Dr.AddMedPHL said:

The OASIS programme put 50mg oral in the same territory as 2.4mg injectable — around 15% mean weight loss — but it needed a dose 20 times larger to…

I do not accept that the fasting window is a minor inconvenience. Adherence data on daily orals with timing requirements is consistently worse than weekly injections, and a drug you take imperfectly is a lower dose than the one on the box.

Adding the numbers, since they settle part of this. 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.

InsuranceTom said:

I do not accept that the fasting window is a minor inconvenience.

Coming at InsuranceTom’s question from a different direction. If two explanations both fit, the useful question is which one predicts something the other does not. That is answerable; arguing about which sounds more plausible is not.

One thing that is still open after CanadaChris’s answer:

Whether the fasting requirement is as strict in practice as the label implies, and what people actually see when they get it wrong?

Closing the loop on my own question.

Follow-up: moving the tablet to the moment I wake, before anything else, was the whole fix. The dose never changed.