HPLC_Greg said:Read four things before the headline number.
This is where I part company with the consensus forming above. I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them. The results probably generalise, and "probably" should be stated as an assumption rather than dropped.
nick_newbie 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…
nick_newbie said:...regarding the trial evidence...
I think this is an underappreciated point. To expand on it with some data:
A recent meta-analysis of 12 RCTs (n=8,400) found that the trial evidence was associated with a significant effect size across diverse patient populations[1].
The NNT was 8, which is comparable to metformin for T2DM prevention. That's a strong clinical argument for this approach.
Dr.BariatricHTX said:I would add the less popular caveat: these trial populations under-represented several groups, older adults and the highest BMI categories among them.
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.
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View ResultsA narrower follow-up, since the general answer is now clear:
Did your prescriber agree with that reading, and if not what was their objection?
Closing the loop on my own question.
Follow-up: I read the paper rather than the summary and the qualifier I was missing was in the second paragraph of the results.