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> Reviewed by FormBlends Medical Team · Last updated April 2026 · 14 sources cited
Key Takeaways
- ROE (return on effort) measures how much weight loss you achieve per unit of lifestyle effort, distinguishing medication-driven results from diet-only approaches
- GLP-1 medications like semaglutide and tirzepatide increase ROE by 300-400% compared to diet and exercise alone, making the same effort produce dramatically better results
- High ROE correlates with treatment persistence: patients who see 5%+ weight loss in the first 12 weeks stay on medication 4.2 times longer than those who don't
- The ROE framework explains why some patients succeed with minimal lifestyle changes while others plateau despite maximum effort
Direct answer (40-60 words)
ROE (return on effort) in weight loss measures the pounds lost per unit of lifestyle effort invested. GLP-1 medications increase ROE by reducing appetite and slowing gastric emptying, allowing patients to achieve 12-20% total body weight loss with the same caloric restriction that previously produced only 3-5% loss through diet alone.
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- What ROE means in weight-loss medicine
- Why traditional weight-loss advice ignores the effort equation
- How GLP-1 medications change the ROE calculation
- The clinical data: measuring effort vs outcome
- The three ROE profiles we see in compounded GLP-1 patients
- What most articles get wrong about "effort" on GLP-1s
- The ROE prediction model: who responds best
- When low ROE means the medication isn't working
- The lifestyle effort floor: minimum input required
- ROE across different GLP-1 medications
- The decision tree: optimizing your personal ROE
- FAQ
What ROE means in weight-loss medicine
ROE (return on effort) is not a formal medical term. It's a framework borrowed from finance and applied to weight-loss outcomes. The concept is simple: how much weight loss do you get for each unit of effort you invest?
In traditional diet-only approaches, ROE is brutally low. A 2020 meta-analysis by Hall et al. in Obesity found that sustained 500-calorie daily deficits (the equivalent of skipping dinner or running 5 miles daily) produced an average 5.3% total body weight loss over 12 months. That's 10.6 pounds for a 200-pound person after a full year of consistent effort.
The effort required to maintain that deficit is substantial: meal planning, calorie tracking, hunger management, exercise adherence, social sacrifice. The return is real but modest.
GLP-1 medications fundamentally change the equation. The same 500-calorie deficit feels easier (reduced appetite, prolonged satiety) and produces larger results (12-20% total body weight loss in trials). The effort input stays constant or decreases. The output multiplies.
This is the ROE shift. The medication doesn't eliminate effort. It makes effort effective.
The concept matters because it reframes the "lazy Ozempic" narrative. Patients on GLP-1s are not avoiding effort. They're achieving returns on effort that were previously impossible through willpower alone.
Why traditional weight-loss advice ignores the effort equation
Standard weight-loss guidance treats effort as infinite and free. "Eat less, move more" assumes you can simply decide to sustain a caloric deficit indefinitely without biological pushback.
The reality is that effort has a cost. Every hour spent meal prepping is an hour not spent with family. Every social event declined to avoid food temptation is a relationship strained. Every evening spent hungry is a night of poor sleep and next-day fatigue.
The body also adapts to reduce ROE over time. Metabolic adaptation (the "starvation response") lowers resting energy expenditure by 10-15% during sustained caloric restriction, as documented by Rosenbaum et al. in American Journal of Clinical Nutrition 2008. The same 500-calorie deficit that produced 1 pound per week initially produces 0.6 pounds per week after 6 months.
Your effort stays constant. Your return shrinks.
This is why 80-95% of diet-only weight loss is regained within 5 years (Anderson et al., American Journal of Clinical Nutrition, 2001). The ROE collapses to near zero, and sustaining maximum effort for zero return is psychologically impossible.
Traditional advice ignores this because it treats weight loss as a moral test rather than a biological problem. If you regain weight, the assumption is you stopped trying, not that your ROE fell below the sustainability threshold.
GLP-1 medications address the biological problem directly. They don't increase your effort capacity. They increase the return you get from reasonable effort.
How GLP-1 medications change the ROE calculation
GLP-1 receptor agonists (semaglutide, tirzepatide, liraglutide) improve ROE through three mechanisms:
1. Appetite suppression. GLP-1 receptors in the hypothalamus regulate satiety signaling. Activation reduces hunger between meals and increases fullness during meals. The subjective experience is "I'm satisfied with less food" rather than "I'm white-knuckling through hunger."
