sean_dublin said:

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

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.

Adding the clinical framing, because it changes how the question reads.

DerekSJ_a1c 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.

pat_auckland said:

Steady state is the thing most people miss.

I read this differently from pat_auckland, 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.

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