Users who had sleeve, bypass or switch procedures years earlier report that both drugs reduce food noise and support further loss even when restriction from surgery remains. Some prefer reta because it avoids the strong food aversion they felt on tirz while still curbing cravings; others stack low doses of both. Weight drops of 10-125 lb are described, with attention paid to protein intake and muscle preservation via DEXA and training. Experiences differ on how much the vagus-nerve changes from surgery alter GLP-1 response.
What this discussion establishesWhether the stomach stretches back to normal size over time or only when overfilled; whether nerve severance makes GLP effects additive or blunted.
Still openOptimal long-term maintenance dose after bariatric surgery and how much further loss is typical once food noise returns.
Nothing here is advice.
I had sleeve surgery ten years ago. It got me to a comfortable weight but I still want to get my BMI below 30. I think adding reta could be a logical next step. Has anyone here tried that combination?
By now the stomach has probably stretched back out, right? I don't think there would be any problem. Side effects from these meds usually aren't stomach-related anyway, and plenty of people start them soon after surgery, so reta should be similar.
The sleeve has stretched some, yet I still get that restricted feeling when I stick to the high-protein, low-carb plan my doctor gave me, and I can drop weight that way. The real struggle is after a few months when I slip and start binging on carbs again. I tried a low dose of tirz from a relative and the drop in food noise made it easy to stay on track. At the usual starting dose I felt like I couldn't eat at all, so I quit. Hearing that reta cuts food noise without killing appetite as hard made me think it might fit better.
A lot of people think the weight loss from these surgeries comes only from making the stomach smaller, but that's only part of it. The procedure also cuts part of the vagus nerve that carries satiety signals from the gut to the brain. That change in signaling is a big reason the weight comes off. Rodent studies that just sever the nerve without touching the stomach still produce major loss. Another person here said the two effects added up for them and they lost more on a GLP after their surgical loss had plateaued. I wouldn't count on the same outcome, but maybe it will work that way for you too.
Either reta or tirz should work fine. You don't need to push tirz high enough to create food aversion. If you aren't going high enough on reta to get the metabolic boost, tirz is probably just as useful. How much weight are you hoping to lose? I would expect some extra effect from the changes in ghrelin and GLP production after surgery.
My highest was 370. I weighed 340 when I had the surgery and got down to 260 afterward. For the last five years I've bounced between 280 and 305. On tirz for three weeks I dropped 14 lb. I'm 6'3" and want to get under 240 so I'm no longer in the morbid-obesity range; 235 would be ideal. I have a lot of muscle and plan to work hard to keep as much of it as I can.
The stomach doesn't just stretch from time passing. It stretches when someone keeps overfilling it. I had my sleeve more than ten years ago and I still can't handle large amounts of food.
Sounds like you still have a decent amount to lose. I'm a couple inches shorter, started tirz 16.5 weeks ago at 282 lb and hit 238 this morning. I switched to reta partly because of the idea it might spare lean mass better. I'd suggest getting a DEXA scan at the start and again later to check how well you're holding onto muscle. I'm using reta, TRT and HMB-FA to limit losses. Between my last two scans I dropped 18.7 lb and only about half a pound was lean mass.
I reached my goal with reta. Go ahead and try it.
I had VSG 17 years ago after peaking near 600 lb. Like you, surgery took me to about 250 and I stayed there for years. Then carb cravings took over, I climbed back toward 400 and needed knee replacements. After one replacement I got down to 300 on my own, then crept back to 325. Compounded tirz helped me lose 125 lb in 16 months while I actually gained 4 lb of lean mass according to three DEXA scans. The final 23 lb came off in one month on 4 mg reta. Overall I've lost around 400 lb. For maintenance I alternate 1 mg tirz and 1 mg reta every 84 hours and brought my BMI from 84 down to 27. I didn't lift during that time but did a lot of physical therapy. Diet stayed solid and I added some other supports. Reta works well; start low and slow, watch your resting heart rate and add taurine if needed. It doesn't suppress appetite the way tirz does, so keep protein high.
One week in and here's a quick update. I started with two separate 1 mg doses the first week and tomorrow move to a single 2 mg dose for week two. I plan to stay at 2 mg for four weeks, then likely go to 4 mg and only increase further if I need to. I've heard good advice to raise the dose only when necessary. So far I really like it. No food aversion at all, which was the worst part of tirz. I can think about food and eat normally, yet I feel satisfied afterward. I might be imagining it, but I feel warmer inside, almost like being in ketosis even though I'm not low-carb, just high-protein. I've eaten what feels like plenty but the scale is already moving, down 3 lb the first week. It's nice to be able to eat; tirz made food repulsive. Food noise is basically gone and I'm eating what seems like a healthy amount with lasting satisfaction.
I stayed hungry on reta until I reached 6 mg, so I added tirz for hunger control and never followed a strict schedule. I still combine both and am now at 8 mg reta.
My doctor wants me around 2000 calories and 130 g protein while losing. On week two at 2 mg I'm struggling to get past 1500 calories because I feel full so quickly and only sometimes hit the protein target. On tirz there were days I couldn't reach 600 calories, which didn't feel healthy. I'm hoping my body adjusts so I can eat more before moving up to 4 mg.
Stay at 2 mg for the full four weeks. After a month reta should be fully active, so there's no reason to move to 4 mg if you still can't comfortably eat at least 2000 calories a day.
I didn't have a sleeve; I had a duodenal switch with biliopancreatic diversion, basically a sleeve plus bypass. Tirz worked better for me but brought side effects like crushing fatigue, odd food taste and bad constipation, so I add reta on top.