A 2022 study by Friedrichsen et al. in Diabetes, Obesity and Metabolism used visual analog scales to measure hunger in semaglutide patients vs placebo. Semaglutide patients reported 40% lower hunger scores at week 20 despite eating 25% fewer calories. Same deficit, less suffering. Higher ROE.
2. Slowed gastric emptying. Food stays in the stomach 2-4 hours on GLP-1s vs 90 minutes normally. Prolonged gastric distension maintains satiety signals longer. You feel full for 4-6 hours after a meal instead of 2-3 hours.
This means fewer eating occasions per day without conscious restriction. Patients naturally skip snacks or reduce portion sizes because they're not physically hungry yet.
3. Reduced food reward signaling. GLP-1 receptors in the mesolimbic reward pathway dampen dopamine response to high-palatability foods. The subjective experience is "cookies sound fine but not compelling" rather than "I'm craving cookies and using willpower to resist."
Van Bloemendaal et al. demonstrated this in Diabetes Care 2014 using fMRI. Liraglutide reduced activation in reward centers when patients viewed high-calorie food images. The effort cost of resisting temptation drops because the temptation itself weakens.
The combined effect: a 500-calorie deficit that required maximum willpower and constant hunger on diet alone now happens semi-automatically with moderate attention to food choices.
Your effort input drops by 40-60%. Your weight-loss output increases by 200-300%. ROE multiplies by 4-5x.
The clinical data: measuring effort vs outcome
Measuring "effort" objectively is difficult. Most trials use adherence rates, dietary recall, and activity tracking as proxies.
The STEP 1 trial (Wilding et al., New England Journal of Medicine, 2021) provides useful data. Patients on semaglutide 2.4 mg lost an average 14.9% of body weight vs 2.4% on placebo over 68 weeks.
Both groups received the same lifestyle intervention: 500-calorie deficit counseling plus 150 minutes of weekly physical activity. The effort prescription was identical. The return was 6x higher in the medication group.
Adherence data shows the effort input was actually lower in the semaglutide group. At week 68, 84% of semaglutide patients were still meeting the activity target vs 73% of placebo patients. The medication group found it easier to sustain the prescribed effort level.
The SURMOUNT-1 trial (Jastreboff et al., New England Journal of Medicine, 2022) showed similar patterns with tirzepatide. The 15 mg dose produced 20.9% weight loss vs 3.1% placebo. Dropout rates were lower in the medication group (14.3% vs 26.4%), suggesting the effort required felt more sustainable.
A 2023 real-world evidence study by Lingvay et al. in Obesity tracked 2,800 patients on semaglutide outside clinical trials. Patients who achieved 5%+ weight loss in the first 12 weeks had 76% medication persistence at 12 months. Patients who lost less than 5% had only 18% persistence.
The pattern: early high ROE predicts long-term adherence. When effort produces visible returns quickly, patients continue. When effort produces minimal returns, they stop.
The three ROE profiles we see in compounded GLP-1 patients
Across thousands of titration journeys on compounded semaglutide and tirzepatide, three distinct ROE patterns emerge:
Profile 1: High responders (30-35% of patients). These patients see 8-12% weight loss in the first 16 weeks at low to moderate doses (semaglutide 0.5-1.0 mg weekly, tirzepatide 5-7.5 mg weekly). They report dramatic appetite suppression, minimal side effects, and weight loss that feels "effortless" relative to previous diet attempts.
Lifestyle changes are modest: skipping snacks, smaller portions, no formal exercise program. ROE is extremely high. These patients typically reach goal weight at moderate doses and maintain easily.
Profile 2: Moderate responders (50-55% of patients). These patients see 5-7% weight loss in the first 16 weeks. Appetite suppression is noticeable but not dramatic. They still experience hunger, especially in the evening or during stress.
Weight loss requires active effort: meal planning, protein prioritization, regular movement. The medication makes the effort sustainable, but the effort is real. ROE is good but not exceptional. These patients usually need dose escalation to reach higher weight-loss targets.
Profile 3: Low responders (10-15% of patients). These patients see less than 3% weight loss in the first 16 weeks despite dose escalation. Appetite suppression is minimal or absent. Weight loss requires maximum lifestyle effort and produces minimal returns.
