This study is a follow-up to the STEP1 trial and assessed the impact of stopping semaglutide 2.4mg compared to placebo on weight trajectory with a 1-year follow-up.

As expected there was significant weight regain which was associated with adverse metabolic parameters.

This highlights the chronic nature of obesity and need for long-term treatment as is the case with other complex chronic diseases.

1. I appreciate these analyses were exploratory but formal statistical analyses may inform further studies.

2. The weight regain appeared to be plateauing by the end of 1-year. How do these results compare to previous studies with withdrawal of weight loss medications and what may explain the differences. Comparison with STEP 4 would be useful to include in the discussion.

3. The 5% weight loss threshold has some evidence for improving metabolic parameters and is mandated by regulatory authorities for weight loss medications. Those with >20% weight loss still had >5% weight loss on average. Overall what proportion of patients had 5% or greater weight loss from baseline

4. Those with pre-DM and T2D lose less weight with GLP-1RA and other weight loss medications. Is the glycemic status at 1-year a modulator of weight regain?