Weight regain is not a failure of willpower and it is not a mystery
The variance around the mean regain trajectory is large and unexplained, exactly as it is for the weight loss.
Patient experience
Page 7 of 8 of this archive, newest first.
Randomised withdrawal is the cleanest design in this field and the least discussed
The regain trajectories, arm by arm, with the estimands named.
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.
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.
Not everybody regains at the same rate, and nobody knows why
Regain begins immediately, proceeds at a decelerating rate, and does not usually return to baseline within the observed follow-up. Each of those three clauses matters.
What STEP 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 one-quarter rule, and the paper that took it apart
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
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
Stepping down against stopping: two decisions treated as one
These agents produce no dependence and no withdrawal syndrome. What a taper would be for is therefore a real question rather than an obvious one.
What the placebo arms of the withdrawal trials actually tell us
Three randomised withdrawal designs have tested what happens when treatment stops. Their results are consistent and they are consistently misreported.
On-off cycling, and the argument from receptor biology that does not hold
The schedules in circulation, described accurately, with their evidentiary status attached.
Why "muscle-sparing" is a marketing term and not a measurement
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.
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.
Side effects, cost, supply, target: four reasons with four trajectories
Why the reason for stopping changes what happens afterwards.
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.
Tapering: a word borrowed from drugs with withdrawal syndromes
These agents produce no dependence and no withdrawal syndrome. What a taper would be for is therefore a real question rather than an obvious one.
What STEP 4 tells us about maintenance, and what it does not
The commonest real-world strategy in this drug class is the least studied one.
What the placebo arms of the withdrawal trials actually tell us
The evidence on stopping is better than the evidence on almost anything else in this field, because somebody deliberately randomised it.
Why people actually stop, in the order they actually stop
Cost is the modal reason for discontinuation in every dataset we have seen, and it is absent from the clinical literature.
Why "muscle-sparing" is a marketing term and not a measurement
The gap between a defensible recommendation and a confident one is where most of the harm in this subject lives.