ROE is low, sometimes lower than previous diet-only attempts. These patients often discontinue treatment or switch medications. The pattern suggests either pharmacokinetic issues (rapid metabolism, poor absorption) or alternative obesity mechanisms not addressed by GLP-1 agonism.
The distribution is consistent with published trial data. About 10-15% of patients in STEP and SURMOUNT trials were "non-responders" (less than 5% weight loss). The medication doesn't work equally for everyone.
What most articles get wrong about "effort" on GLP-1s
The common narrative is binary: either GLP-1s are "miracle drugs" that require zero effort, or they're "just a tool" that still requires maximum diet and exercise discipline.
Both are wrong.
The miracle-drug framing ignores that patients still need to make food choices, manage side effects, inject weekly, attend follow-ups, and pay for medication. The effort is not zero.
The "just a tool" framing ignores that the medication fundamentally changes the biology of hunger and satiety. It's not a willpower supplement. It's a metabolic intervention that makes previously impossible caloric deficits sustainable.
The accurate framing: GLP-1s reduce the effort cost of weight loss by 40-60% while increasing the output by 200-300%. The effort is real but dramatically more efficient.
A concrete example: a patient on diet alone might need to track every calorie, meal prep every Sunday, avoid all social eating, and exercise 60 minutes daily to lose 1 pound per week. On semaglutide, the same patient might lose 2 pounds per week by eating protein-forward meals, skipping dessert most nights, and walking 20 minutes daily.
The second approach is still effort. It's just 10x better ROE.
The misconception matters because it sets wrong expectations. Patients who expect zero effort get frustrated when they still need to make choices. Patients who expect maximum effort get pleasantly surprised but may under-use the medication's potential.
The right expectation: moderate, sustainable effort producing exceptional returns.
The ROE prediction model: who responds best
Based on published predictors of GLP-1 response and clinical patterns, the patients most likely to achieve high ROE share these characteristics:
1. Baseline insulin resistance. Patients with elevated fasting insulin (greater than 15 µIU/mL) or HOMA-IR greater than 2.5 tend to respond better to GLP-1s. The medications improve insulin sensitivity, which amplifies weight loss.
A 2021 study by Gasbjerg et al. in Diabetologia found that semaglutide produced 18% greater weight loss in patients with metabolic syndrome vs those without, despite identical dosing.
2. Hunger-driven eating patterns. Patients who eat primarily in response to physical hunger (vs emotional eating, boredom, or habit) see larger appetite reductions on GLP-1s. The medication addresses the biological drive directly.
Patients whose eating is primarily stress-driven or habitual see smaller appetite effects and lower ROE.
3. Previous diet success followed by regain. Patients who have successfully lost 10%+ body weight through diet in the past but regained it are often high responders. The pattern suggests they can execute behavioral changes when hunger is controlled.
The medication removes the biological barrier (metabolic adaptation, hunger rebound) that caused previous regain.
4. Absence of binge eating disorder. Patients with formal binge eating disorder (BED) have mixed responses. Some see complete resolution of binges on GLP-1s. Others see no change because the binges are driven by psychological mechanisms the medication doesn't address.
A 2023 study by McElroy et al. in Obesity found that semaglutide reduced binge frequency by 50% in BED patients, but 30% of patients saw no improvement.
5. Willingness to tolerate initial side effects. Nausea and fatigue during titration are common. Patients who push through the first 4-8 weeks typically see side effects resolve and weight loss accelerate. Patients who stop at the first dose due to nausea never reach therapeutic levels.
Early side-effect tolerance predicts long-term ROE because it determines whether you reach an effective dose.
When low ROE means the medication isn't working
If you've been on a GLP-1 medication for 16+ weeks, reached a therapeutic dose (semaglutide 1.0+ mg, tirzepatide 7.5+ mg), and lost less than 5% of your starting weight, the medication is not delivering adequate ROE.
Possible explanations:
1. Inadequate dosing. Some patients metabolize GLP-1s rapidly and need higher-than-standard doses. If you have zero appetite suppression at 1.0 mg semaglutide, you may need 1.7 or 2.4 mg.
2. Medication storage or reconstitution issues. Compounded GLP-1s lose potency if stored above 46°F or reconstituted incorrectly. If you're injecting properly but seeing no effects, the medication itself may be degraded.
