The Three Phases: What Actually Happens Over Six Months

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Most people want to know two things before they start: what it's going to feel like, and how much is going to happen.

So here's the whole six months, phase by phase, including the uncomfortable parts.

We recommend a minimum of six months. Not because there's anything magic about that number, but because the third phase — the one that determines whether any of this lasts — needs the first two to have done their work properly.

Phase one: Adaptation (about 2–3 months)

This is the demanding phase, and the one requiring the closest supervision from our side. Three separate things are adapting at the same time.

Your body adapting to the medication

Side effects are most likely here, and I'd rather you knew the list in advance than discovered it at 11pm wondering whether something is wrong.

Commonly: gastric discomfort, feeling cold, weakness, dizziness, disturbed sleep, and constipation.

Most of this is manageable, and the primary tool is proper titration — going up in dose at the speed your body tolerates rather than on a fixed schedule. This is a large part of what the weekly review is for, and it's the thing that's missing when someone is simply handed a supply and left to it.

Where titration isn't enough, we give you a rescue stack — over-the-counter medications kept at home covering antacid, simethicone, something for sleep, and something for constipation — with standing instructions to contact us. Our doctor tells you which one, what dose, and for how long.

We very rarely need to stop the programme for side effects. Managed early they mostly stay small. Left alone for three weeks they become the reason people quit.

One thing worth understanding: feeling cold and weak is often not a side effect of the medication at all. It's your body being in a calorie deficit. That's the other side of the coin of losing weight, and it happens on any method — every diet, every approach. The usual fix is eating better-quality calories rather than fewer, and we'll work through that with you.

Your body and your mind separating

This is the part almost nobody warns people about, and it surprises nearly everyone.

The medication mimics a hormone that signals fullness. So your appetite goes quiet. Straightforward enough.

But then it's one o'clock. You're not hungry — the medication is doing its job. And yet you feel slightly weak, and something in you starts craving. Not hunger exactly. Something else.

That craving is real, and it's coming from two places. Partly your body, which has other signals besides hunger. And partly your mind — because here's the thing we don't say out loud often enough:

In modern life, we don't mainly eat for survival or calories. We eat for enjoyment.

Food is pleasure, comfort, routine, celebration, and how you get through a difficult afternoon. When the appetite goes quiet, all of that is still there, wanting something. And the mind registers a shortfall — a lack of enjoyment — that has nothing to do with nutrition.

If nobody explains this, it's disorienting. You think the medication has stopped working, or that you're failing at something.

So a substantial part of this phase is sitting down with you to identify these signals, name them, and separate them. Is this hunger, or is this the four o'clock slump wanting a reward? Once you can tell the difference — and most people can, quite quickly, once someone points it out — you can respond to each one appropriately instead of treating everything as hunger.

That work is the most valuable thing in the whole programme, and it's the part that's still with you years later.

Your activity adapting

You're in a sustained calorie deficit, so exercise has to build progressively rather than aggressively.

In this phase we mostly focus on walking — distance and daily steps. Not glamorous. But it's sustainable, it burns proportionately more fat than higher-intensity work does in a deficit, and crucially it doesn't compete with your body's limited resources during a demanding adjustment period.

Resistance training comes later, deliberately.

Phase two: Burning (2–10 months)

Once everything above is optimised, this phase simply needs time.

I describe it to patients as a stew. Everything is in the pot and the heat is right — now it needs hours. You cannot rush a stew by turning the flame up, and you cannot rush this by taking more medication.

What we're watching for during this phase:

Muscle preservation. The most legitimate criticism of this class of medication is muscle loss, and it's a real risk. Whey protein in the supplement stack, adjusted monthly according to your needs rather than a fixed amount for everyone. And now resistance training starts properly.

Not by joining a gym with a personal trainer. That's not snobbery — it's that a gym membership taken by someone who wasn't already in the habit does not survive month three, and then training stops altogether. So: movements you can do at home, adjusted to your capability, roughly three times a week.

Squats and lunges first, because the muscles of the lower limbs are the largest muscle mass in your body — that's where the return on effort is. Push-ups added if and when you can manage them.

Electrolytes and nutrients. Sustained deficits deplete things. That's part of what the bloods and the supplement stack are for.

Sleep. I'd put this higher than most people expect. A great deal of metabolic repair happens during sleep, and optimising it is one of the more effective and least discussed levers available.

What the scale does, and what to make of it

Early on, weight can come off fast — some people see around a kilogram a week at the start. Enjoy it, but understand it: part of that is water weight, and it's an early bonus rather than the ongoing rate.

After that it settles into something steadier and slower. And this is where I need you to stop reading the scale as the only instrument.

You will have weeks where the weight doesn't move while your body fat percentage falls and your muscle mass rises. That is a good week. An excellent week, actually. But if you're only watching one number, it looks like failure, and people quit during exactly those weeks.

That's why we measure body composition every visit rather than weight alone. So that on a stagnant week I can show you what actually happened.

Plateaus. The rate of loss tends to slow once you've lost somewhere around fifteen percent of your starting weight. That's expected physiology, not a sign anything has broken. We adjust when it happens.

How much, realistically

The published research on this class of medication shows body weight reduction in the region of 16–24% over a year, varying by which medication is used.

What I'd tell you to expect in practice, in a structured programme with everything else optimised, is meaningful change over six months — with the caveat that individual results vary considerably, and that the number on the scale is not the outcome we're actually optimising for. Improved bloods, reduced body fat and preserved muscle are.

I'd be cautious about any programme that promises you a specific figure. Nobody can know your rate in advance.

Phase three: De-escalation (1–2 months)

We reduce the medication dose deliberately, stepping down to let your body acclimatise to being without it.

I want to be direct about why this phase exists at all, because plenty of places don't have one.

