This gets cited here weekly, usually second-hand, so it is worth setting out what it does and does not establish.
STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.
Where I think it is weakest: the population was selected and supported in ways a real cohort is not, so I would read the effect size as a ceiling rather than an expectation.
What I am after is whether there is a lowest maintenance dose with actual maintenance data behind it, or whether everything published sits at the top of the ladder. Not looking for reassurance. Looking for the part I have got wrong.
Figures above are from the primary publication rather than the press summary. If a number here disagrees with one you have, post yours and we will work out which of us is reading a secondary source.
DerekSJ_a1c said:STEP 4 is the study that answers this and it is blunt.
No disagreement with DerekSJ_a1c. One condition attached. One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are. That subgroup is the most interesting unanswered question in the field and it is routinely flattened into the two-thirds headline.
DerekSJ_a1c said:STEP 4 is the study that answers this and it is blunt.
The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.
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Shop Reference StandardsThis one has a reasonably settled answer, so here it is. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.
I would rather be corrected than agreed with, if it comes to it.
Dr.GutHealth said:One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.
Right, and protein targets should be set on a reference weight rather than current weight. Setting 1.6 g/kg on a starting weight of 130kg produces a target nobody hits on a suppressed appetite.
Correct me if the detail matters more than I have assumed.