What the older diet-and-exercise trials found in the hip
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.
Patient experience
Page 4 of 8 of this archive, newest first.
SURMOUNT-2 was built to answer the stopping question, and it did
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
The dose that got you here and the dose that keeps you here
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
Sarcopenia is a diagnosis, not a synonym for losing lean mass
A tour of the source literatures, with an assessment of how far each legitimately reaches.
Coming off: what the pharmacology permits
What a slow reduction could plausibly buy, and what it certainly cannot prevent.
The lead-in, the randomisation, and the year that followed
A withdrawal trial answers a narrower question than it appears to. This piece states which question.
What the older diet-and-exercise trials found in the hip
Weight loss reduces bone mineral density at load-bearing sites. Whether that translates into fractures in this population is unmeasured.
Side effects, cost, supply, target: four reasons with four trajectories
The trials studied planned withdrawal. Almost nobody stops that way.
What SURMOUNT-1 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
Load, not cardio: the distinction the general advice keeps losing
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
The advice is mostly reasonable. The certainty is not earned.
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
The shortage years, and what they taught about interruption
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
The precision question nobody puts to a body-composition report
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
Continued treatment against continued placebo: the comparison that settled it
What was withdrawn, from whom, after how long, and what was measured afterwards.
The advice is mostly reasonable. The certainty is not earned.
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
SURMOUNT-OSA was built to answer the stopping question, and it did
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
A year after stopping: what the trials found at the far end
The variance around the mean regain trajectory is large and unexplained, exactly as it is for the weight loss.
Not everybody regains at the same rate, and nobody knows why
What returns, in what order, and how much of the benefit survives.
What the older diet-and-exercise trials found in the hip
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.