This one has a reasonably settled answer, so here it is. Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts. Receptor-level tachyphylaxis to the delayed-emptying effect develops over weeks while the central appetite effect persists, so the same dose is materially more comfortable at week six than at week two. A slower ladder therefore reaches the same dose with less cumulative nausea, not the same nausea spread thinner.

NurseKim_ATL said:

Holding genuinely reduces total burden rather than redistributing it, because the gastric-emptying component adapts.

No disagreement with NurseKim_ATL. One condition attached. The meal advice is right and incomplete without the hydration point. People stop drinking because drinking makes them feel full, then attribute dehydration symptoms to the drug.

Correct me if the detail matters more than I have assumed.

jason_sac26 said:

The nausea I get is not really nausea, it is an aversion.

Same position here, arrived at the long way round. The line between titrate-through and stop is not severity, it is trajectory and what else is present. Nausea that peaks and improves within a week is the expected pattern. Nausea that is escalating, or that comes with severe upper-abdominal pain radiating to the back, or that prevents fluids for more than a day, is a different conversation and belongs with a clinician the same day.

I would rather be corrected than agreed with, if it comes to it.

Clinical perspective, offered as context rather than as advice. The mechanism and the magnitude are separate questions. Agreeing that something happens says nothing about whether it happens enough to act on.