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Fourth, there is no regulatory or employer demand

Holding at a dose for an extra 4 weeks before escalating is a medically supported strategy when: Nausea or vomiting persists beyond 2 weeks at the current dose You are unable to eat at least 1,000 calories per day comfortably Dehydration symptoms appear (dark urine, dizziness on standing, dry mouth) You are losing weight faster than 1 to 2 pounds per week on the current dose (aggressive weight loss increases side effect risk) In the STEP trials, delayed escalation did not compromise overall weight loss outcomes at 68 weeks