Dr.ObesityLA said:

Four weeks is the pharmacokinetics, not caution.

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss. It's a titration dose to let your body adjust. Don't be discouraged if you don't lose much in the first month.

The therapeutic dose for weight management starts at 1.7mg (semaglutide) or 5mg (tirzepatide). Be patient with the ramp-up.

One thing that is still open after Dr.PainCLE’s answer:

What the trials actually did with participants who could not tolerate a step, because that is the situation I am in and the protocol summaries skip it?

josh_phd_bmore said:

PSA for titration users considering the 0.25mg starting dose: this dose is NOT intended for weight loss.

Coming at josh_phd_bmore’s question from a different direction. One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are. That subgroup is the most interesting unanswered question in the field and it is routinely flattened into the two-thirds headline.

Reporting back.

I held the step an extra three weeks instead of stepping back down, and it settled. Same dose, same everything, just more time — which is exactly what was suggested upthread.

claudia_zurich said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

That is right for the weekly injectables. For the daily agents the interval logic is different and the four-week convention does not transfer.