Retatrutide: Game Changer or More of the Same?

I have many patients asking me about retatrutide with the idea that it will offer something altogether different than what is available now.  While retatrutide is not FDA approved and the authentic product is not available at this time, there is an unprecedented amount of anticipation of when it will be FDA approved, calling it a “game changer,” even amongst academics and in journal articles. I am here to offer another perspective: that it is not a game changer and it is just a “stronger” version of what we have now.

Retatrutide shows an average weight loss of 28%.  This is compared to about 21% for semaglutide and tirzepatide at the highest doses.  For example, for a person who starts at a weight of 250 lb the difference is an average of 7%, or 17.5 lb.  For example, on highest dose semaglutide or tirzepatide, projected average weight loss would be 52.5 lb and with retatrutide highest dose it would be 70 lbs.  To take the example further, if the starting BMI is 40 (about 5 ft 6 inches tall and 250 lb to start), the ending BMI with highest dose semaglutide or tirzepatide would be about 32 and with highest dose retatrutide, it would be about 29.2.  However, the same pitfalls of currently available treatments apply: high rates of side effects and unintended effects, high cost, and high rates of discontinuation. 

Currently, there are three major “problems” with currently available treatments for obesity: 

1. They are too expensive. 

2. They have too many side effects.

3. They are too hard to keep taking forever.

4. They do not work well enough. 

All of these things are probably what lead to rates of discontinuation over 50% at one year and about 87% at 2 years, with weight regain in most people even with diet and exercise. 

Retatrutide ONLY helps with the last group: they do not work well enough.  In my experience, that is the RAREST problem encountered.  It seems retatrutide will cost MORE than current treatments, has HIGHER rates of side effects, and therefore will probably be harder to get and harder to stay on.  It also has the same proportionate amount of LEAN BODY MASS loss and so with a higher total weight loss, it will typically have a high absolute amount of lean body mass loss. Losing lean body mass is generally bad for your health and is a real problem with GLP 1 treatment.

This is not to say I am not enthusiastically in support of incorporating it into practice as soon as it is FDA approved. Just like there are individuals who respond significantly better to dual receptor agonist therapy, there will be individuals who respond significantly better to triple agonist therapy.  The benefits of synergistic treatment on complex hormonal causes of obesity is crucial and the importance of continued research and development cannot be overstated because we DO need a gamechanger: a drug that is easier to take, easier to stay on, and more uniformly effective, with less lean body mass loss.  We also need game changing shifts in the healthcare system and HOW we treat obesity: earlier and consistently with far less barriers for patients. I am just saying we are not there yet. 

So, before you go out and consider the risks of a non FDA approved treatment: pause, think slowly and carefully about whether it offers what you are looking for.  Consider consulting your licensed healthcare provider trained and educated and perhaps even board certified in the specialty of Obesity Medicine. 

These medications are powerful drugs and getting more powerful.   They are certainly in the same range of effects as bariatric surgery. Historically, only 1-2% of people eligible for bariatric surgery have had the procedure, perhaps because of the procedure itself and/or observations people have had of others who have had it.  There are certainly many people for whom bariatric surgery has been a blessing and also people for whom the long term outcome was not what they had hoped.  When we look back in hindsight, will these drugs seem the same? With an estimated cost of over a quarter of a million dollars per quality of life year saved, let’s hope not and let's keep looking. This is too important.

Take Back Your Health, 

Valerie Hope-Slocum Sutherland, MD

*Artificial Intelligence was not used in this article.