Mary Coffield is 77 years old, she is on a GLP-1, and the number on her scale has not moved since April. “For three months, I’ve tried all different things, adjusted medication, but this plateau, I can’t get past it,” she said this week on DOWNSIZED GLP-1 NEWS<\/a>. “It’s killing me.”<\/p>\n The host, Lorraine Durham, who states up front that she is not a doctor and that her guest is not a doctor, offered the reassurance the weight-loss internet hands out for free: the weightlifting Mary began in April is probably building muscle while she keeps losing fat, so the scale is lying to her. That may be true. It has not been tested. The part that has been tested is stranger and more useful than either of them said, because the drug’s own pivotal trials ran for 72 weeks, and in the one study that measured what the last year of treatment actually delivers, it delivered about a quarter of what the first nine months delivered. A flat patch in the second year is not the drug failing. It is the shape of the curve, and the industry’s before-and-after photos are the lie.<\/p>\n Her story arrived in two parts, and the first part is uglier than the second.<\/p>\n She lives in Richmond, Virginia. She spent over 30 years in government service, retired more than 20 years ago, and runs a home-based travel business. Her highest weight was around 250 pounds, and she told Durham she had been losing and regaining for 56 years: “I’ve been trying to maintain my weight for 56 years.” Her former daughter-in-law came to visit having lost 40 pounds on a GLP-1, so Mary asked for the same telehealth company.<\/p>\n The intake form asked her birthday first. “When I told them how old I was, they refused to put me on the program.”<\/p>\n She found a route to treatment anyway. Then the second part: “I started in October and I’ve been at a plateau for over three months.” She dates the stall to April, the month she started lifting weights, and she told Durham she thinks her body is changing underneath a frozen number. She also spent a seven-day cruise eating differently because the drug had cut her sweet cravings, and came home two pounds lighter.<\/p>\n One gap in the episode matters for the numbers below. It does not name the drug she takes. Durham’s own 50-plus pound loss was on compounded tirzepatide, but her guest’s prescription is not stated, and semaglutide and tirzepatide are not interchangeable when you read trial results.<\/p>\n Three months of a flat scale is not a medical mystery. It is a Tuesday.<\/p>\n The best evidence for what a plateau is comes from a trial nobody markets: a randomized withdrawal study of tirzepatide, published in JAMA in December 2023<\/a>, registered as NCT04660643<\/a>.<\/p>\n The design is simple. 783 adults with obesity or overweight, no diabetes, took open-label tirzepatide at their maximum tolerated dose of 10 or 15 mg for 36 weeks. Mean weight reduction over those 36 weeks was 20.9 percent. At week 36, 670 of them were randomized, half continuing the drug and half switched to placebo, for another 52 weeks, with both groups still getting diet and activity instruction.<\/p>\n From week 36 to week 88, the continuation group lost another 5.5 percent of body weight. The placebo group regained 14.0 percent. Overall, from week zero to week 88, the treated group averaged a 25.3 percent reduction against 9.9 percent for placebo. And 89.5 percent of the people who stayed on the drug kept at least 80 percent of what they had lost, against 16.6 percent of the people who stopped.<\/p>\n Read the two numbers together and the plateau becomes arithmetic. Roughly 21 points of loss across 36 weeks, then about 5.5 points across the following 52. Same drug, same patients, same counseling. The last year delivered roughly a quarter of the first nine months, which is what the tail of a weight-loss curve looks like when you finally measure it instead of photographing it.<\/p>\n The Zepbound prescribing information, as the FDA publishes it, describes two fixed-dose trials totaling 2,519 adults in whom “weight reduction was assessed after 72 weeks of treatment (at least 52 weeks at maintenance dose),” with a mean 20.9 percent reduction at the 15 mg dose. The Wegovy label runs the equivalent trial to 68 weeks, with a mean 14.9 percent reduction at 2.4 mg and 83.5 percent of patients losing at least 5 percent.<\/p>\n I read the dosing, geriatric and clinical-studies sections of both labels looking for a weight-loss cutoff, a sentence telling a prescriber to stop because the scale has stalled. The stopping rules in those documents are about tolerability and pregnancy. A patient who is still holding 80 percent of a large loss after a year is not described anywhere in either label as a treatment failure.<\/p>\n Here is the trap in those headline percentages. They are means, so half of any trial population lands below the average, and plenty of those people stayed on the drug and did fine. A number that describes a group is a poor mirror for one 77-year-old in Richmond.