Obesity (Silver Spring, Md.)Jul 27, 2025

Early-Onset Obesity and Response to Tirzepatide Treatment: Analysis of SURMOUNT Clinical Trials

GLP-1 Therapies Weekly Brief ↗PubMed ↗DOI ↗OA ↗

Updated Apr 5, 2026

Abstract

Participants with had a mean obesity duration of 20 years compared to 11 years for those with later-onset obesity.

Individuals with early-onset obesity presented higher baseline BMI (40 kg/m) and waist circumference (118 cm) compared to those with later-onset obesity (37 kg/m and 112 cm, respectively).
Lower baseline levels of HbA1c (5.48% vs. 5.60%) and triglycerides (120 mg/dL vs. 130 mg/dL) were observed in participants with early-onset obesity.
Systolic blood pressure was lower in participants with early-onset obesity at baseline (121 mmHg) compared to later-onset individuals (125 mmHg).
Weight loss and improvements in waist circumference, HbA1c, triglycerides, and systolic blood pressure with tirzepatide at 72 weeks were consistent across both early- and later-onset obesity subgroups.

Simplified

OBJECTIVE: People with (diagnosed at age < 25 years) may present with more cardiometabolic abnormalities and obesity-related complications. This post hoc analysis assessed baseline characteristics and body weight (BW) changes with tirzepatide in people with early- versus later-onset obesity.

METHODS: Participants (N = 3782) from SURMOUNT-1, SURMOUNT-3, and SURMOUNT-4 randomized to tirzepatide or placebo were included. Baseline characteristics and changes in BW and cardiometabolic risk factors at 72/88 weeks were assessed.

RESULTS: In SURMOUNT-1, participants with early- versus later-onset obesity had longer mean obesity duration (20 ± 12 vs. 11 ± 8 years), higher BMI (40 ± 7 vs. 37 ± 6 kg/m) and waist circumference (WC, 118 ± 16 vs. 112 ± 14 cm), and lower HbA1c (5.48% ± 0.4% vs. 5.60% ± 0.4%), triglycerides (median 120 vs. 130 mg/dL), and systolic blood pressure (SBP; 121 ± 13 vs. 125 ± 13 mmHg) at baseline (all p ≤ 0.004). At 72 weeks, improvements with tirzepatide in BW (-23% vs. -22%), WC (-22 vs. -19 cm), HbA1c (-0.51% vs. -0.52%), triglycerides (-32% vs. -31%), and SBP (-8 vs. -8 mmHg) were similar between subgroups. Similar improvements were observed in SURMOUNT-3 and SURMOUNT-4. 2

CONCLUSIONS: In this post hoc analysis, participants with early- versus later-onset obesity exhibited a mixed profile of metabolic health at baseline, including a higher degree of central adiposity and lower HbA1c and SBP. Improvements in BW and cardiometabolic markers with tirzepatide were similar between subgroups.

TRIAL REGISTRATION: ClinicalTrials.gov identifiers: NCT04184622, NCT04657016, NCT04660643.

Key numbers

20 ± 12 years

Mean Obesity Duration

Compared to 11 ± 8 years in later-onset obesity group.

-23%

Body Weight Reduction

vs. -22% in later-onset obesity at 72 weeks.

40 ± 7 kg/m

BMI at Baseline

Compared to 37 ± 6 kg/m in later-onset obesity group.

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Funding

Competing interests

E.G. has received a travel award from Eli Lilly and Company. G.S. reports consulting fees from Rhythm, Novo Nordisk, and Eli Lilly and Company. A.S.K. engages in unpaid consulting and educational activities and serves as an unpaid investigator for Novo Nordisk; engages in unpaid consulting activities and serves as an unpaid investigator for Boehringer Ingelheim, Eli Lilly and Company, and Vivus; and receives donated drug/placebo from Novo Nordisk and Vivus for National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)‐funded clinical trials. D.M., D.C., M.A.M., C.A.K., and C.J.L. are employees and shareholders of Eli Lilly and Company.

PubMed

Early-Onset Obesity and Response to Tirzepatide Treatment: Analysis of SURMOUNT Clinical Trials

Abstract

Key numbers

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Funding

Competing interests

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Abstract

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Funding

Competing interests

Related papers

You found one interesting study. We’ll send the next 7.

What Lands in Your Inbox Each Week:

Recent issues from the glp-1 therapies brief