Why some people lose more weight on tirzepatide than others, and what you can do about it

Tirzepatide results vary a lot from person to person. In the SURMOUNT-1 trial, 91% of people on the highest dose lost at least 5% of their body weight, but only about 36% lost 25% or more. The biggest differences come from dose, whether you have type 2 diabetes, sex, whether you add structured lifestyle support and, above all, whether you stay on treatment. Some of these you can’t change. Several you can. Here’s what the research shows about who loses the most, and how to improve your own results.

Key takeaways

• In SURMOUNT-1, average weight loss at 72 weeks was 15% on 5 mg, 19.5% on 10 mg and 20.9% on 15 mg
• At 15 mg, 91% of people lost at least 5%, 57% lost at least 20% and 36% lost at least 25%
• People with type 2 diabetes lost less on average, about 13% to 15% in SURMOUNT-2
• Women lost more than men in a pooled analysis of four SURMOUNT trials
• Adding intensive lifestyle support before starting led to 26.6% total weight loss in SURMOUNT-3
• People who stayed on tirzepatide kept losing weight, while those who stopped regained 14% of their body weight

How much do tirzepatide results vary?

Tirzepatide, sold as Zepbound for weight management and Mounjaro for type 2 diabetes, is one of the most effective weight loss medications available. But averages hide a wide range.

Here’s what SURMOUNT-1 found in 2,539 adults with obesity or overweight and no diabetes, after 72 weeks:

These figures include everyone who started treatment, even those who stopped early. So the takeaway is clear: most people lose meaningful weight, a large share lose 20% or more, and a smaller group loses less than 5%.

Who tends to lose more weight on tirzepatide

Clinical trials point to five main factors.

1. People on higher doses

The table above shows a clear dose effect. The jump from 5 mg to 10 mg is the biggest. Going from 10 mg to 15 mg adds a smaller extra benefit on average, but some people respond much more at the top dose. For a dose-by-dose breakdown, see what dose of Zepbound is most effective.

2. People without type 2 diabetes

In SURMOUNT-2, which studied 938 adults with type 2 diabetes and overweight or obesity, average weight loss after 72 weeks was:

• 12.8% on 10 mg
• 14.7% on 15 mg
• 3.2% on placebo

That’s still substantial, but lower than in people without diabetes. Researchers think this may be partly because insulin resistance and some diabetes medications, such as insulin and sulfonylureas, make weight loss harder. Better blood sugar control is a major benefit in its own right.

3. Women

A 2024 analysis in Diabetologia pooled four SURMOUNT trials and 4,677 adults. Women lost up to 24.6% of their body weight, compared with up to 18.1% for men. The reasons aren’t fully understood, but differences in body composition and hormones likely play a role. Men can still see strong results. We look at this in weight loss injections for men.

4. People who add structured lifestyle support

In SURMOUNT-3, participants first spent 12 weeks in an intensive lifestyle program and lost 6.9% of their weight. They then started tirzepatide or placebo. After another 72 weeks, those on tirzepatide had lost 26.6% of their starting weight in total, compared with 3.8% on placebo.

That’s one of the largest average results in the SURMOUNT program. It suggests that building eating and activity habits alongside the medication pays off.

5. People who stay on treatment

This is the most important factor of all. In SURMOUNT-4, everyone took tirzepatide for 36 weeks and lost about 21% of their weight. Then half switched to placebo:

• Those who stayed on tirzepatide lost an additional 5.5% over the next year
• Those who switched to placebo regained 14% of their body weight

People who stopped early simply didn’t get the full benefit. For more on what happens after you reach your goal, see can you stop taking tirzepatide after reaching your goal weight.

Support for better results: weight loss lab panel · PCOS treatment · weight loss prescription

Factors that can hold your results back

Beyond the trial findings, these common factors can limit weight loss:

• Other medications. Some antidepressants, antipsychotics, steroids, beta blockers and diabetes drugs like insulin can cause weight gain or slow weight loss.
• Health conditions. Hypothyroidism, polycystic ovary syndrome (PCOS), Cushing’s syndrome and untreated sleep apnea can all make weight loss harder.
• Low protein intake and no strength training. Losing muscle lowers your energy needs and can slow progress.
• Liquid calories and frequent snacking. Sugary drinks, alcohol and grazing can quietly offset the medication’s effect.
• Poor sleep and high stress. Both raise hunger hormones and cravings.
• Metabolic adaptation. As you lose weight, your body burns fewer calories, which naturally slows progress over time. We explain this in why you stop losing weight.