I don't believe in staying on these medications indefinitely. This isn't meant to be a subscription you're on for years. If the only thing holding your weight is a weekly injection, then nothing has actually been fixed — you've rented a result.

So during de-escalation we reinforce every habit built along the way: the eating patterns, the protein, the resistance training, the sleep, and the ability to distinguish hunger from the other things that feel like hunger. The goal is that by the time the medication stops, what's holding your weight is your lifestyle.

In the plane analogy I use — medication as engine, doctor as pilot, everything else as wings and landing gear — this is the landing gear. It's the least exciting component and it's the one that determines whether the flight ends well.

Throughout: what happens every week

You come in weekly for the entire programme. We store your medication here and our trained staff administer it.

Each week we reassess weight and body composition, check tolerability and adjust the dose, review your eating, review your activity, and catch side effects early.

And we talk. That weekly conversation is where the useful things surface — the pattern where weekends look nothing like weekdays, the specific situation that reliably derails you, the reason a particular food is difficult to give up. None of that comes out in a form.

Between visits, the clinic phone is available. Don't sit on a problem for six days.

Bloods

Baseline before starting: full blood count, renal profile, liver function, lipid profile, fasting glucose, HbA1c where relevant, electrolytes, urine, thyroid function — plus anything the individual picture calls for, such as hormonal studies in PCOS or testosterone where obesity has suppressed it.

Repeated at the end of the programme, and again three months after it finishes.

That last one is the one I care most about. Anyone can show improved numbers while treatment is running. The question worth answering is whether the improvement holds once the support is gone.

Klinik Dr Tan, Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu. WhatsApp 017-234 7328. Appointments preferred.

Book a consultation with Dr. Tan — Book Online or WhatsApp 017-234 7328.

简要说明

我是陈医生，亚庇 Lintas Square 的 Klinik Dr Tan。建议疗程至少六个月，分三个阶段。

第一阶段：适应期（约2–3个月） — 最需要密切监测的阶段，三件事同时在适应：

身体适应药物：常见副作用有胃部不适、怕冷、无力、头晕、睡眠受扰、便秘。主要处理方式是正确的剂量调整——依你的耐受度调整，而不是按固定时间表加量，这正是每周复诊的用途。若不足够，我们会给你一套备用药（胃药、消胀气、助眠、通便）放在家里，并附使用指示：出现副作用请联络我们，医生会指示用哪一种、剂量和天数。我们很少因为副作用而中止疗程——及早处理它们多数不会变大。

请注意：怕冷和虚弱往往不是药物的副作用，而是身体处于热量赤字的状态。任何减重方法都会有这一面。通常的解法是吃品质更好的热量，而不是更少。

身心分离：药物模拟饱足荷尔蒙，所以你不饿。但到了一点钟，你不饿，却觉得有点虚弱，而且开始渴望某些东西。那渴望是真实的，一部分来自身体，一部分来自心理——因为现代人吃东西主要不是为了生存或热量，而是为了享受。食物是愉悦、安慰、习惯、庆祝，也是撑过难熬下午的方法。食欲安静下来时，这些需求还在。如果没有人解释，你会以为药失效了，或以为自己失败了。这个阶段很大一部分工作，是帮你辨认这些讯号、命名它们、区分它们——这是饥饿，还是下午四点想要一个奖励？分得出来之后，就能分别回应。这是整个计划里最有价值的部分，也是几年后仍然留在你身上的部分。

活动适应：以走路和步数为主。不华丽，但可持续，在热量赤字状态下燃烧的脂肪比例较高，也不会跟身体有限的资源竞争。阻力训练刻意留到后面。

第二阶段：燃烧期（2–10个月） — 像炖汤，火候对了就需要时间，加大火并不会更快。

• 保住肌肉：这是对这类药物最合理的批评。乳清蛋白每月由医生调整，并在此阶段正式开始阻力训练——不是去健身房请教练（本来没有运动习惯的人，健身房会员通常撑不过第三个月），而是在家可做、依能力调整、一周约三次。深蹲和弓箭步优先，因为下肢是全身最大的肌群。有能力再加伏地挺身。

• 电解质与营养、睡眠（大量代谢修复在睡眠中进行，这是最被低估的一环）。

关于磅秤：初期可能一周掉近一公斤，但其中一部分是水分，那是前期红利不是常态速度。之后会慢下来。你会遇到体重不动、但体脂下降、肌肉上升的星期——那是好的一周，而只看一个数字的人往往就在这种星期放弃。所以我们每次都量身体组成。减掉约15%之后速度会趋缓，这是正常生理，不是出了问题。

实际幅度：研究显示这类药物一年内体重下降约16–24%（因药物而异）。实际情况因人而异，而且磅秤上的数字不是我们真正优化的目标——血液指标改善、体脂下降、肌肉保住才是。要留意任何承诺具体数字的计划。

第三阶段：减量期（1–2个月） — 刻意逐步降低剂量，让身体适应停药。

我不认为应该长期依赖这类药物。 如果维持体重的唯一因素是每周一针，那等于什么都没有解决，你只是租来一个结果。这个阶段强化所有已建立的习惯，目标是停药时，维持体重的是你的生活型态。

每周：药物存放在诊所由受训人员施打；每次评估体重与身体组成、调整剂量、检讨饮食与活动、及早处理副作用。两次之间可随时联络诊所，不要拖六天。

抽血：基线、疗程结束、结束后三个月各一次。最后那次最重要——治疗期间数字好看不难，重点是支撑撤走后还在不在。

Klinik Dr Tan，Lot 27, Ground Floor, Block D, Lintas Square, Kota Kinabalu。WhatsApp：017-234 7328。

预约陈医生 — 在线预约 或通过 WhatsApp 联系 017-234 7328