Semaglutide is turning into heart and kidney medicine, and the weight loss is not why. That is the finding the tidy story misses.
In FLOW, people on the drug lost a modest 5.5 kilograms against 1.45 on placebo, yet their risk of a major kidney event fell 24 percent, from 23.2 to 18.7 percent, roughly 22 people treated for 3.4 years to keep one off dialysis or spare one death. A mediation analysis put the share of that benefit explained by weight loss at essentially zero.
SELECT found the same shape for the heart: the drop in waist circumference accounted for about a third of the effect, the number on the scale for none of it in any straight line. Two-thirds is doing something still unnamed.
A statistical emulation in type 1 diabetes fits the pattern but is not a trial. Consistent is not proven.
