In this phase 2, double-blind, randomized, placebo-controlled trial, 338 adults with obesity or overweight were assigned to receive once-weekly subcutaneous retatrutide (1 mg, 4 mg, 8 mg, or 12 mg) or placebo for 48 weeks. Dose escalation followed predefined schedules. At 48 weeks, the least-squares mean percentage change in body weight with retatrutide reached up to -24.2% in the 12-mg group, accompanied by substantial improvements in cardiometabolic parameters.