glp 1 pathway diagram GLP-1 receptor agonists and DPP-4 inhibitors Pathway, Pharmacodynamics GLP-1R Signaling | Encyclopedia MDPI

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This phenomenon may help explain the obesity paradox, which suggests that, even though people who are obese are at greater risk of developing heart issues, once heart disease develops, individuals with higher BMIs appear to have a lower mortality risk than people with normal BMIs

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There is also discussion in the same Medical News Today article that standard trials escalate doses monthly mainly to optimize effect under defined trial conditions, but that in real-world practice, individuals differ widely in sensitivity, metabolism, side effect profile, etc