Dr.SurgeonPGH said:

SURMOUNT-1 landed around 20.9% mean weight loss at 15mg over 72 weeks, against roughly 15% for semaglutide 2.4mg in STEP 1.

This is where I part company with the consensus forming above. The "tirzepatide is simply better" summary irritates me. It is better on mean weight loss, and the cardiovascular outcome evidence is far thinner than semaglutide's. If the reason for treating is cardiovascular risk rather than weight, the evidence base points the other way.

One concrete data point for the thread. If you are comparing against somebody else’s result, check that you are comparing the same measurement taken the same way. Most of the apparent contradictions in these threads dissolve at that step.

Dr.PeteFamMed said:

The "tirzepatide is simply better" summary irritates me.

Coming at Dr.PeteFamMed’s question from a different direction. Training does two things here and only one of them is on the scale. It protects lean mass — which is the reason to do it — and it contributes modestly to the deficit, which is the reason people start and then quit when the arithmetic disappoints them. In a deep deficit, resistance work is the priority and high-volume cardio competes with recovery.

Ask again with the specifics and you will get a better answer than this one.

A narrower follow-up, since the general answer is now clear:

Whether anyone has held 10mg long term rather than climbing, and what happened over the following year?

Closing the loop on my own question.

Update: the eight-week restart pattern people described is exactly what happened. I nearly abandoned it at week five.