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The 30-minute fasting window is not arbitraryit's required for the drug to work

Results of Phase 2 trials have demonstrated that dulaglutide causes significant, dose-dependent reductions in HbA1c levels, with up to a 1.5% decrease observed after 12 weeks of treatment with a 1.5 mg dose

I also looked up the information about which states rank among the healthiest, and there's an overlap here, which makes sense since obesity and diabetes are two of the main reasons people use the meds

This activation is characterized by the sustained activation of neuroglial cells, such as microglia and astrocytes (Yang et al., 2020)

The main issue is more practical: tirzepatide slows gastric emptying , which can change the absorption of oral medicines, particularly those where small dose differences matter (and levothyroxine is one of them)