Dr.AddMedPHL said:

Steady state is the thing most people miss.

Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.

Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.

zoe_NC said:

The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people…

Thank you — that is the clearest version of this I have read, and I have read a lot of them. I will report back once I have actually tried it.

Dr.AddMedPHL said:

Steady state is the thing most people miss.

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. The trial means are being read too generously in this thread. STEP populations were selected, supported, and titrated by protocol, and the real-world curves are consistently a few points worse. That difference is not noise, it is what happens when you remove the study infrastructure.

mike_nyc said:

I am eight weeks into deliberately reducing rather than stopping, and the appetite change came back faster than the weight did.

mike_nyc said:

...I stopped maintenance dosing and regained all the weight...

This is a really important data point and I appreciate your honesty. The STEP 1 extension data showed ~2/3 of weight regain within 12 months of discontinuation.

This doesn't mean the drug "doesn't work" — it means obesity is a chronic disease requiring ongoing treatment, just like hypertension or diabetes. We don't criticize blood pressure meds for "not working" when BP rises after stopping them.

The framing matters. maintenance dosing is a treatment, not a cure. And that's okay.

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