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The STEP UP trial, a Phase 3b study published in The Lancet Diabetes & Endocrinology in 2025, evaluated a 7.2 mg weekly injection dose in over 1,400 adults with obesity (BMI of 30 or higher) and without diabetes

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Eric Topol of Scripps Research Translational Institute was more direct: "These peptides have no data to support their safety and efficacy." The clinical proponents argue that the FDA's safety concerns immunogenicity risk, impurity risk, organ toxicity are theoretically valid but speculative in practice

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Weeks 1 to 4: Starting Dose Titration Starting dose is 0.25 milligrams of semaglutide weekly, plus 1,000 micrograms of B12