TrialTracker_MD said:The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…
TrialTracker_MD said:...the STEP extension data on maintenance dosing is concerning...
Let me offer a different interpretation of the same data. Yes, 2/3 of weight was regained after discontinuation. But consider:
- This is consistent with EVERY chronic disease medication ever studied
- 1/3 of patients maintained significant weight loss — who are they and why?
- The metabolic improvements partially persisted even with weight regain
- The data supports long-term treatment, not a "course" of therapy
The takeaway isn't "the drug fails when you stop" — it's "chronic diseases require ongoing treatment." We've always known this.
Dr.PainCLE said:Agreed on the ranges, with the condition that a single DEXA is not a measurement, it is one draw from a distribution.
That reframing is the part I needed. Adding it to my notes with a link back to this thread.
TrialTracker_MD said:The intervention that works is boring and well evidenced: resistance training two to three times a week at a genuine effort, protein at 1.4 to 2.0…
This is where I part company with the consensus forming above. I think this board over-worries about lean mass. Some lean loss is obligatory — you need less muscle to move a smaller body, and preserving mass you no longer need is not a health outcome. The question is whether strength and function held, and mine did.
Correct me if the detail matters more than I have assumed.
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Browse GL BiochemLindaRN_retired said:Planning the end of this rather than the middle of it, which nobody around me seems to want to talk about while it is still going well.
STEP 5 long-term data on maintenance dosing: the 104-week (2-year) extension showed sustained weight loss of -15.2% with continued semaglutide vs weight regain in the discontinuation group[1].
Key insight: weight loss continued to accrue between weeks 68 and 104 in many patients, suggesting the nadir may not occur until year 2+. The 68-week primary endpoint in most trials may underestimate maximal efficacy.
This supports long-term, open-ended treatment rather than fixed-duration "courses" of therapy.
[1] Garvey WT, et al. Nat Med. 2022;28:2083-2091.
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