6 months on Zepbound at 12.5 mg — slower than the Reddit posts

I started Zepbound in November 2025 at 256 lbs and a BMI of 35. I had read enough Reddit threads to think 20% body-weight loss was the standard. Six months in, I am at 225 lbs (about 12% loss) — meaningful but slower than the trial average for my dose.

The titration was easier than I expected. 2.5 mg, then 5, then 7.5, then 10, now 12.5 mg. Each dose increase brought a day or two of nausea but never anything close to the horror stories I had read.

The thing that almost made me quit was the fatigue at month four. I was sleeping 9 hours and still exhausted. I assumed it was the medication. Turned out I was eating 1100 calories a day without trying — Zepbound suppresses appetite so completely that I was basically starving myself by accident. Once I deliberately hit 1500 calories with high protein (130 g a day) the fatigue resolved within a week.

My prescriber pushed back on going to 15 mg. She said 12.5 was working and that the side-effect profile gets noticeably worse at 15 for diminishing returns. I trust her judgment but I will admit I am curious about the additional 5% loss the trial showed.

The cost angle: Eli Lilly's direct-pay program (LillyDirect vial) brought my monthly cost to $549 cash. My insurance refused to cover Zepbound — they cited "not medically necessary" despite my BMI and comorbidities. We are appealing.

Where I am now: 31 lbs down, sleep apnea improved enough that I tested off CPAP for the first time in three years, blood pressure dropped 20 points. Six more months on the maintenance dose and then we re-evaluate.