A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial

Carel W. le Roux; Luca Busetto; Louis Aronne; Deborah Bade Horn; Georgios K. Dimitriadis; Beverly Falcon; Luis‐Emilio Garcia‐Perez; Elisa Gomez Valderas; Theresa Hunter Gibble; Cagri Senyucel; Julia P. Dunn

doi:10.1111/dom.70531

A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial

Carel W. le Roux
, Luca Busetto
, Louis Aronne
, Deborah Bade Horn
, Georgios K. Dimitriadis
, Beverly Falcon
, Luis‐Emilio Garcia‐Perez
, Elisa Gomez Valderas
, Theresa Hunter Gibble
, Cagri Senyucel
, Julia P. Dunn

Eli Lilly and Company

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: With new advancements in obesity medicine, clarity on goals and expectations for successful disease management is limited. This post hoc analysis assessed application of proposed treat-to-target (TtT) thresholds for obesity to the outcome measures of SURMOUNT-5, which randomised participants with obesity to tirzepatide or semaglutide.

METHODS: The proportion of participants in each treatment group reaching proposed TtT thresholds for waist to height ratio (WHtR) <0.53, body mass index (BMI) <27 kg/m 2, or a combination was evaluated. The associations between the thresholds and achieving low disease activity to remission (meeting goals for at least four of five defined cardiometabolic risk parameters) and normalisation or improvement in SF-36v2 physical component score (PCS) from baseline to week 72 were explored.

RESULTS: About 23.1%-33.9% of participants treated with tirzepatide and 14.2%-20.7% treated with semaglutide reached the TtT thresholds, with greater weight reduction than the overall population. About 77% of participants who reached WHtR <0.53 achieved low disease activity to remission, with an odds ratio of 2.31 (p < 0.001) compared to those who did not reach this target. The BMI threshold was not statistically associated with the assessed outcomes for SF-36v2 PCS.

CONCLUSION: In this post hoc analysis of SURMOUNT-5, most participants who reached the proposed TtT thresholds achieved the goal of low disease activity to remission defined by cardiometabolic risk parameters. These data suggest that TtT thresholds in obesity medicine may clarify goals in shared decision-making and improve clinical outcomes.

Original language	English
Pages (from-to)	1-12
Number of pages	12
Journal	Diabetes, Obesity and Metabolism
Early online date	3 Feb 2026
DOIs	https://doi.org/10.1111/dom.70531
Publication status	Published online - 3 Feb 2026

Bibliographical note

Data Access Statement

Lilly provides access to all individual participant data collected during the trial, after anonymisation, with the exception of pharmacokinetic or genetic data. Data are available to request 6 months after the indication studied has been approved in the US and EU and after primary publication acceptance, whichever is later. No expiration date of data requests is currently set once data are made available. Access is provided after a proposal has been approved by an independent review committee identified for this purpose and after receipt of a signed data sharing agreement. Data and documents, including the study protocol, statistical analysis plan, clinical study report, blank or annotated case report forms, will be provided in a secure data sharing environment. For details on submitting a request, see the instructions provided at www.vivli.org.

Keywords

cardiometabolic measures
obesity
treat‐to‐target
obesity management
waist to height ratio
tirzepatide

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cite this

le Roux, C. W., Busetto, L., Aronne, L., Horn, D. B., Dimitriadis, G. K., Falcon, B., Garcia‐Perez, LE., Valderas, E. G., Gibble, T. H., Senyucel, C., & Dunn, J. P. (2026). A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial. Diabetes, Obesity and Metabolism, 1-12. Advance online publication. https://doi.org/10.1111/dom.70531

