This is a continuation of a long topic, addressed by post number rather than by page. Start at post 1.
Post #30 is right about the mechanism and I think understates the practical bit.
Practical experience of Older adults, offered as one case with the conditions stated, not as a general finding. Conditions first, because they are what make it interpretable.
A definition problem is doing most of the work in this Older adults discussion. Once the term is pinned down I suspect the disagreement mostly goes away and what is left is small.
On post #33 — agreed on the reasoning, with one qualification.
Extrapolating a point estimate to somebody well outside the enrolled range should be described as an extrapolation every time it is done.
Post #34 answers the question as asked. The question underneath it is different.
Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance.
I read post #33 twice before replying, because I had assumed the opposite.
Older adults: I would want to see the raw numbers rather than the summary before agreeing. Summaries lose exactly the information that would settle this.
The reason Older adults is hard to answer is that the obvious measurement and the relevant quantity are not the same thing, and substituting one for the other is silent.
Genetic and ancestry-related differences in response are asked about regularly and the published evidence is thin enough that the honest answer is short.
Worth checking against a second source before it gets quoted onward.
Where I part company with post #36, and it is a narrow parting.
Being outside the studied population does not mean a treatment is unsafe. It means the usual evidence is not available and the reasoning has to be explicit.
Adding a source would improve this post and I do not have one to hand.
Older adults would be much easier to settle if anyone reported the denominator. Almost nobody reports the denominator.
Appreciated. The plain phrasing does more work here than a longer post would.
Post #41 put the caveat in the right place and I want to underline it.
Where the Older adults reasoning breaks down for me is the step from the group result to the individual case. That step is almost never argued for.
Building on post #41 rather than restating it.
Hypoglycemia risk: in people already on insulin or sulfonylureas, adding a GLP-1 agonist requires insulin dose reduction and close monitoring for hypoglycemia. This is manageable with attention.
Correct me on the arithmetic if it is wrong; I would rather know.
Older adults were included in the trials in smaller numbers than their share of the eventual population, so precision in that subgroup is poor.
Post #45 is the version of this I will quote in future. One addition.
Two claims get bundled together under Older adults and they need separating. The descriptive one — this is what was observed — is usually well supported. The causal one — this is why — usually is not.
Almost every disagreement in threads like this one dissolves once you say which of the two you are making.
Agreed, and I will stop repeating the version of this I had been repeating.
Post #48 answers the question as asked. The question underneath it is different.
Adolescents: a distinct evidence base exists. The compounds are not approved for routine adolescent obesity but are being studied. Adolescent physiology and psychology differ from adults' in ways that matter for this medication class.
I would hold that lightly until someone with a larger sample weighs in.
Reporting rather than recommending, on Older adults. What happened is above. Whether it should have is a different question and not one I am qualified to answer.
Older adults: sarcopenia risk is higher, polypharmacy is common, and the clinical trials did not enroll many people over 75. Extrapolating to very old people is extrapolating beyond the data.
Not the answer, but possibly the question that gets there.
Counterpoint on Older adults, offered without confidence: the same observation is consistent with a much duller explanation, and nobody has ruled the dull one out.
Useful. I had the fact and not the reason, which turns out to be the important half.
Pregnancy and planning: these compounds are not approved for use in pregnancy. Planning windows (how long to wait before attempting pregnancy) are not formally established. Conservative approaches wait several months to allow clearance.
It is one reading of the data and not the only reasonable one.
The most useful reply I ever got about Older adults was a request to state my units. It sounds like pedantry and it has saved me twice.
Building on post #55 rather than restating it.
Summarising the Older adults thread so far, since it is long and the answer is buried: the first reply has the method, the fourth has the correction to it, and the rest is people agreeing at length.
Post #55 put the caveat in the right place and I want to underline it.
Post-surgical populations, particularly after procedures affecting the gastrointestinal tract, interact with a delayed-emptying mechanism in ways that need specialist input.
I had written a reply contradicting post #58 and deleted it. Here is what survived.
One more thing on Older adults that took me far too long to see: the two figures people quote are not measuring the same quantity. Once you notice that, the apparent contradiction disappears.