Short answer first, then the reasoning. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

Dr.LipidDallas said:

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

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.

Correct me if the detail matters more than I have assumed.

anders_CPH said:

Denied on prior authorisation twice, approved on the third attempt after a peer-to-peer, and the only thing that changed was who was doing the…

That holds for the injectable. The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people quote them as if they were.

From the other side of the consultation, briefly.

anders_CPH said:

...my insurance denied cost and coverage coverage because...

Insurance denial is the single biggest barrier to GLP-1 access. Let me share the appeal framework that worked for me and several community members:

1. Document medical necessity (BMI, comorbidities, failed alternatives)
2. Reference clinical practice guidelines (AGA, AACE, Endocrine Society)
3. Cite cost-effectiveness data (preventing diabetes/surgery saves money long-term)
4. Request peer-to-peer review between your doctor and the plan's medical director
5. File external appeal with your state insurance department if internal appeal fails

Don't accept the first denial. The appeal process exists for a reason.