Test yourself
11 questions
01
According to the essay, why is framing GLP-1 agonists as either miraculous or dangerous inadequate?
ABecause the drugs have not been studied long enough to draw conclusions
BBecause the clinical reality sits between those positions, and the decisions that matter are made in that space
CBecause the miraculous framing is correct and the dangerous framing has been disproven
The essay opens by rejecting both extremes. The clinical decisions that matter – composition, concurrent training, psychological preparation – exist in the space between the binary positions.
02
What mean body weight reductions does the essay cite for semaglutide and tirzepatide in randomised trials?
ATen to fifteen percent over fifty-two weeks
BTwenty-five to thirty percent over eighty weeks
CFifteen to twenty-two percent over sixty-eight to seventy-two weeks
The essay cites 15–22% mean body weight reduction over 68–72 weeks from the STEP and SURMOUNT trial programmes.
03
In the STEP 1 body composition substudy, approximately what proportion of total weight lost was classified as lean tissue?
ARoughly twenty percent
BRoughly thirty-nine percent
CRoughly fifty-five percent
The substudy found ~8.4 kg fat loss and ~5.3 kg lean mass loss – making lean tissue roughly 39% of total weight lost.
04
Why does the essay say the 5.3 kg lean mass loss figure overstates actual skeletal muscle loss?
ABecause DEXA lean mass includes water, glycogen, connective tissue and organ mass – not just skeletal muscle
BBecause the substudy used an outdated DEXA protocol that inflated lean mass readings
CBecause most participants were concurrently resistance training, which preserved their muscle
The essay emphasises that DEXA lean body mass is everything that is not fat or bone – total body water, glycogen, connective tissue, organ mass. A substantial portion of the lean mass reduction represents water and glycogen depletion, not contractile muscle fibre loss.
05
What muscle-to-fat loss ratio does the essay describe as achievable with structured resistance training, adequate protein, and sleep?
AApproximately 1:2
BApproximately 1:4
CApproximately 1:6
The essay states that in a well-managed programme – resistance training 3–5×/week, protein ≥1.6 g/kg, adequate sleep – the achievable target is a muscle-to-fat loss ratio of approximately 1:4.
06
What is 'slimmer's paralysis' as described in the essay?
AA neurological side effect caused by the direct neurotoxicity of semaglutide
BCompression of the common peroneal nerve at the fibular head after rapid loss of the cushioning fat pad, presenting as foot drop
CTemporary lower-limb weakness caused by caloric deficit during any pharmacological weight loss
The essay explains this as a mechanical consequence of rapid fat loss at a specific anatomical site – the subcutaneous fat pad cushioning the common peroneal nerve around the fibular head – not a drug side effect. It occurs across all weight-loss modalities.
07
How does the essay characterise the most intelligent clinical use of GLP-1 agonists for some patients?
AAs a bridge – a temporary intervention that reduces body mass to a point where resistance training, dietary restructuring and habit formation can take hold
BAs a permanent replacement for dietary and exercise interventions
CAs a last resort after bariatric surgery has been attempted and failed
The essay describes the drug as a bridge for some patients – suppressing the signal, reducing mass to a point where joints tolerate exercise and concurrent behavioural work can take hold. The drug is the beginning of the process, not the end.
08
What analogy does the essay use to argue there is no clinical shame in lifelong GLP-1 therapy?
AInsulin therapy in type 1 diabetes
BLifelong anticoagulation after mechanical heart valve replacement
CAntihypertensives and statins – chronic disease management frameworks we already accept without moralising
The essay draws a direct parallel: we do not ask patients on antihypertensives to "earn" their blood pressure, nor frame lifelong statin use as moral failure. The same chronic disease management framework applies.
09
What happened in the STEP 1 extension trial after participants discontinued semaglutide for one year?
AThey maintained most of their weight loss but lost cardiometabolic improvements
BThey regained two-thirds of their prior weight loss and cardiometabolic improvements reverted toward baseline
CThey regained all lost weight within six months but retained improved blood pressure
The STEP 1 extension showed two-thirds weight regain within one year of discontinuation, with cardiometabolic improvements reverting in parallel – consistent with obesity as a chronic disease.
10
What psychological observation does the essay make about some patients who achieve weight loss pharmacologically versus behaviourally?
APharmacologically assisted patients universally report higher life satisfaction
BSome patients experience a hollowness when the pharmacological result reverses, because the psychological reward of sustained personal effort is a different category of experience
CBehavioural weight loss always produces better mental health outcomes than pharmacological weight loss
The essay carefully distinguishes the physiological legitimacy of pharmacological treatment from the psychological reality some patients report – a hollowness from the absence of evidence that they built the result themselves. Both observations are true simultaneously.
11
What does the essay argue should be included in the prescribing conversation before the first injection?
AA mandatory psychiatric evaluation and clearance
BA signed commitment to discontinue the drug within twelve months
CThe psychological dimension of treatment – preparing the patient that the result may feel different from what they expected
The essay frames this as completing the informed consent – not undermining the treatment. Preparing a patient for the possibility that the result may feel different from what they expected is part of the prescribing conversation.
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