Short answer first, then the reasoning. 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.

Dr.KarenChen said:

Extending the interval and reducing the dose are pharmacologically different.

Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution. Hydration status moves the lean compartment by a kilogram or more between scans, so any comparison of scans done at different times of day or different hydration states is noise.

LindaRN_retired said:

Planning the end of this rather than the middle of it, which nobody around me seems to want to talk about while it is still going well.

This matches mine closely enough to be worth saying so. 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 That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

From the other side of the consultation, briefly.

Pregnancy after maintenance dosing weight loss: stopped GLP-1 medication 3 months before TTC as recommended. Was terrified of regaining weight during pregnancy.

Worked closely with my OB and MFM. Gained 26 lbs during pregnancy (within recommended range). Baby is healthy. The metabolic improvements from pre-pregnancy weight loss gave both of us a healthier pregnancy.

If you're planning pregnancy, discuss the medication discontinuation timeline with your OB. GLP-1 agonists are NOT safe during pregnancy.