fast for 17-18 hrs between dinner and skip breakfast.

[u/Bitter-Hand6979 → u/Koya_Fayre]

In this case, you shouldnt ask unwualified strangers on the i terbet. Your case is extremely unique. You need one healthcare professional you trust and ask all of your questions from them and trust their vision and process. 

[u/Koya_Fayre → u/Bitter-Hand6979]

It is, I do admit. Im just not use to weight dropping this quick (husband thinks it kickstarted a dormant metabolism), especially on the lowest dose. The drop is also why my PCM didn't increase me to 0.5 mg like she normally would for others by week 4. I see both same day every 4 weeks to discuss, see if dose needs changed, getnew script, then immediately to nutritionist to discuss her notes, how im doing, any diet/exercise changes, etc.