SUSTAIN-6 to SELECT — what worked for you?

Dr.ObesityMed said:

Steady state is the thing most people miss.

Agreed, though "tolerable" needs defining. A dose you tolerate by eating almost nothing is not tolerated, it is being paid for somewhere else — usually in lean mass, sometimes in adherence three months later.

FDA_TrackerJim said:

The oral formulation has different absorption behaviour and the dose numbers are not interchangeable, which is worth saying out loud because people…

Bookmarking. The distinction being drawn above is the one nobody else makes.

Dr.ObesityMed said:

Steady state is the thing most people miss.

I will push back on the "any working dose is fine" framing. The maintenance evidence sits overwhelmingly at the top studied dose, and the extension data shows regain tracking dose reduction rather than tracking stopping. Holding low is reasonable; pretending it is evidentially equivalent is not.

fiona_VT said:

Prescribed on cardiovascular grounds rather than for weight, and almost everything written for patients assumes the opposite.

fiona_VT said:

...cardiovascular risk is just another fad...

I understand the skepticism — we've all seen "miracle" weight loss solutions come and go. But consider what makes GLP-1 agonists different:

• Phase 3 RCTs with thousands of participants (not 20-person pilot studies)
• Published in NEJM, JAMA, Lancet (not press releases)
• Replicated across multiple independent research groups
• Proven cardiovascular and renal benefits beyond weight loss
• Biological mechanism fully characterized at the receptor level

This isn't a fad — it's a new drug class supported by the highest level of clinical evidence. The comparison to past fads is understandable but inappropriate.

Moderator note: reminder that nothing in this thread is medical advice, and that clinical claims need a source. Tagging this one for the weekly digest.