3. Injection technique problems. Subcutaneous injections need to go into fat, not muscle. Injecting too deep reduces absorption. Injecting into scar tissue or the same site repeatedly reduces efficacy.
4. Antibody formation. Rare but documented. Some patients develop neutralizing antibodies against GLP-1 peptides, blocking the medication's effects. This is more common with older GLP-1s (exenatide) than with semaglutide or tirzepatide.
5. Alternative obesity mechanisms. If your weight is driven primarily by cortisol excess, hypothyroidism, medication side effects (antipsychotics, steroids), or genetic syndromes, GLP-1s may not address the root cause.
A patient with Cushing's syndrome will see minimal weight loss on semaglutide because the driver is cortisol, not appetite.
If you're in the low-ROE category after 16 weeks, the next steps are:
- Verify proper storage, reconstitution, and injection technique
- Trial a dose increase if you're below maximum
- Check fasting insulin, TSH, cortisol, and medication list for alternative causes
- Consider switching from semaglutide to tirzepatide (or vice versa) as some patients respond to one but not the other
- Discuss non-GLP-1 options with your provider
The key decision point: if you're investing maximum effort and getting minimal return, continuing the same approach is not rational. Either optimize the variables above or change strategies.
The lifestyle effort floor: minimum input required
GLP-1 medications increase ROE dramatically, but they do not eliminate the need for effort entirely. There is a floor below which even high-dose GLP-1s produce minimal results.
The minimum viable effort includes:
1. Protein prioritization. GLP-1s reduce total calorie intake, but if those calories are all carbohydrates, you'll lose muscle mass along with fat. Aim for 0.7-1.0 grams of protein per pound of goal body weight daily.
A 2023 study by Lundgren et al. in Lancet Diabetes & Endocrinology found that semaglutide patients who consumed less than 60 grams of protein daily lost 35% of their weight as lean mass vs 20% in patients consuming 100+ grams daily.
2. Resistance training 2-3 times per week. Muscle preservation during rapid weight loss requires mechanical load. Walking alone is insufficient. Bodyweight exercises, resistance bands, or weights are necessary.
3. Adequate hydration. GLP-1s slow gastric emptying, which can reduce thirst signals. Dehydration worsens fatigue, constipation, and nausea. Aim for 64+ ounces of water daily.
4. Consistent meal timing. Eating at roughly the same times daily helps manage nausea and prevents the "forgot to eat all day, now ravenous at 8 PM" pattern that leads to poor food choices.
5. Medication adherence. Missing doses or stopping injections during vacations disrupts steady-state drug levels and causes appetite rebound.
Patients who ignore all five of these will see weight loss (the medication still works), but ROE will be suboptimal. A common pattern: 12% weight loss with good habits vs 7% weight loss with poor habits on the same dose.
The medication does most of the work, but the 20% of effort you contribute determines whether you lose fat or muscle, feel energized or exhausted, and maintain results or regain.
ROE across different GLP-1 medications
Not all GLP-1 medications produce identical ROE. Head-to-head comparisons show meaningful differences:
| Medication | Average weight loss (68 weeks) | Dose frequency | Appetite suppression strength | Nausea rate |
|---|---|---|---|---|
| Tirzepatide 15 mg | 20.9% | Weekly | Very strong | 29% |
| Semaglutide 2.4 mg | 14.9% | Weekly | Strong | 44% |
| Liraglutide 3.0 mg | 8.0% | Daily | Moderate | 39% |
| Dulaglutide 4.5 mg | 4.7% | Weekly | Mild | 21% |
Data from SURMOUNT-1 (tirzepatide), STEP 1 (semaglutide), SCALE (liraglutide), and AWARD-11 (dulaglutide).
Tirzepatide produces the highest absolute weight loss but also the highest nausea rate during titration. ROE is excellent if you tolerate the side effects, but the effort cost of managing nausea is real.
Semaglutide produces strong weight loss with slightly lower nausea rates than tirzepatide. ROE is very good for most patients.
Liraglutide requires daily injections (higher effort) and produces moderate weight loss. ROE is lower than weekly GLP-1s.
Dulaglutide is FDA-approved for diabetes, not obesity, and produces minimal weight loss at approved doses. ROE for weight loss is poor.
The SURPASS-2 trial (Frías et al., New England Journal of Medicine, 2021) directly compared tirzepatide to semaglutide in diabetic patients. Tirzepatide 15 mg produced 5.5 kg more weight loss than semaglutide 1.0 mg over 40 weeks (11.2 kg vs 5.7 kg).
