Dr.GutHealth said:

A step that is uncomfortable at week two is frequently comfortable at week six with no change in dose, because the gastric-emptying component…

I disagree that the ladder is purely tolerability. The maintenance and regain data cluster at the top doses, so a ladder abandoned halfway leaves you outside the evidence base for the part that matters most — keeping it off.

BiostatsBrad said:

Four dose steps in, holding each one the full four weeks, and I am trying to work out whether the interval is a pharmacological requirement or a…

Dose escalation anxiety for titration: I was terrified to move from 0.5mg to 1.0mg based on horror stories in this forum. But my actual experience? Slightly more appetite suppression, zero additional side effects.

Remember that the people posting about terrible side effects are a biased sample. Most people titrate up without drama — they just don't post about it because it's uneventful.

julia.endo said:

I disagree that the ladder is purely tolerability.

Adding the part of the answer the thread has not reached. The useful move here is to separate what is established from what is widely repeated. Those two sets overlap less than the confident tone of most write-ups suggests, and the second set is where nearly all the disagreement on this board comes from.

Following on from pam_columbus — and this may be the naive question:

Why the interval is four weeks rather than two, and whether a slower ladder gets to the same place?

Reporting back.

Closing this out: I held the step for six weeks rather than four and it settled without a dose change. The interval was the answer, not the dose.