matt_MKE said:

Extending the interval and reducing the dose are pharmacologically different.

Epigenetic implications of GLP-1 therapy and maintenance dosing: emerging evidence suggests that sustained weight loss and metabolic improvement may produce epigenetic changes (DNA methylation, histone modification) that persist beyond drug discontinuation[1].

This is speculative but fascinating: could long-term GLP-1 agonist treatment "reprogram" metabolic gene expression? If so, it would explain why some patients maintain weight loss better than others after discontinuation.

More research needed, but the concept of pharmacologically-induced epigenetic remodeling is intellectually exciting.

A narrower follow-up, since the general answer is now clear:

Whether there is a lowest maintenance dose with actual maintenance data behind it, or whether everything published sits at the top of the ladder?

VendorMark said:

Epigenetic implications of GLP-1 therapy and maintenance dosing: emerging evidence suggests that sustained weight loss and metabolic improvement may…

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 4 months before TTC as recommended. Was terrified of regaining weight during pregnancy.

Worked closely with my OB and MFM. Gained 28 lbs during pregnancy (within recommended range). Baby is healthy. The metabolic improvements from pre-pregnancy weight loss gave both of us a healthier pregnancy.

If you're planning pregnancy, discuss the medication discontinuation timeline with your OB. GLP-1 agonists are NOT safe during pregnancy.

Reporting back.

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.

james_edin said:

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 4 months before TTC as recommended.

Maintenance phase reality on maintenance dosing: reached my goal 9 months ago and now I'm in maintenance. It's a different mental game.

During weight loss, the scale going down is constant positive reinforcement. In maintenance, the scale staying the same is... just... nothing. It's anticlimactic. The dopamine hit is gone.

What keeps me going: lab improvements, physical capabilities, how I feel, fitting in clothes I love, and the knowledge that regain happens when people stop being intentional. I'm staying intentional.