Answering the narrow version, because the broad one does not have a single answer. The mechanism that matters here is not stomach emptying, it is central. GLP-1 receptor agonism in the arcuate nucleus stimulates POMC neurons and suppresses AgRP/NPY signalling, which is why the effect is appetite and food salience rather than physical fullness. Delayed gastric emptying largely tachyphylaxes over the first months; the appetite effect does not.

Dr.AddMedPHL said:

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

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.

KevinCompounds said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

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.

Clinical perspective, offered as context rather than as advice.

Metabolic syndrome resolution on cardiovascular risk: I went from meeting 4 of 5 diagnostic criteria to meeting ZERO after 12 months of treatment.

The 5 criteria (and my journey):

1. Waist circumference: 51" → 37" ✅ Resolved
2. Triglycerides: 247 → 112 ✅ Resolved
3. HDL: 35 → 59 ✅ Resolved
4. Blood pressure: 147/97 → 120/74 ✅ Resolved
5. Fasting glucose: 127 → 87 ✅ Resolved

Metabolic syndrome reversal is, in my view, the most medically significant outcome of GLP-1 therapy.