This one has a reasonably settled answer, so here it is. Extending the interval and reducing the dose are pharmacologically different. Reducing the dose lowers the whole exposure curve evenly; extending the interval keeps the peak and drops the trough. Since the appetite effect tracks the trough, interval extension tends to give you good days and bad days rather than a uniformly smaller effect, which most people find harder to live with.

NurseKim_ATL said:

Extending the interval and reducing the dose are pharmacologically different.

Agreed, and reference ranges are laboratory-specific. Comparing your number to somebody else's range, or to a screenshot from another country, is how people convince themselves something is wrong.

MarkLI_maint said:

I am eight weeks into deliberately reducing rather than stopping, and the appetite change came back faster than the weight did.

Same position here, arrived at the long way round. STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

Clinical perspective, offered as context rather than as advice.

MarkLI_maint said:

...I stopped maintenance dosing and regained all the weight...

This is a really important data point and I appreciate your honesty. The STEP 1 extension data showed ~2/3 of weight regain within 12 months of discontinuation.

This doesn't mean the drug "doesn't work" — it means obesity is a chronic disease requiring ongoing treatment, just like hypertension or diabetes. We don't criticize blood pressure meds for "not working" when BP rises after stopping them.

The framing matters. maintenance dosing is a treatment, not a cure. And that's okay.