[PREMIUM] Post-bariatric regain reversal — looking for input

matt_MKE said:

Extending the interval and reducing the dose are pharmacologically different.

No disagreement with matt_MKE. One condition attached. STEP 4 is the study that answers this and it is blunt. Participants who continued kept losing; participants switched to placebo regained about two thirds of what they had lost within a year, and the metabolic improvements faded with the weight. That is the same pattern as every other chronic-disease medication ever withdrawn, and it is an argument about the condition rather than about the drug.

matt_MKE said:

Extending the interval and reducing the dose are pharmacologically different.

The regain framing needs pushing back on. Two thirds regained means one third did not, and the trial provided no ongoing support to either group. Treating regain as pharmacologically inevitable is as unsupported as treating maintenance as automatic.

Short answer first, then the reasoning. One third of STEP 4 participants held most of their loss without the drug, and nobody has convincingly characterised who they are. That subgroup is the most interesting unanswered question in the field and it is routinely flattened into the two-thirds headline.

PharmacoVig_BOS said:

STEP 4 is the study that answers this and it is blunt.

Second this.