Dr.ObesityLA said:

The dose-response is real but shallow at the top.

This answered a question I did not know how to ask. I will report back once I have actually tried it.

Clinical perspective, offered as context rather than as advice.

hannah_MT 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.MetabolicMD said:

Steady state is the thing most people miss.

I read this differently from Dr.MetabolicMD, on substance rather than tone. 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.

One concrete data point for the thread. One practical note: write down what you did and when, before you need it. Reconstructing a timeline from memory three months later is how people end up unable to answer the one question that would have resolved it.

Moderator note: good thread. Keeping it here rather than moving it, because the question is general enough to be useful.