Dr.NutriCornell said:The dose-response is real but shallow at the top.
Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.
Worth separating that from semaglutide, which this thread keeps folding into the same question. They behave differently and the advice does not transfer.
The figures, for anyone assembling their own picture. Worth knowing that the injection site changes very little. Abdomen, thigh and upper arm are bioequivalent for semaglutide, so a site change is not a plausible explanation for a bad week.
Dr.GastroMayo said:The trial means are being read too generously in this thread.
Coming at Dr.GastroMayo’s question from a different direction. 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.
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View ResultsOne thing that is still open after mike_mod’s answer:
What the dose-response curve actually looks like above 1.7mg, because the trial means hide how few people account for the extra loss?
Reporting back.
Six weeks on from posting: I stopped reading the weekly number and started reading a four-week average, and the "stall" I opened this thread about was a 1.8kg loss I could not see.