The one randomised trial that combined an incretin with supervised exercise
One randomised trial has combined a GLP-1 receptor agonist with supervised exercise. Its result is the single most useful piece of evidence in this area.
Tirzepatide
Page 3 of 18 of this archive, newest first.
Measuring more frequently generates more flags and not more information
The argument for a baseline panel is that it makes every subsequent result interpretable. The argument against frequent monitoring is that noise accumulates faster than…
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.
The skeleton responds to load, and load is falling
What the Journal would want measured before treating this as settled in either direction.
Holidays, surgery, sickness: interruption in practice
Supply interruption is the commonest cause of unplanned re-titration in this market, and it is almost never framed that way.
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.
Why "muscle-sparing" is a marketing term and not a measurement
Almost every practical recommendation in circulation was established in a population that does not resemble the people now following it.
Side effects, cost, supply, target: four reasons with four trajectories
The trials studied planned withdrawal. Almost nobody stops that way.
What the trial protocols permitted, and what the labels omitted
Nausea and gastric delay attenuate over weeks at an unchanged dose. That single physiological fact is the entire justification for holding.
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.
Vitamin D, adiposity, and a volume-of-distribution problem
What the trials measured, which in the case of micronutrients is very little.
Target dose, effective dose, and the distance between them
The dose-response curve in this class flattens near its top. That has direct consequences for whether the final rung is worth climbing.
Holding a dose is a decision, not a failure
Every major phase 3 protocol in this class allowed escalation to be delayed for tolerability. Almost no product label explains the mechanics of doing so.
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.
Percentage of loss, absolute kilograms, and the sleight of hand between them
Both the reassuring reading and the alarming reading are supportable from the same tables. This piece sets out which is which.
What the upper limit of normal for ALT should be, and why it is not
What the renal and hepatic outcome programmes actually measured, and over what duration.
Reading the survodutide titration schedule as a regulatory artefact
What the regulatory dossiers actually contain on dose selection is remarkably thin, and worth knowing before treating the ladder as settled science.
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.
Beta-arrestin, cAMP, and the part of dulaglutide’s mechanism nobody quotes
The receptor is expressed in more tissues than the popular account allows, and that is the whole story.
The glycaemic panel before treatment: what is worth measuring and when
The assay is not the problem. The interpretation of a lagging integral as a current measurement is the problem.