The TRIUMPH-1 phase 3 RCT (randomized, placebo-controlled, n≈600 adults with obesity, funded by Eli Lilly with clear conflicts via investigator disclosures) delivered mean losses of 19-28.3% at 80 weeks on 4-12 mg weekly retatrutide, exceeding phase 2 NEJM results (Jastreboff 2023, n=338, 24% at 48 weeks) and rivaling sleeve gastrectomy averages of 25-30% from meta-analyses (e.g., 2022 Lancet series, observational cohorts >10k patients). Yet Healthline coverage underplays that bariatric outcomes show 20-40% regain by year 5 in longitudinal registries, while retatrutide's glucagon component may accelerate lean mass loss absent exercise co-interventions. No direct RCT comparator to surgery exists, and cardiovascular surrogate improvements (waist, triglycerides, hsCRP) lack hard endpoint confirmation pending full TRIUMPH CVOT readout. Real-world adherence will likely mirror semaglutide's 40-60% discontinuation rates within 12 months per claims data, limiting population impact despite the 30%+ subset losses at 104 weeks.