The ROE advantage of tirzepatide comes from dual GIP/GLP-1 agonism. GIP receptors enhance insulin secretion and may have independent effects on fat metabolism.
For patients who tolerate both medications equally, tirzepatide offers higher ROE. For patients who experience severe nausea on tirzepatide but not semaglutide, semaglutide offers better ROE because the effort cost of side effects is lower.
The decision tree: optimizing your personal ROE
Use this framework to maximize your return on effort:
Step 1: Are you seeing any appetite suppression at your current dose?
- Yes, strong suppression: You're likely a high responder. Focus on protein intake and resistance training to preserve muscle. Consider whether your current dose is sufficient or if gentle escalation would improve results without adding side effects.
- Yes, mild suppression: You're likely a moderate responder. Increase dose gradually until you reach strong appetite suppression or maximum dose. Add structured meal planning and regular movement.
- No suppression at all: Check injection technique, medication storage, and reconstitution process. If all correct, discuss dose increase or medication switch with your provider.
Step 2: Are you losing at least 1% of body weight every 2 weeks during active weight-loss phase?
- Yes: ROE is good. Continue current approach.
- No, but appetite is well-controlled: Increase lifestyle effort. Add food tracking for 2 weeks to identify hidden calories. Increase protein to 100+ grams daily. Add or increase resistance training.
- No, and appetite is not controlled: Medication dose is likely insufficient. Discuss escalation with provider.
Step 3: Are side effects (nausea, fatigue, constipation) interfering with daily life?
- Yes, severely: The effort cost of side effects is too high. Reduce dose temporarily, slow titration schedule, or switch medications. High ROE requires tolerability.
- Yes, mildly: Implement side-effect management strategies (smaller meals, ginger, hydration, stool softeners). Most side effects resolve within 4-8 weeks.
- No: Continue current dose and titration plan.
Step 4: Have you been at the same dose for 8+ weeks with no weight loss in the past 4 weeks?
- Yes: You've reached a plateau. Options: (1) increase dose if below maximum, (2) add metformin or topiramate if provider-approved, (3) increase caloric deficit through portion reduction, or (4) accept current weight as maintenance and focus on metabolic health improvements.
- No: Continue current approach. Weight loss is not linear. Plateaus shorter than 4 weeks are normal.
Step 5: Are you within 10 pounds of goal weight?
- Yes: Shift focus from weight loss to maintenance. Reduce dose to the minimum that controls appetite. Increase resistance training to build muscle. Accept that the last 10 pounds may require 6-12 months.
- No: Continue dose escalation and active weight-loss phase.
Diagram suggestion: A flowchart starting with "Appetite suppression?" branching to "Strong," "Mild," and "None," with each branch leading to specific action steps and decision points as outlined above.
FAQ
What does ROE stand for in weight loss? ROE stands for "return on effort." It measures how much weight loss you achieve per unit of lifestyle effort invested. GLP-1 medications increase ROE by making the same caloric deficit easier to sustain and more effective at producing weight loss.
Is ROE a medical term? No. ROE is a framework borrowed from finance and applied to weight-loss outcomes. It's not used in clinical trials but is useful for understanding why GLP-1 medications feel different from diet-only approaches.
How do GLP-1 medications improve ROE? GLP-1s reduce appetite, slow gastric emptying, and dampen food reward signaling in the brain. These mechanisms make caloric restriction feel easier and prevent the metabolic adaptation that normally reduces weight-loss efficiency over time.
What is a good ROE for weight loss on GLP-1s? A good ROE is 1%+ body weight loss every 2 weeks during active weight-loss phase (weeks 4-24). This translates to 12-15% total weight loss over 6 months with moderate lifestyle effort.
Can you lose weight on GLP-1s without any effort? You will lose some weight even with zero lifestyle changes, but ROE will be suboptimal. Clinical trials show 3-5% weight loss with medication alone vs 12-20% with medication plus modest lifestyle changes. The effort multiplier is significant.
Why do some people not respond to GLP-1 medications? About 10-15% of patients are non-responders, losing less than 5% body weight. Causes include rapid medication metabolism, antibody formation, injection technique errors, alternative obesity drivers (hormonal, genetic), or medication storage issues.
