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Scott Butsch, the Director of Obesity Medicine in the Bariatric and Metabolic Institute at the Cleveland Clinic, said

A controlled, sustainable ratetypically around 12 pounds per week after the initial phasehelps reduce physiological stress and lowers the risk of hair loss

This process is called titration , and it matters because most side effects happen when you start or when the dose increases

[DOI] [PMC free article] [PubMed] [Google Scholar] 54.Vasquez-Martinez G., Mayoral-Andrade G., Tomanek-Chalkley A., Zepeda-Orozco D., Allen B.G., Mapuskar K.A., Vasquez-Martinez G., Mayoral-Andrade G., Tomanek-Chalkley A., Zepeda-Orozco D., et al

[DOI] [PubMed] [Google Scholar] 126.Khojah H.M., Ahmed S., Abdel-Rahman M.S., Hamza A.-B

The maintenance phase begins once you've identified the dose producing meaningful appetite suppression and weight loss without intolerable side effects