DebRD_ATL said:

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

Saving this. It is the first explanation that did not require me to already understand it. I will report back once I have actually tried it.

Adding the clinical framing, because it changes how the question reads.

BiostatsBrad 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.

PharmacoVig_BOS said:

Albumin binding above 99% is the whole reason weekly dosing works, and it is also why the trough matters more than the peak.

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.

One concrete data point for the thread. Relative versus absolute is the distinction that gets lost: a 20% relative reduction on a high baseline risk is a large absolute benefit, and the same relative figure on a low baseline risk is a small one.

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

Moderator note: two posts asking for a source have been merged into one. Please search the thread before asking again. No action needed from anybody.