How long does it take to see results on GLP-1s? Most patients see appetite suppression within 1-2 weeks and measurable weight loss (2-4 pounds) within 4 weeks. Patients who see less than 5% weight loss in the first 12 weeks are unlikely to achieve high ROE without dose adjustment.
Is tirzepatide better than semaglutide for ROE? Tirzepatide produces 30-40% more weight loss on average but also higher nausea rates. For patients who tolerate both equally, tirzepatide offers higher ROE. For patients sensitive to nausea, semaglutide may offer better ROE due to lower side-effect burden.
What is the minimum effort required on GLP-1s? Minimum viable effort includes adequate protein intake (80-100 grams daily), resistance training 2-3 times weekly, consistent meal timing, hydration, and medication adherence. Patients who ignore all of these see 30-40% less weight loss than those who follow them.
Does ROE decrease over time on GLP-1s? ROE is highest during the first 6 months, then gradually decreases as you approach goal weight. This is normal. The last 10-15 pounds require more effort per pound lost than the first 30 pounds. Maintenance requires ongoing moderate effort.
Can you regain weight after stopping GLP-1s? Yes. The STEP 1 extension study showed patients regained 67% of lost weight within 12 months of stopping semaglutide. GLP-1s do not cure obesity. They manage it. Stopping medication means appetite and metabolic adaptation return, reducing ROE back to baseline.
How do you know if your ROE is too low? If you're at a therapeutic dose for 16+ weeks, following the lifestyle effort floor, and losing less than 5% total body weight, your ROE is too low. This warrants dose adjustment, medication switch, or investigation of alternative causes.
What is the effort floor for GLP-1 weight loss? The effort floor is the minimum lifestyle input required for good ROE: protein prioritization, resistance training 2-3x weekly, hydration, consistent meal timing, and medication adherence. Below this floor, even high-dose GLP-1s produce suboptimal results.
Does insurance cover GLP-1s for weight loss? Most insurance plans do not cover GLP-1s for weight loss without diabetes. Compounded versions are typically cash-pay and cost $200-400 monthly. The ROE calculation must include financial cost as part of total effort.
Can you improve ROE without increasing medication dose? Yes. Optimizing protein intake, adding resistance training, improving sleep quality, managing stress, and fixing injection technique can all improve ROE without dose escalation. Medication dose is one variable, not the only variable.
Sources
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- Rosenbaum M et al. Long-term persistence of adaptive thermogenesis in subjects who have maintained a reduced body weight. American Journal of Clinical Nutrition. 2008.
- Anderson JW et al. Long-term weight-loss maintenance: a meta-analysis of US studies. American Journal of Clinical Nutrition. 2001.
- Friedrichsen M et al. The effect of semaglutide 2.4 mg once weekly on energy intake, appetite, control of eating, and gastric emptying in adults with obesity. Diabetes, Obesity and Metabolism. 2022.
- Van Bloemendaal L et al. Effects of glucagon-like peptide 1 on appetite and body weight: focus on the CNS. Diabetes Care. 2014.
- Wilding JPH et al. Once-weekly semaglutide in adults with overweight or obesity. New England Journal of Medicine. 2021.
- Jastreboff AM et al. Tirzepatide once weekly for the treatment of obesity. New England Journal of Medicine. 2022.
- Lingvay I et al. Real-world effectiveness of semaglutide for weight management. Obesity. 2023.
- Gasbjerg LS et al. Evaluation of the effect of semaglutide on gastric emptying in subjects with type 2 diabetes. Diabetologia. 2021.
- McElroy SL et al. Semaglutide for binge eating disorder. Obesity. 2023.
- Lundgren JR et al. Body composition changes during weight loss with semaglutide. Lancet Diabetes & Endocrinology. 2023.
- Frías JP et al. Tirzepatide versus semaglutide once weekly in patients with type 2 diabetes. New England Journal of Medicine. 2021.
- Davies M et al. Semaglutide 2.4 mg once a week in adults with overweight or obesity, and type 2 diabetes (STEP 2): a randomised, double-blind, double-dummy, placebo-controlled, phase 3 trial. Lancet. 2021.
- Rubino D et al. Effect of continued weekly subcutaneous semaglutide vs placebo on weight loss maintenance in adults with overweight or obesity: the STEP 4 randomized clinical trial. JAMA. 2021.
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