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Triple agonists add glucagon receptor activation, which: Increases resting energy expenditure by 8% to 12% (Jall et al., Diabetes Care 2024) Promotes hepatic fat oxidation and reduces steatosis May offset some of the lean mass loss seen with GLP-1 monotherapy (early signal, not yet confirmed in long-term trials) The weight loss ceiling for retatrutide appears to be 24% to 26% based on phase 3 data, though long-term real-world outcomes are not yet available

It implies that ER is required for execution of this RCD [164]

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Starting with small amounts and increasing gradually can help minimise these effects