Every fortnight, every third week, seasonally: an unstudied practice
An absence of evidence is not evidence of harm. It is also not a licence.
Patient experience
Page 5 of 8 of this archive, newest first.
The scale is not the measurement, and neither is the handheld device in the clinic
A body-composition report gives four decimal places and no confidence interval. That is the whole difficulty in one sentence.
Side effects, cost, supply, target: four reasons with four trajectories
Why the reason for stopping changes what happens afterwards.
A few hundred participants carry the whole body-composition argument
A substudy powered to describe a mean is not a substudy powered to detect a clinically meaningful individual change.
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.
What TRIUMPH-3 tells us about maintenance, and what it does not
Every withdrawal trial compared full dose against nothing. The clinically interesting comparison — full dose against a reduced one — has not been randomised.
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.
What STEP 5 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
Why the bone question is harder than the muscle question
A plausible mechanism, a measurable change, and no outcome data. This is what an open question looks like.
Percentage of loss, absolute kilograms, and the sleight of hand between them
The trials measured mass. Nobody measured whether the participants got weaker.
The supply gap as a clinical event
Why the reason for stopping changes what happens afterwards.
Why people actually stop, in the order they actually stop
Real-world persistence figures, with their definitions stated, because the definitions are doing most of the work.
The visceral fat result nobody quotes, from the substudy everybody cites
The trials measured mass. Nobody measured whether the participants got weaker.
The shortage years, and what they taught about interruption
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
Eating enough protein on a suppressed appetite is an arithmetic problem before it is a nutritional one
The resistance-training and energy-deficit literature supports a higher protein intake. None of it was conducted in people taking an incretin.
The hormonal adaptations persist for years. That is the mechanism.
The physiology of regain was described a decade before these drugs, and it explains the trajectory without invoking anything specific to them.
Maintenance dosing: what is licensed, what is practised, and what is evidenced
Dose reduction is not withdrawal, and the trials that tested withdrawal cannot be read as testing it.
The lead-in, the randomisation, and the year that followed
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
Every fortnight, every third week, seasonally: an unstudied practice
The schedules in circulation, described accurately, with their evidentiary status attached.
Sarcopenia is a diagnosis, not a synonym for losing lean mass
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.