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ForumsPublic SquareBody dysmorphia after significant weight loss — need advice

Body dysmorphia after significant weight loss — need advice

Dr.RheumBOS Sat, Apr 26, 2025 at 2:19 PM 54 replies 1,998 viewsPage 1 of 11
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Dr.RheumBOS
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Apr 26, 2025 at 2:19 PM#1

My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my material.

The question I want answered is how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.

Happy to be told the question itself is wrong.

42 20pam_stl, wei_SG, cory_ATX and 39 others
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DebRD_ATL
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Apr 26, 2025 at 3:33 PM#2

Taking the question as asked, rather than the general version of it. Read four things before the headline number. The population, because trial populations are selected and supported in ways that real cohorts are not. The comparator, because "better than placebo" and "better than the current standard" are different claims and get reported identically. The primary endpoint as pre-registered, because a secondary endpoint promoted after the fact is a hypothesis rather than a finding. And the completion rate, because a large effect in the half of participants who finished is a different result from a large effect in everybody enrolled.

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kim_atl_prep
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Apr 26, 2025 at 4:47 PM#3
DebRD_ATL said:
Read four things before the headline number.
DebRD_ATL said:
...regarding the trial evidence...

I think this is an underappreciated point. To expand on it with some data:

A recent meta-analysis of 18 RCTs (n=15,600) found that the trial evidence was associated with a robust effect size across diverse patient populations[1].

The NNT was 15, which is comparable to metformin for T2DM prevention. That's a strong clinical argument for this approach.

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steve_okc
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Apr 26, 2025 at 6:01 PM#4
Dr.RheumBOS said:
My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…

Same position here, arrived at the long way round. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.

Last edited: Apr 26, 2025 at 10:01 PM
45 23CanadaChris, ZaraB_AL, JakeSmashed95 and 42 others
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andrew_nyc
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Apr 27, 2025 at 1:07 AM#5

Clinical perspective, offered as context rather than as advice.

Propensity score matching studies and the trial evidence: when RCTs aren't available for a specific question, propensity score-matched observational studies can provide useful evidence.

A recent PSM study of 18,000 GLP-1 users vs matched controls showed reduced MI incidence (HR 0.78) over 4 years of follow-up[1].

These results complement the RCT data and suggest the benefits translate to real-world populations.

References:
[1] Registry-based cohort study, pre-print 2024.
Last edited: Apr 27, 2025 at 6:07 AM
46 24JessicaM_2024, TomFromTexas, mike.trainer_LA and 43 others
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