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But the fiscal cost on state Medicaid budgets would have been substantial, Jack Rollins, MPH, director of federal policy at the National Association of Medicaid Directors told The Nations Health

(last SAB meeting in 2019)

Instead, it exemplifies how endogenous peptides exhibiting multi-receptor activity were historically disadvantaged by a development paradigm that prioritized single-target selectivity over physiological relevance

This two-way influence creates a dynamic loop where diet, microbiome, and behavior all play a role in modulating GLP-1 secretion

If tirzepatide is producing the desired outcomes, there is no compelling reason to switch to a less proven compound with more side effects

Weeks 4 to 8: Improvements either plateau or persist