mike_nyc said:

The pharmacokinetics explain nearly every practical question asked here.

Pushing back on mike_nyc here. The "earlier than weight loss explains" argument is weaker than this thread makes it sound. Blood pressure and inflammatory markers move fast and are downstream of early weight loss, so the mechanism is not as cleanly separable as the summaries imply.

One concrete data point for the thread. Numbers worth memorising for this class: Tmax one to three days for the weekly peptides, terminal half-life about a week for semaglutide and about five days for tirzepatide, steady state at four to five half-lives, subcutaneous bioavailability high enough that site choice is irrelevant.

That is the short version; the long version is somebody else's post.

PurityPaulOR said:

The "earlier than weight loss explains" argument is weaker than this thread makes it sound.

PurityPaulOR said:

...we're creating a generation dependent on cardiovascular risk...

I understand the concern, but consider this analogy: are we "creating a generation dependent on" blood pressure medication? Cholesterol medication? Thyroid medication?

Obesity is a chronic disease with biological drivers. Treating it with medication is no different from treating any other chronic condition. The "dependency" framing implies weakness or moral failure — neither of which is accurate.

If ongoing medication is what keeps someone healthy, that's successful treatment, not dependency.

Following on from LarryQC_SD — and this may be the naive question:

Which effects tachyphylax and which persist, because the answer explains why tolerability improves while the appetite effect keeps working?

OP back with an update, since a thread like this is useless without one.

Closing this out: the trough rather than the peak explains the pattern I was seeing on day six, which I had been blaming on the vial.