What up as the flying metal germ tube dropped me back in MN after an amazing event with Coach Kav in Reston VA.

Today I still watching the internet lose its darn mind over one number:

28.7%

That’s the headline weight loss from the Phase 3 TRIUMPH-4 retatrutide trial, currently being passed around like a golden ticket to metabolic Willy Wonka land.

And yeah—on paper?

That number is wild, no doubt...

...But before you start celebrating or rage-posting about “shortcut culture,” let’s do the boring-but-important thing: Actually look at the data.

What TRIUMPH-4 Actually Was

This wasn’t influencer science.

It was:

• Randomized
• Double-blind
• Placebo-controlled
• 68 weeks long

Participants:
Adults with obesity/overweight + knee osteoarthritis.

Groups:

• Retatrutide 9 mg
• Retatrutide 12 mg
• Placebo

Everyone got:

• Weekly injections
• Lifestyle counseling
  (No, not deadlifts and sled pushes.)

The Headline Results (Why Everyone’s Screaming)

At 68 weeks:

• 12 mg: –28.7% body weight (~71 lb)
• 9 mg: –26.4% (~64 lb)
• Placebo: –2.1% (~4–5 lb)

Even averaging everyone at the top dose lands you around 23–24% mean weight loss.

That’s not normal dieting.
That’s bariatric-adjacent territory.

The Underrated Win: Knee Pain & Function

This part matters more than the scale:

• ~75% reduction in knee pain with retatrutide
• ~40% reduction with placebo
• Meaningful improvements in physical function

For people whose knees hurt just standing up, that’s not cosmetic—that’s quality of life.

Now the Part Everyone Skips

Here’s what the study did not report:

No DXA
No body composition data
No lean mass reporting
Muscle loss = UNKNOWN

Say it with me:

We do not know how much muscle was lost.

And history tells us that large, rapid weight loss without resistance training and adequate protein rarely spares muscle.

That silence matters.

Side Effects & Reality Checks

This wasn’t magic:

• GI side effects were common, albeit at the higher doses
• Dropouts occurred
• Careful dose titration mattered
• Drug is still investigational (not approved)
• The full study has not been published yet
• We are only seeing the highlights so far

If someone is selling this as risk-free salvation, they’re skipping pages on purpose.

What Retatrutide Actually Is

Retatrutide is a triple agonist:

• GLP-1
• GIP
• Glucagon receptors

Translation:
Powerful appetite suppression + altered energy balance + metabolic signaling turned up to eleven.

Which is exactly why context matters.

The Takeaway You Actually Need

Here’s the line the internet hates:

Drugs don’t replace training, protein, or conditioning.

They don’t replace:

• Resistance training
• Adequate protein
• Cardiac conditioning
• Long-term behavior change

Used well? They can be an option under the guidance of your doc and not some internet 18 year GooRooo that has a peptide connection.
​
Used as replacements only? Metabolic debt and no new habits learned with a side of muscle loss.

My Bottom Line

Retatrutide is impressive.
The weight loss is real so far.
The knee pain improvements are meaningful.

...But without lean mass data, claims about “high-quality” weight loss are unfinished science.

Keep your physiology hat on.
Read the fine print.
Stop pretending one lever fixes a complex system.

No hype.
No pharma worship.
Just applied physiology.

Much love and skeptical gainZ,
Dr. Mike
​
PS- If someone tells you drugs replace discipline, they don’t understand biology.
If someone tells you drugs are useless, they don’t understand humans.
As usual, the truth lives in the uncomfortable middle.

PPS -When you are ready there are 3 ways you can work with me
1) Listen to one of my podcasts totally free HERE.
2) Read one of the tons of free articles I have on my site HERE.
3) Book a private 1 hour virtual call to ask me any questions. Cost is $250 and you can email Jodie HERE​

Reference:​
The TRIUMPH-4 results were announced via Eli Lilly press release on December 11, 2025. Detailed results will be "presented at a future medical meeting and published in a peer-reviewed journal" (not yet available)
​

_____________________

Mike T Nelson CISSN, CSCS, MSME, PhD
Associate Professor, Carrick Institute
Owner, Extreme Human Performance, LLC
Editorial Board Member, STRONG Fitness Mag

Mike T Nelson is a PhD and not a physician or registered dietitian. The contents of this email should not be taken as medical advice. It is not intended to diagnose, treat, cure, or prevent any health problem - nor is it intended to replace the advice of a physician. Always consult your physician or qualified health professional on any matters regarding your health.

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