Dr.SurgeonPGH said:

Most of what circulates confidently in this community traces back to one summary of one study, and the qualifier was dropped somewhere in the third…

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.

mona_PHX said:

The mechanism that matters here is not stomach emptying, it is central.

That reframing is the part I needed. I will report back once I have actually tried it.

Dr.SurgeonPGH said:

Most of what circulates confidently in this community traces back to one summary of one study, and the qualifier was dropped somewhere in the third…

Filing a mild objection. Mild because I might be wrong; an objection because nobody has addressed the case that does not fit. 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.

If somebody has the primary source to hand I would rather cite it than paraphrase it.

The figures, for anyone assembling their own picture. If you are comparing against somebody else’s result, check that you are comparing the same measurement taken the same way. Most of the apparent contradictions in these threads dissolve at that step.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. No action needed from anybody.