Adding the numbers, since they settle part of this. The practical numbers: about 1% oral bioavailability, 30 minutes fasted before food, no more than 120ml of plain water, and coffee counts as food for this purpose.

A narrower follow-up, since the general answer is now clear:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

lucas_SP_BR said:

The practical numbers: about 1% oral bioavailability, 30 minutes fasted before food, no more than 120ml of plain water, and coffee counts as food for…

Coming at lucas_SP_BR’s question from a different direction. The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to get there because almost none of the tablet is absorbed. The dose numbers are not comparable across routes and quoting them side by side confuses people.

Closing the loop on my own question.

Follow-up: moving the tablet to the moment I wake, before anything else, was the whole fix. The dose never changed.

hans_munich said:

The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to…

Agreeing with hans_munich, and the qualification matters more than the agreement. Worth adding that the tablet is taken daily, so a missed dose costs far less than a missed weekly injection. That is a genuine advantage nobody lists.