No Appetite Suppression

That makes sense and we now believe she is one of the non-responders. The real problem now is staying at goal weight because her appetite is so strong. On an off day she can binge thousands of calories. I need to look harder at other appetite suppressants.

You could also see a therapist. Many claim to do CBT but results vary and some people find the experience unhelpful or worse. A self-help book might be a safer first step. DBT is another approach used for binge eating because it teaches emotion-regulation skills that some people never learned growing up.

Has she tried bupropion? It is being studied with naltrexone for binge eating. Phentermine is a stronger traditional stimulant option that requires an EKG first and worked better for me than bupropion, though still weaker than a GLP. The only approved drug for binge eating is lisdexamfetamine. Modafinil is sometimes used for energy rather than appetite. Seeing a psychiatrist who specializes in eating disorders would be ideal.

I agree that therapist quality varies and that guided self-help can be useful. CBT-based guided self-help is already in treatment guidelines for binge eating. People should still check credentials carefully because a bad therapeutic relationship can cause harm. AI might help in some cases, though of course AI could also end up killing us all.

What does the dosing schedule look like when you combine reta and tirz? We still have that option left, though our expectations are low since each drug alone and even with cagri did nothing.

Related thread on setmelanotide. It is used for severe obesity caused by specific genetic defects in the melanocortin-4 receptor pathway, mainly for people with POMC, PCSK1 or LEPR deficiency.

The urges come and go. She eats 2150 calories a day while being athletic, roughly a 150-calorie deficit, yet stays hungry between meals and goes to bed hungry despite three spaced meals plus a snack. Around day five or six after the injection the binge urge seems stronger, but that may just be placebo. She is athletic and recently got a sponsorship from a fitness brand. Even I, at 110 kg, am surprised by how much food she can put away if it is not controlled.

Has she tried split dosing? Several people split a single GLP or pin different compounds on different days to keep appetite suppression steadier across the week.

How tightly does she track meal counts and portions? A 150-calorie deficit can disappear with small unplanned snacks. High-level athletes usually follow structured meal plans to manage appetite and preserve muscle. She could simply be one of the non-responders. I felt strong effects at low reta doses that faded once I passed 3 mg. I also had stronger binge urges on days five and six.

I want to learn more about binge eating for a younger family member and this matches everything I have read. I will add more details in a quote for anyone interested.

To be honest, the weight loss came mostly from several months of heavy depression that later lifted. She turned that energy into training multiple times a day and is now one of the most athletic people I know. Binge eating started during the depression, not before. I still expected 12 mg reta plus 2.4 mg cagri to leave no room for those thoughts, but once she hit her target the hunger returned. It is not only binge urges but a constant starved feeling even at a small deficit. I will look into CBT.

Thanks for all the suggestions. She is already on vyvanse, valdoxan and wellbutrin, so it is interesting you mentioned those, yet they have not helped the binge eating. The main problem is not only binge eating but an unrelenting appetite. She eats about 200 calories below maintenance, spreads meals out, and still goes to bed very hungry.

The weight came off over nine months, not rapidly, and without any GLP-1 or peptide, just from the depression and then channeling it into the gym. The leptin angle is new to me and I will spend the rest of the night reading about it.

We started splitting doses once we reached 7 mg reta and front-loaded on a six-day cycle. We went up to 12 mg anyway to test whether a very high dose would finally work, but it did not. We also tried splitting cagri twice a week and pinning it two days after the reta dose, still with no effect.