> as it only causes a reduction in 10%-20% of body weight

This was simply when the studies ended. Weight loss for most definitely tails off, but doesn't completely stop if you continue longer than the 18mo SURMOUNT-4[0] study went for with Tirzepatide.

I also do not know if this was patients going on maintenance dosing, staying the same, or ramping up doses to the full 15mg max dose. Would need to re-read it as it's been some time.

fwiw Tirzepatide is actually around 25% average loss vs. 20%. My anecdotal evidence from my peer group shows that the vast majority can go further than 25% (if needed) and then maintain it - but that does require significant lifestyle changes to maintain. The few who simply kept eating junk but less of it had far less drastic results.

I do consider it a performance enhancing drug for dieting due to that fact. Those that use it as one tool of many seem to do incredibly well. Those that use it as the only tool have much worse outcomes. No surprises there, but it was surprising to me how durable so far those who decided to make life changes have stuck with it now over the course of around 3+ years.

My random guess would be that if you use it to break habits and establish new ones, you tend to become a super responder. I like to tell people it was perhaps roughly 60% of my weight loss (36% or so, but I tapered off due to hitting my goal) was due to the drug, 40% due to other factors like eating better and creating new workout habits. The drug simply made it much easier than previous attempts at dieting, and the results turned into a feedback loop.

Another pet theory of mine is that if you use it to break a food addiction, you end up being able to stay on the wagon easier. This is based on other life experiences with other substances - the longer you stay off, the easier it becomes (for most) to abstain. Especially if you create new habits in their place. I no longer crave those late night taco bell runs like I once did even when (mostly) off the drug itself.

[0] https://pubmed.ncbi.nlm.nih.gov/38078870/