Answering the narrow version, because the broad one does not have a single answer. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

NeuroNate said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

Agreeing with NeuroNate, and the qualification matters more than the agreement. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

mike_mealprep said:

Nausea arrived on day two of each dose step, lasted about four days, and disappeared entirely by the second week — until the step where it did not.

Same position here, arrived at the long way round. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

Clinical perspective, offered as context rather than as advice. The version of this that has an answer is narrower than the version being asked. Narrow it and it becomes tractable; leave it broad and the thread will produce nine confident and incompatible replies.