SELECT trial: 20% MACE reduction — looking for input

Dr.PathRoch said:

Read four things before the headline number.

This is exactly what I could not find anywhere else. Adding it to my notes with a link back to this thread.

Adding the clinical framing, because it changes how the question reads.

Dizziness and cardiovascular risk: I was lightheaded for the first 2 weeks. Root cause was a combination of reduced caloric intake and mild dehydration.

Fix: minimum 80-100oz water daily, don't skip meals even if you're not hungry (eat small protein-rich snacks), and stand up slowly from sitting/lying positions. Also check your blood pressure — GLP-1-induced weight loss can make BP meds too strong, requiring dose reduction.

lisa_labSD said:

Relative and absolute effects need reading together.

Pushing back on lisa_labSD here. 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.

TinaHashiRN said:

SELECT is the trial that changed the framing of this class, because it was an outcome trial rather than a weight trial: about a 20% relative reduction…

TinaHashiRN said:

...we're creating a generation dependent on cardiovascular risk...

I understand the concern, but consider this analogy: are we "creating a generation dependent on" blood pressure medication? Cholesterol medication? Thyroid medication?

Obesity is a chronic disease with biological drivers. Treating it with medication is no different from treating any other chronic condition. The "dependency" framing implies weakness or moral failure — neither of which is accurate.

If ongoing medication is what keeps someone healthy, that's successful treatment, not dependency.

Moderator note: a post naming a supplier has been edited. Discuss suppliers in the review sections, not here.