roxy_nash said:

The mechanism that matters here is not stomach emptying, it is central.

That reframing is the part I needed. Sending this to two other people who asked me the same thing last week.

From the other side of the consultation, briefly.

Dr.AddMedPHL said:

...but the FDA says semaglutide...

Interesting point. I want to add some regulatory nuance: the FDA labeling reflects the specific clinical trial data submitted for approval. Real-world clinical practice often extends beyond the FDA label based on emerging evidence and clinical judgment.

Example: semaglutide was first approved for diabetes (Ozempic), then obesity (Wegovy). The molecule didn't change — our understanding of its applications expanded. Similarly, semaglutide may evolve as more data accumulates.

Dr.RheumBOS said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

Adding the numbers, since they settle part of this. Give anything pharmacological four weeks before you judge it, and give anything measured weekly a four-point rolling average before you call it a trend.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. No action needed from anybody.