This one has a reasonably settled answer, so here it is. 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".

I would rather be corrected than agreed with, if it comes to it.

BariatricNurseD said:

The dose-response is real but shallow at the top.

All true, with one condition: that curve is for people who reached the dose on schedule. Anyone who slowed the ladder for tolerability is on a different, flatter curve, and comparing yourself with the published mean will make you feel like a non-responder when you are not.

lisa_labSD said:

Lost weight quickly, developed right-upper-quadrant pain after fatty meals, and ended up having an ultrasound that found what everybody had already…

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.

I would rather be corrected than agreed with, if it comes to it.

From the other side of the consultation, briefly.

Gallbladder ultrasound monitoring on gallbladder risk: given the known gallstone risk with rapid weight loss, my doctor orders gallbladder ultrasound every 6 months:

Baseline: normal, no stones or sludge
Month 6: small amount of biliary sludge, no stones
Month 12: sludge resolved, gallbladder normal

Ursodeoxycholic acid (Ursodiol) 300mg BID was prescribed prophylactically from the start. This reduces gallstone formation during rapid weight loss by ~60% per the available data. Ask your doctor about prophylactic ursodiol if you're losing weight rapidly.