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Two questions come up more than any others. A colleague asks what is actually in the obesity drug pipeline. A patient asks how the medication they were just prescribed compares to the alternatives. I was answering both from my own notes and bookmarks, one message at a time, and wanted something I could send instead.
So I built two pages. This issue covers what each one does, what each one does not do, one methods detail that matters for how you read any weight loss trial, and a short note on how the newsletter is supported.
The trial explorer
michaelalbertmd.com/trials lists active phase 2 and 3 obesity drug studies indexed through a ClinicalTrials.gov search, and it refreshes from the registry rather than from a hand-maintained list. You can browse by drug, phase, and sponsor, and each entry links to the registry record. Because it depends on how sponsors register and tag their studies, listings can be incomplete, and the page says so. Clinicians use it to see when readouts like TRIUMPH are expected. Patients use it to see what is being studied, in plain language. A free subscription unlocks it; there is no paid version.
The medication comparison
michaelalbertmd.com/medications is new. It is a filterable comparison of selected trial results for approved and pipeline obesity medications: percent total body weight loss, with the source trial, duration, and estimand shown where the record specifies them. Unlike the tracker, which pulls from the live registry, this is a curated dataset I maintain by hand. It opens in alphabetical order and is not a ranking; the page cautions against reading it as one. Filters cover mechanism, route, outcomes data, adverse effects, weight loss threshold, and duration. It is open to everyone with no signup.
The estimand label is the detail I want to explain, because it affects how you read every weight loss trial. A trial can report two different results for the same dose depending on which question the analysis asks. In STEP 1, 1,961 adults with overweight or obesity and without diabetes were randomized to semaglutide 2.4 mg or placebo for 68 weeks.¹ Under the treatment policy estimand, which assesses results regardless of treatment discontinuation or rescue intervention, mean weight change with semaglutide was 14.9%, versus 2.4% with placebo. Under the trial product estimand, which estimates results assuming treatment was taken as intended without rescue intervention, it was 16.9%. Both are correct answers to different questions. Comparison charts that mix the two across drugs can create misleading comparisons, so this table shows the estimand wherever the record provides it. Cross-trial comparison has further limits: populations, baseline weight, and trial eras differ, and a table is not a head-to-head trial.
| The core claim A weight loss percentage without its estimand, trial duration, and population is not a comparable number. The comparison shows all three wherever the trial record provides them. |
Substance Over Noise goes out twice a week. The list is a mix of clinicians who prescribe these medications and patients who take them, and the articles and tools are written for both.
Here is what to expect:
One article a week on weekday mornings, plus a Saturday essay. Topics: incretin and obesity pharmacology, lipids and cardiovascular risk, metabolic disease, and the evidence behind longevity claims.
Every article opens with a Clinical Takeaway table and closes with full references. Press-release data is labeled as press-release data until the paper is published.
Trial readouts covered as they land, including the remaining TRIUMPH retatrutide results expected this year.
Free tools and cheat sheets, listed below, updated as the evidence changes.
| Substance Over Noise · What is free | ||||||||||||
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| The cheat sheets are PDF downloads from the products page at read.michaelalbertmd.com/products. The GLP-1 Prescribing Field Guide is on the same page as a paid download. |
| Optional. Nothing here is required to read or use anything above. | |||
| The articles, both online tools, and the three cheat sheets are free. Two things support the work financially, and both are optional. Supporting Reader is $5 a month or $50 a year; it funds the research, writing, and tools and does not unlock any content. The GLP-1 Prescribing Field Guide, Clinician Edition, a 26-page prescribing reference, is a paid PDF download from the same products page as the cheat sheets, at $19.99. Some issues will also carry a clearly labeled ad. Vineyard, where I am Chief Medical Officer, is my employer and commercial affiliation rather than a funder of the newsletter; the disclosure is at the bottom of every issue. | |||
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The bottom line
michaelalbertmd.com/trials shows what is being studied. michaelalbertmd.com/medications shows how selected trial results compare, with the estimand, duration, and source behind each number where the record provides them. Both are free. Bookmark them and share them with colleagues and patients.
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A comparison table shows which medication produced the largest average weight loss in its trial. It does not tell you which medication is right for a given patient, which depends on comorbidities, coverage, tolerability, and goals. That is the work at Vineyard, where our clinicians treat obesity as a chronic disease.
See how Vineyard approaches obesity care → |
Disclosure: The author is Chief Medical Officer of Vineyard, a telehealth obesity medicine practice. This article is educational and is not individualized medical advice. Talk with your own clinician before making changes to your care.
REFERENCES
1. Wilding JPH, Batterham RL, Calanna S, et al. Once-weekly semaglutide in adults with overweight or obesity. N Engl J Med. 2021;384(11):989-1002. doi:10.1056/NEJMoa2032183. (STEP 1; NCT03548935)
2. ClinicalTrials.gov. U.S. National Library of Medicine. Active phase 2 and phase 3 obesity trials, accessed September 2026. https://clinicaltrials.gov
Evidence-based obesity medicine, twice a week. Free.