What you can do to get more from tirzepatide

You can’t change your sex or diabetes status, but you can work on the factors the trials show matter most:

1. Work up to an effective dose. Many people stay too long on low doses. If side effects are manageable and progress has stalled, talk to your provider about stepping up.
2. Take every dose on time. Missed doses let drug levels fall and appetite return. If you miss one, follow the 4-day rule in what happens if you skip a tirzepatide dose.
3. Build habits from the start. SURMOUNT-3 suggests lifestyle support adds to the medication’s effect. Focus on protein-first meals, fiber, fewer liquid calories and regular movement.
4. Protect your muscle. Strength train at least three times a week and eat enough protein. See building muscle while losing fat on tirzepatide.
5. Review your other medications with your provider, especially if any are linked to weight gain.
6. Check for underlying conditions. Lab tests can look for thyroid problems, insulin resistance and other issues that slow weight loss.
7. Give it time. In a 2025 SURMOUNT analysis, weight typically didn’t plateau until 24 to 36 weeks, and later on higher doses. A slow first few months doesn’t mean the medication isn’t working.
8. Plan for the long term. Staying on a maintenance dose protects your results, as SURMOUNT-4 showed.

For practical day-to-day tips, see why some people lose weight faster on Zepbound and how to optimize your results.

When your results are lower than expected

If you’ve been on tirzepatide for several months, taken it consistently and still lost less than 5% of your body weight, talk to your provider. Options may include:

• Increasing your dose, if you haven’t reached the maximum and side effects allow
• Checking labs and reviewing your other medications
• Getting more structured nutrition or activity support
• Considering a different medication if tirzepatide still isn’t working well for you

For a checklist of common causes, see why you might not be losing weight on tirzepatide.

The bottom line

Tirzepatide works for most people, but the amount of weight lost varies widely. In trials, people on higher doses, people without type 2 diabetes, women, people who added structured lifestyle support and, most of all, people who stayed on treatment tended to lose the most. You can improve your own results by reaching an effective dose, taking every dose on time, building protein and strength habits, checking for underlying conditions and giving the medication time to work. If progress stalls, work with your provider to adjust your plan rather than giving up.

Want a plan built around your own response to tirzepatide? Talk to a Heally provider through our tirzepatide program.

FAQ

Why do some people lose more weight on tirzepatide than others?

Results depend on dose, whether you have type 2 diabetes, sex, lifestyle habits and how consistently you stay on treatment. In trials, people on higher doses, people without diabetes, women and people who stayed on tirzepatide tended to lose the most.

What percentage of people lose weight on tirzepatide?

In SURMOUNT-1, 85% to 91% of people on tirzepatide lost at least 5% of their body weight over 72 weeks, depending on dose. At 15 mg, 57% lost at least 20% and about 36% lost at least 25%.

Do people with diabetes lose less weight on tirzepatide?

On average, yes. In SURMOUNT-2, adults with type 2 diabetes lost 12.8% on 10 mg and 14.7% on 15 mg over 72 weeks. That’s less than people without diabetes, but still substantial, and blood sugar control improves too.

Do women lose more weight on tirzepatide than men?

In a pooled analysis of four SURMOUNT trials, women lost up to 24.6% of their body weight compared with up to 18.1% for men. Men still see strong results, especially on higher doses with consistent treatment.

What can I do if tirzepatide isn’t working well for me?

Make sure you’re on an effective dose and not missing doses, eat enough protein, strength train and limit liquid calories. Ask your provider to review your other medications and check for conditions like hypothyroidism. If progress is still slow, discuss a dose change or other options.

How long does it take to see full results on tirzepatide?

Months. In a 2025 analysis of SURMOUNT trials, weight typically didn’t plateau until 24 to 36 weeks, and later for people on higher doses. Most of the weight loss in trials happened over the full 72 weeks.

Sources

1. Jastreboff AM, et al. “Tirzepatide Once Weekly for the Treatment of Obesity” (SURMOUNT-1). New England Journal of Medicine, 2022. investor.lilly.com summary
2. Garvey WT, et al. “Tirzepatide once weekly for the treatment of obesity in people with type 2 diabetes” (SURMOUNT-2). The Lancet, 2023.
3. Wadden TA, et al. “Tirzepatide after intensive lifestyle intervention in adults with overweight or obesity: the SURMOUNT-3 phase 3 trial.” Nature Medicine, 2023. investor.lilly.com summary
4. Aronne LJ, et al. “Continued Treatment With Tirzepatide for Maintenance of Weight Reduction in Adults With Obesity: The SURMOUNT-4 Randomized Clinical Trial.” JAMA, 2024. jamanetwork.com
5. Garcia LE, et al. Sex differences in weight reduction with tirzepatide, post hoc analysis of SURMOUNT-1 to -4. Diabetologia, 2024. eurekalert.org
6. Horn DB, Kahan S, et al. “Time to weight plateau with tirzepatide treatment in the SURMOUNT-1 and SURMOUNT-4 clinical trials.” Clinical Obesity, 2025.

This article is for educational purposes only and is not a substitute for professional medical advice. Individual results vary. Tirzepatide is available by prescription only and carries an FDA boxed warning about the risk of thyroid C-cell tumors. Do not use it if you or a family member has had medullary thyroid carcinoma or Multiple Endocrine Neoplasia syndrome type 2.