The only way I hit my protein target without much trouble was mixing unflavored protein powder into coffee. I blend it with cool liquid first, then add the hot coffee slowly to avoid clumps. Two or three scoops plus a cup of high-protein milk, a packet of high-protein instant breakfast and two cups of coffee gave me 107-120 g protein in one shake. I do this because I'm not a breakfast person.
I had RNY 22 years ago and still can't eat large portions; the restriction is permanent. Weight loss stopped after the first year and a few pounds even returned. The GLP meds changed that and finally took off the last 40 lb so I got below goal. They worked really well. I went from sema to tirz to reta.
What's your tirz dose and how do you space the injections, if you don't mind sharing?
I'm five years out in June and have maintained well while recomping my body. Food noise was still loud though, and combined with perimenopause it led to about 10 lb of regain or inflammation. A very low tirz dose starting last January removed that regain and kept me steady, but food aversions have increased lately. I had shoulder surgery in February that kept me out of the gym for two months and limited me to light cardio until recently. Because I couldn't move much and was still eating to protect the pouch while on the meds, those 10 lb came back. I'm now on a split dose around 8 mg tirz per week and will soon add a low dose of reta to try to get control again. I've had a vial ready for a month but held off mixing it because it felt wasteful while I wasn't active.
My dosing routine works in a repeating cycle I find pretty unusual. It begins with one milligram of tirz, then forty-eight hours pass before three milligrams of reta, the same gap leads to one milligram of tirz again, and the pattern continues with three milligrams of reta.
I had VSG 16 years ago and still have decent restriction. Tirz two years ago took the weight off again. I switched to reta for no particular reason and have kept every pound off since. I take 10 mg every six days.
I had gastric bypass and once fully healed my hunger signals returned to normal. I still ate less because I got full faster, but that didn't fix the mental food noise. I managed to eat around the bypass and regain everything, and the same thing happened to my cousin. The GLP-1 meds made a huge difference with the food noise.
My last tirz pin was Friday at 3.5 mg and today I took my first 1 mg reta. I'm planning to follow a similar pattern to yours, though right now keeping tirz higher and using reta as the add-on.
Take reta slowly. No need to rush and it can bring side effects.
Reta feels almost too easy when it's working. I lost most of my second round of weight on compounded tirz, then switched to reta over about a month. I dropped 23 lb in one month at 4 mg while everything else was dialed in and I was using NAD+ for energy. Stepped on the scale this morning and had to double-check. I need to put in more work and will raise reta to 5 mg today. Went for a 45-minute walk with my husky and hope I won't need a dog walker next week while watching my shoulder.
It's tough when the sling comes off and your brain thinks the arm is ready to use again, but it isn't. I'm only one dose into reta and will do my tirz tonight. Hopefully getting back toward normal activity will help shed the post-surgery rebound weight.
Mine was on 9/11/2001, what a day. Thanks for posting; I tried sema for three weeks and was sure it wasn't working because of the RNY and small portions. Now on week four or five of reta your story gives me hope. Nothing dramatic yet, but I started low. How long have you been on reta and at what dose? Never mind, I see your dose. Same here, the pouch is still intact and I still dump, which is actually helpful. I was starting to wonder if this wouldn't work because of the RNY until I found this thread. I'm also running my own labs and won't change doses until I check basics to avoid messing up what I've worked hard to manage.
I combine reta and tirz. My surgeon is fully supportive of using GLPs to reach goal. Currently 2 mg tirz with 7 mg reta. I really can't overeat but wasn't losing more; weight had stabilized after surgery then started creeping back.
I've been on reta for about a year and a half.
Love the dog, did you have shoulder surgery? I had mine two years ago.
Thanks, he makes us a little vain. About six weeks ago I had three rotator-cuff tears repaired on the right with a collagen patch, plus bicep tenodesis and labral repair. It was my good shoulder; the left needs work next.
I also had bicep tendon repair. It wasn't too bad but I still have a lot of pain in that shoulder from arthritis that set in afterward.
Mine was on 9/11/2001, what a day. Thanks for posting; I tried sema for three weeks and was sure it wasn't working because of the RNY and small portions. Now on week four or five of reta your story gives me hope. Nothing dramatic yet, but I started low. How long have you been on reta and at what dose? Same here, the pouch is still intact and I still dump, which is actually helpful. I was starting to wonder if this wouldn't work because of the RNY until I found this thread. I'm also running my own labs and won't change doses until I check basics to avoid messing up what I've worked hard to manage.
I've been on reta for a year and a half already. I'm three pounds under goal and never thought I'd get this low.
VSG five years ago. No reta experience but sema and tirz both worked well for me.
Got the gastric sleeve operation over a decade ago. Similar to plenty of folks I found ways to work around the limits. Quantity wasn't the issue for me since large portions made me sick for a long time. Instead the trouble came from poor choices like constant snacking on sweets and salty treats throughout the day. Those urges controlled everything and my mind stayed fixated on treats stashed in the kitchen. I kept supplies hidden in multiple spots which felt pathetic. Once I began the new shots something clicked off inside my thoughts. Interest in those old snacks vanished completely. These days my focus stays on getting enough protein and water without any mental takeover. It hit me then that this must be how regular people experience daily life. These types of treatments rescued my situation and I regret not accessing them sooner.
I don't dump, thankfully, but still can't eat much at all.
I had RNY back in 2008 and have been on reta since January. I'm happy with the progress on the weight I regained from poor eating habits after 2020. It's not the same surgery but I've seen lots of people with prior bariatric procedures do well on GLP meds in general.
If you have tried it, this topic is still open. Sign in to reply — it takes a minute.