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Choose Bariatric Surgery If: BMI 40, or BMI 35 with serious complications (diabetes, sleep apnea, heart disease) Want "one-time" intervention with proven 20+ year track record Can tolerate surgical risks and commit to permanent lifestyle changes Failed multiple weight loss attempts including medications Type 2 diabetes (surgery has superior remission rates) Insurance covers surgery (6070% do) Choose Retatrutide If (When Available 2028): BMI 30 (likely eligibility criteria) Want to avoid surgical risks Cannot or will not undergo surgery Failed other GLP-1 medications or want the strongest available option Severe obesity + fatty liver disease (retatrutide achieved 82.4% liver fat reduction in Phase 2a) Want reversibility and flexibility (can stop if needed) Willing to accept limited long-term data (~2 years only) Can afford ongoing costs for unknown duration Special Populations Young adults (1830): Retatrutide offers reversibility important if planning children later

reveal that GLP-1R agonistinduced weight loss requires GLP-1Rs in the CNS, while Secher et al