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Dose Escalation Schedule: First 20 Weeks (Escalation Phase): Weeks 1-4: 2.5 mg weekly (all groups) Weeks 5-8: 5 mg weekly Weeks 9-12: 7.5 mg weekly (for 10 mg and 15 mg groups) Weeks 13-16: 10 mg weekly (for 10 mg and 15 mg groups) Weeks 17-20: 12.5 mg weekly (for 15 mg group only) Week 21+: Maintenance dose (5 mg, 10 mg, or 15 mg) Primary Results (72 Weeks): Weight Loss by Dose: Key Findings (15 mg Dose): Percentage of Patients Achieving Weight Loss Milestones: 5% weight loss: 96% (vs 28% placebo) 10% weight loss: 89% (vs 16% placebo) 15% weight loss: 78% (vs 9% placebo) 20% weight loss: 63% (vs 3% placebo) 25% weight loss: 50% (vs 1% placebo) These are the best weight loss results ever achieved in a clinical trial for any medication

affected only ~25% in trials) Injection site reaction (redness, swelling, itching) Nausea Vomiting Diarrhea Constipation Decreased appetite Fatigue Dyspepsia (indigestion) Abdominal pain Burping (may have sulfur smell) Hair loss Rare but serious risks Thyroid C-Cell Tumors Pancreatitis Gastroparesis (stomach paralysis) Hypoglycemia (if used with insulin) Gallbladder disease Kidney issues (linked to dehydration) Pulmonary aspiration under anesthesia ALWAYS disclose Tirzepatide use to surgical teams Contraindications Do not use if pregnant or breastfeeding Do not use with a personal or family history of Medullary Thyroid Carcinoma or MEN 2 (Multiple Endocrine Neoplasia) Do not use if you have Type-1 diabetes, diabetic retinopathy, or severe GI disease Do not use if you are allergic or hypersensitive to Tirzepatide ================================================================================================= Stacking Suggestions AOD-9604 enhances fat breakdown and further accelerates weight loss alongside appetite suppression Tesamorelin synergistic for fat reduction, especially visceral fat and metabolic regulation Semax or Selank manage mood and cognitive function while adjusting to appetite changes NAD+ or MOTS-C support energy, mitochondrial efficiency, and metabolism while on a caloric deficit BPC-157 beneficial for gut repair if experiencing nausea, indigestion, or stomach discomfort CJC-1295 / Ipamorelin for muscle maintenance and enhanced metabolic recovery while losing fat

While Tirzepatide offers promising benefits for managing Type 2 diabetes and supporting weight loss, its potential impact on kidney health should not be overlooked

Louis Veterans Affairs Health Care System

Compression garments worn during recovery help reduce swelling, enhance the healing process, and optimize your results