Forty-four per cent: reading the nausea figure properly
Severity in these tables is graded by interference with activity, not by how unpleasant the experience was. Those are different measurements.
Nutrition
Page 2 of 11 of this archive, newest first.
The supplement trade found this drug class quickly, and the citations did not improve
The resistance-training and energy-deficit literature supports a higher protein intake. None of it was conducted in people taking an incretin.
Antiemetics, laxatives and the thin literature underneath them
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
The skeleton responds to load, and load is falling
Weight loss reduces bone mineral density at load-bearing sites. Whether that translates into fractures in this population is unmeasured.
The interventions with trial support, and the much longer list without
Almost nothing in the standard management repertoire has been tested in a randomised trial in this specific population. We say what is extrapolated and from where.
What actually helps, ranked by evidence
Dietary measures are widely recommended, plausible on mechanism, and supported mainly by observational data and clinical experience.
Lean mass is a compartment, not a tissue
The instrument determines the answer more than the drug does, and the trade quotes the answer without naming the instrument.
Load, not cardio: the distinction the general advice keeps losing
The older-adult diet-and-exercise trials are the closest analogue to rapid pharmacological weight loss, and they are twenty years old.
What the trials monitored, and what that implies about routine practice
What the pivotal programmes measured and how often, which is a more defensible template than most published monitoring schedules.
Dose-limiting: a definition worth being strict about
Trial discontinuation figures are a floor, not an estimate: trial populations are supported in ways ordinary patients are not.
A guide to the results that will resolve themselves
A substantial proportion of the abnormal results generated during rapid weight loss are consequences of the weight loss rather than findings about the person.
What the older diet-and-exercise trials found in the hip
The evidence base is one secondary analysis, several small studies and a large amount of extrapolation from bariatric surgery.
What the trials adjudicated, and how
We give background rates alongside trial rates, because an event occurring during treatment is not thereby caused by it.
Monitoring intervals, and the case against measuring too often
Every additional analyte raises the probability of a flagged result and lowers the average information content of the panel.
Dose-limiting: a definition worth being strict about
An effect is dose-limiting when it prevents adequate intake, prevents normal activity, or produces a risk of its own. Discomfort alone is not the test.
The incidence tables, read line by line
Trial adverse-event tables count episodes reported to a study nurse. They are the best data we have and they systematically under-record the mundane.
The interventions with trial support, and the much longer list without
Constipation is the most tractable of the effects and the most consistently under-managed.
When to stop escalating and when to stop entirely
We set out the questions that distinguish a symptom to manage from a dose to change.
Hydration, protein and the two failures that compound each other
The intervention with the clearest evidence is the one nobody frames as an intervention: adjusting the dose.
Two sessions a week, and the evidence behind the prescription
The recommendation survives scrutiny. The reasoning offered for it frequently does not.