anders_CPH said:

Steady state is the thing most people miss.

Bookmarking. The distinction being drawn above is the one nobody else makes. I will report back once I have actually tried it.

Clinical perspective, offered as context rather than as advice.

PharmacoVig_BOS 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.

TrialNerd_Beth said:

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

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

Adding the numbers, since they settle part of this. The boring version of this is the one that works, and the boring version is: measure a baseline, change one variable, wait, measure again under the same conditions. Nobody wants that answer and it is still the answer.

Moderator note: a couple of off-topic posts removed. Tagging this one for the weekly digest.