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ForumsPublic SquareLoose skin after major weight loss — my results so far

Loose skin after major weight loss — my results so far

BethLabQueen Tue, Dec 17, 2024 at 2:13 PM 43 replies 2,238 viewsPage 1 of 9
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BethLabQueen
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Dec 17, 2024 at 2:13 PM#1

My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my material.

The narrow version of the question is how to read a result like this without either dismissing it or over-reading it, since the summaries all read like press releases.

If the honest answer is that nobody knows, that is a useful answer and I would rather have it.

4 7maya_sedona, stefan_berlin, Dr.EM_Chicago and 1 other
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CarlaRPh_TPA
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Dec 17, 2024 at 2:25 PM#2

Short answer first, then the reasoning. Relative and absolute effects need reading together. A 20% relative reduction on a high baseline risk is a large absolute benefit; the same relative figure on a low baseline risk is a small one, and press summaries almost always quote the relative number because it is bigger.

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julia.endo
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Dec 17, 2024 at 2:37 PM#3
CarlaRPh_TPA said:
Relative and absolute effects need reading together.

Forest plot interpretation for the the trial evidence meta-analysis: when reading the pooled estimate, pay attention to:

  1. Point estimate (HR/RR/OR) — center of the diamond
  2. Confidence interval width — precision of the estimate
  3. I² statistic — heterogeneity across studies
  4. Individual study weights — are results driven by one large trial?
  5. Prediction interval — range of plausible true effects in future settings

The the trial evidence meta-analysis shows a pooled RR of 0.85 (95% CI 0.66-0.85), I²=43%. This is a robust and consistent effect.

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kim_atl_prep
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Dec 17, 2024 at 2:49 PM#4
BethLabQueen said:
My own curve sits about four points below the published mean and I spent two months assuming that meant something was wrong with me or with my…

Same position here, arrived at the long way round. The gap between trial results and real-world results is consistent and it is not fraud. Trial participants get titration by protocol, scheduled contact, free drug and dietetic support; removing that infrastructure costs a few percentage points every time it has been measured. When your own curve sits below the published mean, that is the likeliest explanation before anything about you or your material.

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TrialNerd_Beth
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Dec 17, 2024 at 3:52 PM#5

Clinical perspective, offered as context rather than as advice.

Bayesian meta-analysis perspective on the trial evidence: traditional frequentist meta-analyses report point estimates and confidence intervals. Bayesian approaches provide probability distributions that are more intuitive for clinical decision-making.

For example: "There is a 98.5% probability that semaglutide 2.4mg produces >10% weight loss vs placebo" is more actionable than "RR 3.4, 95% CI 2.8-4.1, p<0.001."

The the trial evidence evidence is strong under both frameworks, but Bayesian analysis better communicates the degree of certainty for individual patient counseling.

Last edited: Dec 17, 2024 at 7:52 PM
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