Why the bone question is harder than the muscle question
What the Journal would want measured before treating this as settled in either direction.
Patient experience
Page 6 of 8 of this archive, newest first.
Why people actually stop, in the order they actually stop
A supply interruption is a discontinuation with no notice, no taper and no plan. That is a distinct clinical situation.
Two sessions a week, and the evidence behind the prescription
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
Side effects, cost, supply, target: four reasons with four trajectories
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
What SURPASS-4 tells us about maintenance, and what it does not
A survey of the maintenance evidence, which is shorter than the survey of the withdrawal evidence.
Bone density during rapid weight loss: what is known, which is less than you would hope
The evidence base is one secondary analysis, several small studies and a large amount of extrapolation from bariatric surgery.
A few hundred participants carry the whole body-composition argument
What was pre-specified, what was exploratory, and what was calculated afterwards by people who did not run the trial.
What we would need to randomise to answer this properly
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
What the placebo arms of the withdrawal trials actually tell us
What was withdrawn, from whom, after how long, and what was measured afterwards.
The lead-in, the randomisation, and the year that followed
The regain trajectories, arm by arm, with the estimands named.
The substudies, read properly: who was scanned, when, and with what
Both the reassuring reading and the alarming reading are supportable from the same tables. This piece sets out which is which.
Every fortnight, every third week, seasonally: an unstudied practice
An absence of evidence is not evidence of harm. It is also not a licence.
Two-thirds back: the extension nobody expected to be the headline
What was withdrawn, from whom, after how long, and what was measured afterwards.
Bone density during rapid weight loss: what is known, which is less than you would hope
Density is a proxy for strength and an imperfect one, particularly when soft-tissue thickness over the measurement site is changing.
Grams per kilogram of what? The denominator problem in protein guidance
Where the familiar figures come from, what populations they were measured in, and how far the extrapolation reaches.
Two sessions a week, and the evidence behind the prescription
The recommendation survives scrutiny. The reasoning offered for it frequently does not.
A year after stopping: what the trials found at the far end
The physiology of regain was described a decade before these drugs, and it explains the trajectory without invoking anything specific to them.
Eating enough protein on a suppressed appetite is an arithmetic problem before it is a nutritional one
The practical difficulty is not knowing the target. It is meeting it on an appetite that has been pharmacologically reduced by half.
Why "muscle-sparing" is a marketing term and not a measurement
The rule that a quarter of weight lost is lean tissue has been in textbooks for decades and does not survive close reading.
The lowest effective dose is a real concept with almost no data behind it
The commonest real-world strategy in this drug class is the least studied one.