<\/p>\n Durham’s explanation is the kind of thing patients badly want to hear, and she was honest about her standing when she offered it: “I’m not a doctor, but from what you’re telling me with the weightlifting you’re doing, some body recomposition, you’re probably still losing body fat but you’re probably gaining a little bit of muscle.”<\/p>\n Plausible, and outside the evidence. The pivotal programs for both drugs measured body weight, not body composition, and they did not randomize anyone to resistance training partway through a plateau and track fat mass against the scale. No primary source in these trials tells you that a flat scale is hiding fat loss. Within the trial data, a flat scale is a flat scale.<\/p>\n Two other claims from the episode stay unverified. Mary raised vitamin D3 and K2 as a possible cause of a slowed metabolism, and said she would research it and raise it with her doctor; nothing in the trial record supports a vitamin explanation for a late plateau. Durham then suggested a dose increase could be part of the answer. The trials used fixed escalation schedules and maintenance doses, so they cannot tell you whether raising a dose in month six restarts weight loss, and anything sharper than that would be prescribing advice, which this page does not give.<\/p>\n The body may well be changing. The evidence that it is currently changing is one scale and one hope.<\/p>\n The refusal at intake deserves its own paragraph, because the documents under which she was refused do not contain the rule that refused her.<\/p>\n Zepbound’s label states that in the two weight-reduction studies, 226 patients treated with the drug (9 percent) were 65 or older and 13 (0.5 percent) were 75 or older, and that “no overall differences in safety or effectiveness have been observed between patients 65 years of age and older and younger adult patients.” Wegovy’s label reports 233 patients treated with the injection (9 percent) aged 65 to under 75, and 23 (1 percent) aged 75 and over. Neither label sets an upper age limit.<\/p>\n Honest caveat, because it cuts the other way too: 13 patients over 75 is 13 patients. That is not a body of evidence strong enough to promise any individual 77-year-old the same result as a 47-year-old, and the label does not promise it either. But there is a distance between “we cannot be certain of the benefit at 75” and “we will not prescribe to you at 77,” and only one of those is written down anywhere official. A telehealth company’s age policy is that company’s policy. It is not pharmacology, and it belongs in writing.<\/p>\n She was refused by a form. The federal label she was refused under contains no such line.<\/p>\n Why has my weight loss slowed to almost nothing?<\/strong> The trials show the curve flattens hard after the first several months. In the tirzepatide withdrawal trial, participants lost a mean 20.9 percent in the first 36 weeks and then 5.5 percent across the next 52 weeks on the same drug. The slow phase is the designed phase.<\/p>\n Does a plateau mean the drug stopped working?<\/strong> Not by the trial data. Of those who continued treatment, 89.5 percent held at least 80 percent of their weight loss through week 88, against 16.6 percent of those who switched to placebo.<\/p>\n Should I stop if the scale is flat?<\/strong> The primary data says withdrawal has a price: a mean 14 percent regain over 52 weeks in the continuation trial, and in a later analysis published in JAMA Internal Medicine<\/a> of 308 participants who stopped, 254 of them (82.5 percent) regained at least a quarter of the weight they had lost within one year. Any decision about stopping belongs with your prescriber.<\/p>\n Is there an age limit on these drugs?<\/strong> The FDA labels for tirzepatide and semaglutide set no upper age limit and report no overall safety or effectiveness differences in patients 65 and older, while also enrolling very few patients over 75. A clinic’s cutoff is a clinic’s policy.<\/p>\n Two disclosures that belong on the record. These numbers come from trials of the brand-name drugs; compounded versions are not FDA-approved and were not the products studied, whatever the vial says. And the episode this article works from is two patients talking, one of whom says plainly, twice, that she is not a doctor. The trial record is the part worth keeping.<\/p>\n Sources: U.S. Food and Drug Administration \/ DailyMed Zepbound label<\/a>, DailyMed Wegovy label<\/a>, JAMA, Aronne et al., SURMOUNT-4<\/a>, JAMA Internal Medicine, Horn et al.<\/a>, ClinicalTrials.gov NCT04660643<\/a>, DOWNSIZED GLP-1 NEWS<\/a>.<\/p>\nMary Coffield – refused at 77, then flattened at month six<\/h2>\n
SURMOUNT-4 – the trial already mapped the flat patch<\/h2>\n
The labels – nothing in them says a stalled scale means stop<\/h2>\n
The weightlifting question – the trials did not measure it<\/h2>\n
The 77 problem – the refusal was policy, not pharmacology<\/h2>\n
Frequently asked questions<\/h2>\n