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Many phenotyping approaches in IC/BPS have been proposed, and important clinical differences have been found between phenotypic groups

Advantages: Minimizes overlapping GLP-1 receptor activation Reduces nausea risk during first tirzepatide dose Allows clear attribution of side effects to the new medication Disadvantages: 7 to 10 day gap in appetite suppression Some patients report increased hunger and modest weight regain (1 to 3 pounds) during washout Psychological difficulty for patients who rely on medication for appetite control Clinical data supporting washout: a 2025 retrospective study (Kushner et al., Obesity Science & Practice) found no difference in final weight-loss outcomes between washout and overlap strategies, but washout patients reported 18% lower nausea rates during the first month of tirzepatide

For years, bariatric surgery has been a popular and effective way to help people with obesity achieve significant, long-term weight loss and slow the progression or even reverse their MASLD/MASH