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The studies Ive seen say that patients tend to plateau with semaglutide at 60 weeks

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The present studies demonstrate that frequent dietary l-carnitine, even among some vegans/vegetarians, induces the gut microbiotas capacity to produce TMAO, and may thus foster proatherogenic processes (6)

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Polyethylene glycol 3350 (MiraLAX) is generally recommended as first-line pharmacologic therapy because it is safe for extended use, does not cause electrolyte disturbances when used as directed, and effectively softens stool by drawing water into the intestinal lumen