Months 2-3 on GLP-1: Dose Increases and Finding Your Rhythm

You've made it through the first month. Your body has had time to adjust to the starting dose, you've figured out some strategies that work for you, and now comes the phase where things start to get real: dose titration.

Months 2 and 3 are often described as the "finding your footing" phase. You'll experience one or more dose increases, the medication's effects will strengthen, and you'll likely start seeing more noticeable changes on the scale and in how your clothes fit. But this phase also brings challenges—stronger side effects with each increase, learning to eat even less than before, and adjusting your expectations as you settle into a new normal.

This guide will help you navigate the dose escalation process, manage the intensified effects, and build habits that support your success as you move toward your maintenance dose.

Understanding the Titration Schedule

GLP-1 medications aren't prescribed at their full therapeutic dose from day one. Instead, doses increase gradually—a process called titration—to minimize side effects and help your body adjust. Here's what the typical schedules look like:

Month	Semaglutide (Wegovy)	Tirzepatide (Zepbound)
Month 1	0.25 mg	2.5 mg
Month 2	0.5 mg	5 mg
Month 3	1.0 mg	7.5 mg
Month 4	1.7 mg	10 mg
Month 5+	2.4 mg (maintenance)	12.5 or 15 mg (maintenance)

What to Expect with Each Dose Increase

Each time your dose goes up, you essentially re-enter a mini adjustment period. Your body needs to calibrate to the higher medication level. Here's the typical pattern:

The First Few Days After Increasing

Within 24-72 hours of your higher dose, you may notice:

• Intensified side effects: Nausea, if you experienced it before, may return or worsen temporarily
• Stronger appetite suppression: Food may seem even less interesting
• Fatigue: Your body is working to adjust
• GI changes: Bowel patterns may shift again

Days 4-7

The initial intensity typically eases:

• Side effects begin settling down
• You adapt to the new level of appetite suppression
• Energy usually returns to baseline

Weeks 2-4 at the New Dose

By the second week at a new dose, most people have largely adjusted:

• Side effects have diminished or become manageable
• The new appetite level feels more normal
• You're developing strategies specific to this dose level
• Weight loss often accelerates compared to the previous dose

Then, as you approach the next increase, you might notice the effects plateauing—a sign that your body has fully adjusted and you're ready for the next step.

Managing Intensified Side Effects

Side effects that were mild at lower doses can become more challenging as you titrate up. Here's how to handle the most common issues:

Nausea That Returns or Worsens

Many people experience renewed nausea with each dose increase. Strategies that become especially important:

• Eat even smaller portions: What worked at the lower dose may be too much now
• Slow way down: Take 20-30 minutes to eat a small meal
• Avoid trigger foods: Greasy, fried, and very sweet foods are often worse at higher doses
• Time your injection: Some people find taking their shot before bed helps them sleep through peak nausea
• Ginger, ginger, ginger: Tea, candies, supplements—whatever form works for you
• Ask about anti-nausea medication: Your provider can prescribe ondansetron or promethazine for severe cases

Appetite So Suppressed You Barely Eat

At higher doses, some people find they have almost no appetite. While this sounds like "success," eating too little creates problems:

• Muscle loss (your body breaks down muscle for protein)
• Nutritional deficiencies
• Fatigue and weakness
• Hair thinning (common with rapid weight loss and inadequate nutrition)

Constipation Getting Worse

Higher doses slow gut motility more, often worsening constipation:

• Increase water intake: Aim for 80+ ounces daily
• Add fiber strategically: Psyllium husk, chia seeds, vegetables
• Movement helps: Walking stimulates gut motility
• Magnesium: Magnesium citrate or glycinate can help (check with provider)
• Stool softeners: Docusate sodium (Colace) is gentle and safe for regular use
• Don't ignore it: Severe, prolonged constipation needs medical attention

When Side Effects Don't Improve

If side effects remain severe after 2-3 weeks at a new dose, contact your provider. Options include:

• Staying at the current dose longer before increasing
• Stepping back to the previous dose temporarily
• Adding medications to manage specific symptoms
• Evaluating whether a slower titration schedule makes sense

Don't suffer in silence—your provider should help you find a tolerable path forward.

Weight Loss in Months 2-3: What's Typical?

This is where weight loss often accelerates. At therapeutic doses, the medication is doing more of its job, and you're likely eating significantly less than before you started.

