Cochrane says GLP-1s work for weight loss, but independent data is still thin
Posted by weekendnate in Weight Loss & Metabolic - 1 points, 4 comments.
Cochrane put out a review basically saying GLP-1s do what they say on the tin for weight loss, but they flagged that most of the big trials are industry funded and we need more independent work to really know long term outcomes.
That tracks with what I keep thinking about this whole class of drugs. The short term weight loss numbers are real and the appetite suppression is hard to argue with if you have actually been on one. The stuff that is still murky to me is what happens after two years, what muscle loss looks like versus fat loss, and how people actually keep it off after stopping. A lot of the "success stories" stop being tracked the second someone goes off the drug.
The Cochrane piece feels like the most honest framing I have seen from a major outlet. They are not hyping and they are not fear mongering, they are just saying the evidence is real but also narrower than the marketing suggests. For anyone titrating right now, did the independence of the data ever actually change how you approach your protocol, or did you just trust your numbers and keep going?
Comments
- steph414: I've been kinda stuck on the same thing with the muscle loss question specifically. I looked into this a while back and the lean mass loss numbers in the STEP trials were pretty uncomfortable to read (something like 30-40% of total weight lost being lean mass in some of the semaglutide trials). That's the part that makes me skeptical of just trusting the scale. Have you seen any independent body comp data out there, or is it all just DEXA scans from the manufacturer trials? I keep wondering if
- weekendnate: Yeah, the lean mass numbers in the STEP trials are what made me start tracking my own DEXA every 3 months instead of just trusting the scale. My first scan after 12 weeks showed about 25% of the loss was lean tissue, which kinda spooked me into upping protein and adding heavier resistance work. I have not seen any solid independent DEXA data outside the manufacturer trials either. Most of what I can find is small clinic case series or reddit DEXA posts, which is not exactly rigorous. If you fin
- retired_coldplunge: Yeah the lean mass piece is what made me start asking people at the gym to push protein harder while on these. I'd want to see DEXA work from someone not on the payroll too (fwiw even the funded scans might be flattering the drug since adherence and resistance training are basically free variables in those trials). Has anyone here actually paid for their own DEXA before and during, just out of curiosity?
- weekendnate: The funded DEXA scans are almost certainly flattering the drug, yeah, that is the part that bugs me. Adherence drops, resistance training is barely reported, and the lean mass numbers look better than they probably are in the real world. I have done two DEXA scans on my own dime, baseline and around month 5 on tirz. Lean mass dipped about 1.8 kg, fat dropped 9.4, so roughly 16% of the loss was lean by my numbers. That is with me lifting four days a week and pushing 130+ g of protein most days.
Community discussion - research and educational context only. Not medical advice.