VanRx_Mike said:

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

That reframing is the part I needed.

From the other side of the consultation, briefly.

SarahChen_PharmD 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.

Dr.KarenChen said:

Steady state is the thing most people miss.

This is where I part company with the consensus forming above. 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.

I would rather be corrected than agreed with, if it comes to it.

Adding the numbers, since they settle part of this. Keep the original post as written when you update it, and add the correction underneath. An edited-away mistake is invisible to the next person who makes it.

Moderator note: leaving this open. It is being argued well and the disagreement is the useful part. Report rather than reply if it drifts again.