Typical Patterns

• Monthly loss: 4-8 pounds per month is common during this phase
• Cumulative loss by end of month 3: Often 8-15% of starting weight
• Week-to-week variation: Expect fluctuations; weight doesn't drop linearly

The Scale Isn't Everything

Pay attention to other indicators of progress:

• How clothes fit: Often changes before the scale does significantly
• Energy levels: Many people feel more energetic as they lose weight
• Lab values: Blood sugar, cholesterol, and blood pressure often improve
• Physical capabilities: Walking further, climbing stairs easier, moving better
• Mental clarity: Some people report improved focus and mood

What If Weight Loss Stalls?

Plateaus happen even on medication. If weight loss stalls for 2-3 weeks:

• Don't panic: Plateaus are normal and temporary
• Check your eating: Are you eating more than you realize? Track for a few days
• Evaluate protein: Adequate protein helps preserve muscle and metabolism
• Consider sodium and water: Water retention can mask fat loss
• Look at the trend: One week isn't a plateau; 3+ weeks might warrant attention
• Your body needs catch-up time: Sometimes your body adjusts internally before the scale moves

Building Habits During This Phase

Months 2-3 are crucial for establishing habits that will serve you long-term. The medication is a tool, but habits are what sustain results.

Eating Habits to Develop

• Protein first: Start every meal with protein before anything else
• Mindful eating: Eat slowly, chew thoroughly, put your fork down between bites
• Planned meals: Don't wait until you're starving (you probably won't be) to figure out what to eat
• Quality over quantity: With less food intake, make every bite count nutritionally
• Hydration routine: Drink water throughout the day, not just when thirsty

Movement Habits to Build

Now is an excellent time to establish regular physical activity if you haven't already:

• Walking: The most underrated exercise. Aim for 30+ minutes most days.
• Strength training: Even basic resistance exercises help preserve muscle during weight loss
• Consistency over intensity: Regular moderate activity beats occasional intense workouts
• Find what you enjoy: Sustainable exercise is exercise you'll actually do

Tracking Habits

• Weigh at consistent times: Same time, same conditions, no more than once daily
• Take measurements monthly: Waist, hips, chest—sometimes these move when the scale doesn't
• Food logging (optional but helpful): Even a few days per week can reveal patterns
• Note how you feel: Energy, mood, sleep—these matter too

The Psychological Shift

By months 2-3, you're likely experiencing a significant psychological shift in your relationship with food. This can be both liberating and disorienting.

Common Experiences

• "Food noise" quieting: The constant background thoughts about food diminish
• Social situations changing: Eating out, gatherings, and food-centered events feel different
• Identity questions: "Who am I if I'm not the person who loves food?"
• Discovering other coping mechanisms: If food was comfort, you need new ways to handle stress

Tips for Navigating the Shift

• Acknowledge the change: It's okay to grieve your old relationship with food
• Find new pleasures: What brings you joy besides eating?
• Be patient with yourself: Psychological adjustment takes longer than physical adjustment
• Consider therapy: A therapist specializing in eating/weight issues can help
• Connect with others: Online communities of GLP-1 users can be valuable support

Communicating with Your Provider

Regular check-ins with your provider are important during this phase. Be prepared to discuss:

• How you're tolerating each dose increase
• Your weight and any measurements you're tracking
• Side effects and what's working (or not) to manage them
• Your eating patterns and any concerns about nutrition
• Questions about the titration schedule
• Any new symptoms or health changes

Questions to Ask

• "Am I progressing as expected?"
• "Should I continue to the next dose or stay here longer?"
• "Are there any labs I should get at this point?"
• "What should I do if [specific side effect] happens?"
• "How do I know when I've reached my maintenance dose?"

Looking Ahead to Months 4-6

As you complete months 2-3, you're approaching the phase where many people reach (or get close to) their maintenance dose. Here's what's coming:

• Continued dose increases until you reach maintenance level
• Peak weight loss period: Months 4-6 often show the most dramatic total changes
• Side effects stabilizing: Once at maintenance dose, side effects typically plateau
• New challenges: Maintaining motivation, handling compliments and questions, buying new clothes
• Thinking long-term: How will you sustain this? What's your plan for the future?

Months 2-3 are a bridge—you're past the very beginning but not yet at the sustained phase. Be patient with yourself, stay consistent, and trust the process. You're doing the work, and the results are coming.