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Trial Structure Duration: 48 weeks of treatment Participants: 338 adults randomized 2:1:1:1:1:2:2 to placebo or retatrutide groups Doses tested: 1mg, 4mg, 8mg, 12mg (all with slow titration from 2mg starting dose) Lifestyle intervention: All participants received counseling on diet (500 kcal/day deficit) and exercise (150 min/week) Primary endpoint: Percent weight change at 24 weeks Key secondary endpoints: Weight change at 48 weeks, proportion achieving 5%, 10%, 15% loss The trial used a slow titration protocol to minimize side effects: all groups except the 1mg dose started at 2mg weekly and escalated every 4 weeks

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