Phase 3 28.7% vs Phase 2 24.2%: what am I missing?

Peer review matters. Company 28.7% could shrink later.

The 24.2% was efficacy etsimand, not a completer average. That can explain part of the gap.

A1c 5.8 to 5.4 is solid. How long?

Your fasting glucose drop is almost 16 points. Yeah, glucose often moves before weight early on.

I've been digging into the CTgov entries. NCT05548231 enrolled 32, NCT06039826 46, and NCT05931367 was the knee OA study at 445.

The two bigger completed studies are NCT05882045 at 1,946 and NCT05929066 at 2,335. That is why I would not compare your single log to 28.7% at all. The Phase 2 24.2% at 48 weeks is already a mean, and the Phase 3 press releases are not peer-reviewed.

Your A1c change is interesting though; glucose shifts can lag or lead weight change depending on the person.

I'd take 18% at 48 weeks. Small trials aren't powered for 24 vs 28.

But if the big Phase 3 enrolled different BMI ranges, the percentage gap might be baseline effect.

Exactly. The knee OA arm was 445 people, so not tiny, just not the main obesity cohort.

I plugged the percentages into my own starting weight instead of comparing the percentages head-on: at 231 lbs, 24.2% would be 175 and 28.7% would be 165. So the phase 3 'step up' is about 10 lbs for someone my size, not a whole different universe.

My 48-week drop was 18.2%, and it was lumpy as hell: stuck at 201 for almost five weeks, then 189 after a vacation where I walked 12k steps a day. Trial means hide that; they also depend on baseline BMI, how dropouts are counted, and whether the phase 2 population had more people with T2D or different adherence.

The 1,946 and 2,335 trials are big enough to matter, but still not peer-reviewed. I'd read 28.7% as maybe real but probably a different population plus support, not a magic new level. What was baseline BMI in the phase 2 vs phase 3?

Everyone keeps quoting 48 weeks at 19.1%, which honestly makes it a phase 2 dropout with good PR.

The scale called me a failure for nine days, then my jeans fell down. Trust the tape too.

My week 30 to 40 stall turned out to be sleep, not food: I was averaging 5.5 hours and 4k steps, then got back to 7.5 hours and a 45-minute after-dinner walk, and the scale moved 7 lbs over six weeks.

If phase 3 sites had better sleep/step coaching, that alone could explain part of the 28.7 vs 24.2 gap. How was your sleep and step count during weeks 30 to 40?

28.7% smells like completers-only math; were the Phase 3 withdrawals counted the same way as Phase 2?

I stopped chasing headline percentages after my 7-day average hid a 4-lb salty weekend. I track navel waist and a monthly photo; scale was down 21% at week 48, but waist was down 5.5 inches. The 28.7 vs 24.2 gap could just be different baseline BMI or adherence rules, not a new step change.

My 28.7-style whoosh was just water: one salty weekend erased 3 lbs, then it came back by Wednesday.

Your 231 to 189 is about 18.2%, so you're already closer to the Phase 2 mean than it feels. I added 8k steps and two 20-minute dumbbell circuits at week 36; my 12-week rate went from 0.7 to 1.1 lb/week without changing meals much. Trial lifestyle support may explain part of the 28.7 gap.

Week 30 broke my brain: scale flat 10 days, then down 3.2 lbs by day 14.

Sleep was my weird lever: weeks 3–11, at 7.5 hours I averaged 1.1 lb/week, at 5.5 hours only 0.4. The reversal was that forcing 8 hours made me anxious and snacky; 7.5 plus a 20-minute after-dinner walk fixed my evening cravings beter than any food swap.

The 28.7 is a protocol mean, not a promise for what week 48 looks like in real life. What broke a long flat stretch was adding 3x/week squats and rows for 6 weeks: scale flat, navel tape down 1.5 inches, shirts went L to M. Waist measured weekly, same spot every time, before trusting any headline.