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.
Kind of tired of people taking anabolic steroids and then claiming it's a smaller part of their success or people being born rich talking about hard work whilst being on the golf course.
Just be happy that we live in a time where drugs have been painstakingly researched and move on without the ego boost. Be humble.
Multi-variate causation doesn't losslessly or deterministically reduce to a single dimension. Particularly when the causes aren't independent.
The drugs facilitate behaviour change. Changed behaviour helps the drugs work. Both done together are stronger than independently, and the strength of that interaction (and the overall effect) is mediated by other inputs.
I don't think anyone is arguing that the outcome would 100% not happen if it weren't for the drugs, but I think it is useful to note that part of the benefit comes from the habits the drugs help you form rather than simply 100% the appetite reduction the drug produces.
Since you brought up steroids, plenty of people take a gram of gear and look like they don't even lift. I'm not saying that someone taking anabolic steroids should act like they've worked just as hard as someone who is natural and at the same level of musculature, but good results take effort and consistency in the gym, diet, and rest of your lifestyle. You get some benefit just from being on steroids, but and there might be some genetic freak hyper-responders that blow up without any of that, but the overwhelming majority of people aren't going to look like they're a steroid user if they're not pushing themselves very hard as well, and the sheer amount of mediocre physiques from people on gear proves it.
Similarly, if someone turns their lifestyle around with the help of a GLP-1, if they change up their diet from crap to decent or good, if they move from being sedentary to exercising regularly, does the drug get 100% of the credit? Do we throw away all of the other work done?
You can both take a drug and also put in significant work that you can and should be proud of. Both things can be true.
I take a tiny dose of retatrutide for IBS (works amazingly well, btw). I’m not overweight. One week I stupidly got my injections mixed up and I took what’s still a fairly low but standard dose.
I could barely eat 1/3 of my supper. Granted, I’m sure you get used to it somewhat but it’s no small help that it’s giving you and I don’t know if it would help make new habits. The whole point of what most of us non-overweight people do is not eat despite being able to eat more, or even still being hungry. How are you learning that habit when it’s hard to eat and you stay full ridiculously long?
Sounds like you've never taken steroids brother, and with that mindset you shouldn't, because I'll tell you that no matter how much you shoot into your muscles, if you don't put in the work in the gym, there's no way you're going to get jacked.
Belgian Blues dont really need to go to the gym, so it’s not really that hard to phantom.
You will gain some additional contractile tissue doing nothing on gear. The average person, if faced with the two options, will gain more actual contractile tissue opting to lift weights without gear.
You can find huge quantities of people in gyms that are on gear and look like they barely lift.
Belgian Blues grow that large because of a mutation with their myostatin gene. This is hardly the same method of action.
For me? By changing my diet, understanding what "full" actually feels like, and keeping certain things I know I will binge eat out of the house. Plus the knowledge that I can have a bad day or two and get right back on the horse of healthy eating and be totally fine - if I gain a couple pounds I know precisely how to take them off in a repeatable and successful manner. That mental bit is key.
But for food itself - it's eating differently. Basically avoiding carbs and sugars does 90% of the work. It's not a 100% cutting out of my diet like Atkins, but it's prioritizing lean proteins and then simply being fuller for longer.
And part of it is learning you can be hungry for a period of time and not indulge. Which is much easier when you don't have those snacks you can't resist in the house.
It's certainly nothing groundbreaking, but habits are built over time. Motivation fades. I'm certainly not motivated every day or week or even month to eat well - but now it's habit and routine so it's almost more difficult to break it to go to the store to buy junk, or decide to order take out.
Going to the gym on a regular strict basis? I'm not exactly sure what changed. Likely being able to look in the mirror and feel a little vain? And knowing now it's all just about consistency. If I miss a day, just make it up the next day and stay on schedule. No big deal.
All those things stayed roughly the same after I came off Tirzepatide and hit my goal weight. They became harder of course, and I had some rebound (I overshot where I wanted to be on purpose on advice from my doctor) weight gain like most do - but I've now been stable at a healthy weight for over 18mo now. Habits have continued and stuck in place.
I'm not offended by the suggestion. It just doesn't make logical sense based on first person evidence. Those who change up their routines seem to (so far, at least) be having much longer and durable success. Taking the drugs absolutely allowed them (and myself) to do so, but it doesn't explain why others did not and the nearly perfect correlation between outcomes.
It could simply be luck I suppose? I'm not sure what other explanation could explain differing outcomes.
The thing is - I honestly don't care. If I return to old habits again and the drugs get me off those, great. I'll take it for life. It's not a moral issue to me, it's a practical one. When friends of friends come to me for advice, I will continue to tell them that it's most effective if you use it as a means to performance enhance your dieting and then use that space and motivation from the results to change your lifestyle habits that got you there to begin with. It's simply what seems to work at a pragmatic level.
Telling someone "don't worry, the drugs are going to change your grocery shopping decisions, get you walking on a daily basis, and get you into a consistent gym routine 100% on your own" seems rather silly. I can't see how it's helpful to anyone. It sets far more people up for success if they also put effort into change from their end as well.
Re: Steroids - those who work out while on them are going to see larger gains than those who don't. They are called performance enhancing drugs for a reason, same as I think of the GLP-1 drugs - just in a different category. You certainly will get results with either, but they increase the results of effort put in as well.
In the end, do what works for you! The health outcomes of these drugs are amazing, and I think they will be up there with the most important medications ever invented in terms of quality of life years saved.
You're not going to accidentally an Arnold by injecting testosterone and sitting on the couch every day.