Dr.GastroMayo said:

One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are.

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.

Adding the numbers, since they settle part of this. For anyone assembling their own picture: Tmax is one to three days, terminal half-life about 165 to 170 hours, steady state at four to five weeks, and subcutaneous bioavailability near 89%. Those four numbers explain most of the questions people ask about timing.

kate.chem said:

The regain framing needs pushing back on.

Adding the part of the answer the thread has not reached. The dose-response is real but shallow at the top. Across STEP 1 and STEP 4 the gap between 1.7mg and 2.4mg is a couple of percentage points of body weight on average, and the average is carrying a wide spread — plenty of people at 1.7mg sit above the 2.4mg mean. If a dose is working and tolerable, "working" is the relevant variable, not "maximal".

One thing that is still open after Dr.ObesityLA’s answer:

Whether there is a lowest maintenance dose with actual maintenance data behind it, or whether everything published sits at the top of the ladder?

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

I went to a lower dose rather than a longer interval on the strength of the trough argument in this thread, and the difference in how even it feels is obvious.