Dr.BariatricHTX said:

The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.

Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.

SleepDoc_PDX said:

Steady state is the thing most people miss.

Saving this. It is the first explanation that did not require me to already understand it. Sending this to two other people who asked me the same thing last week.

Dr.BariatricHTX said:

The honest answer is that the effect is real, the magnitude is contested, and the individual variation is larger than either.

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.

One concrete data point for the thread. Give anything pharmacological four weeks before you judge it, and give anything measured weekly a four-point rolling average before you call it a trend.

Happy to go further on any of that.

Moderator note: two posts asking for a source have been merged into one. Please search the thread before asking again. Thread quality here is what the rules are for. Keep it up.