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The head-to-head SURMOUNT-5 trial answered this question definitively for most situations

MC1R Pathway Melanogenesis Via MC1R engagement, MT-2 activates the Gs/adenylate cyclase/cAMP/PKA pathway in melanocytes, upregulating tyrosinase activity and stimulating eumelanin production the same primary pigmentation mechanism as MT-1, but with additional receptor activity overlapping the broader melanocortin axis

The trial also showed that GI side effects were "mostly mild to moderate in severity" and were "partially mitigated with a lower starting dose." This means that many of the side effects people try to manage through timing can also be addressed through dose adjustment

She helps patients protect muscle, stabilize nutrition, and maintain healthy habits long after active treatment is complete