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doi: 10.1038/s41586-020-2456-9 231 Robledinos-AntnN.Fernndez-GinsR.MandaG.CuadradoA

Acknowledgements This research was funded by the Natural Science Foundation of Zhejiang Province (No

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these were bile acid metabolites such as cholate and chenodeoxycholate, lipid metabolites such as arachidonic acid, C16:0-LPC, C18:0-SM, docosapentaenoate, adrenic acid and stearoyl ethanolamide, metabolites involved in the metabolism of protein or amino acids, such as imidazole propionate, ADMA and creatine, and active metabolites or neurotransmitters such as the n-acetylputrescine, diacetylspermine, malonate

How to Switch The transition is straightforward: Stopping Saxenda: No taper required Can stop after last daily dose No withdrawal effects Starting semaglutide: Begin at starting dose (0.25mg weekly) Follow standard titration schedule Some providers start at higher doses for patients switching from other GLP-1s, but standard titration is safest Timing: Can start semaglutide the week after stopping Saxenda No mandatory washout period Some providers start immediately after last Saxenda dose What to Expect During transition: Appetite suppression may temporarily decrease during early semaglutide titration GI side effects may recur as you adjust to new medication Full semaglutide effect takes 4-5 months to reach After transition: Most patients see additional weight loss beyond what Saxenda achieved Weekly dosing is typically more convenient Similar ongoing management Transition Considerations Timing expectations: Dont expect immediate additional weight loss Titration period is necessary even for patients experienced with GLP-1s Full benefit of switch becomes apparent at maintenance doses Managing expectations: Some initial adjustment period is normal The convenience benefit is immediate Weight loss benefit develops over months Practical Considerations for Each Medication Understanding day-to-day use helps set expectations