So many variables here. Welcome to HCM! What are doing differently than last time can you think of anything? Qsymia has phentermine and topiramate in it. Phentermine is a mild stimulant/appetite depressant and we don t know how topiramate works on weight loss. It is a side-effect noticed in other patients so this drug was created. I am curious as to it working the first time. Did you regain the weight or just want to lose more? Topiramate usually works best the first time or in the initial phases of dosing I have noticed. You may be correct. I can see that you may be correct in your expectations because if you are following the correct diet and exercising you should be losing weight regardless of any pill. We all need to get out of a pill mentality. Now, I congratulate you on getting back into a fitness routine, but I didnt hear anything about how you are eating. Qsymia will not raise your metabolism, but green tea will. Try drinking 3 cups per day. Breakfast should be protein, not carbohydrates. Most women lose on 1200 calorie diet even though it should be personalized. Small meals, two small snacks, nothing 3 hours before bedtime. Eight glasses of water 8x per day. Be strong. Rely on yourself, not the pill! I have a free educational site with a weight loss board, take a look: www.pinterest.com/kathyshattler Thank you and come back again! Kathy Shattler, MS,RDN