@article{dd40928a1b6d4e698a96fccc1d382e82,

title = "A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial",

abstract = "INTRODUCTION: With new advancements in obesity medicine, clarity on goals and expectations for successful disease management is limited. This post hoc analysis assessed application of proposed treat-to-target (TtT) thresholds for obesity to the outcome measures of SURMOUNT-5, which randomised participants with obesity to tirzepatide or semaglutide.METHODS: The proportion of participants in each treatment group reaching proposed TtT thresholds for waist to height ratio (WHtR) <0.53, body mass index (BMI) <27 kg/m 2, or a combination was evaluated. The associations between the thresholds and achieving low disease activity to remission (meeting goals for at least four of five defined cardiometabolic risk parameters) and normalisation or improvement in SF-36v2 physical component score (PCS) from baseline to week 72 were explored. RESULTS: About 23.1\%-33.9\% of participants treated with tirzepatide and 14.2\%-20.7\% treated with semaglutide reached the TtT thresholds, with greater weight reduction than the overall population. About 77\% of participants who reached WHtR <0.53 achieved low disease activity to remission, with an odds ratio of 2.31 (p < 0.001) compared to those who did not reach this target. The BMI threshold was not statistically associated with the assessed outcomes for SF-36v2 PCS.CONCLUSION: In this post hoc analysis of SURMOUNT-5, most participants who reached the proposed TtT thresholds achieved the goal of low disease activity to remission defined by cardiometabolic risk parameters. These data suggest that TtT thresholds in obesity medicine may clarify goals in shared decision-making and improve clinical outcomes.",

keywords = "cardiometabolic measures, obesity, treat‐to‐target, obesity management, waist to height ratio, tirzepatide",

author = "\{le Roux\}, \{Carel W.\} and Luca Busetto and Louis Aronne and Horn, \{Deborah Bade\} and Dimitriadis, \{Georgios K.\} and Beverly Falcon and Luis‐Emilio Garcia‐Perez and Valderas, \{Elisa Gomez\} and Gibble, \{Theresa Hunter\} and Cagri Senyucel and Dunn, \{Julia P.\}",

note = "{\textcopyright} 2026 Eli Lilly and Company. Diabetes, Obesity and Metabolism published by John Wiley \& Sons Ltd.",

year = "2026",

month = feb,

day = "3",

doi = "10.1111/dom.70531",

language = "English",

pages = "1--12",

journal = "Diabetes, Obesity and Metabolism",

issn = "1463-1326",

publisher = "John Wiley \& Sons, Inc.",

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T1 - A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial

AU - le Roux, Carel W.

AU - Busetto, Luca

AU - Aronne, Louis

AU - Horn, Deborah Bade

AU - Dimitriadis, Georgios K.

AU - Falcon, Beverly

AU - Garcia‐Perez, Luis‐Emilio

AU - Valderas, Elisa Gomez

AU - Gibble, Theresa Hunter

AU - Senyucel, Cagri

AU - Dunn, Julia P.

PY - 2026/2/3

Y1 - 2026/2/3

N2 - INTRODUCTION: With new advancements in obesity medicine, clarity on goals and expectations for successful disease management is limited. This post hoc analysis assessed application of proposed treat-to-target (TtT) thresholds for obesity to the outcome measures of SURMOUNT-5, which randomised participants with obesity to tirzepatide or semaglutide.METHODS: The proportion of participants in each treatment group reaching proposed TtT thresholds for waist to height ratio (WHtR) <0.53, body mass index (BMI) <27 kg/m 2, or a combination was evaluated. The associations between the thresholds and achieving low disease activity to remission (meeting goals for at least four of five defined cardiometabolic risk parameters) and normalisation or improvement in SF-36v2 physical component score (PCS) from baseline to week 72 were explored. RESULTS: About 23.1%-33.9% of participants treated with tirzepatide and 14.2%-20.7% treated with semaglutide reached the TtT thresholds, with greater weight reduction than the overall population. About 77% of participants who reached WHtR <0.53 achieved low disease activity to remission, with an odds ratio of 2.31 (p < 0.001) compared to those who did not reach this target. The BMI threshold was not statistically associated with the assessed outcomes for SF-36v2 PCS.CONCLUSION: In this post hoc analysis of SURMOUNT-5, most participants who reached the proposed TtT thresholds achieved the goal of low disease activity to remission defined by cardiometabolic risk parameters. These data suggest that TtT thresholds in obesity medicine may clarify goals in shared decision-making and improve clinical outcomes.

AB - INTRODUCTION: With new advancements in obesity medicine, clarity on goals and expectations for successful disease management is limited. This post hoc analysis assessed application of proposed treat-to-target (TtT) thresholds for obesity to the outcome measures of SURMOUNT-5, which randomised participants with obesity to tirzepatide or semaglutide.METHODS: The proportion of participants in each treatment group reaching proposed TtT thresholds for waist to height ratio (WHtR) <0.53, body mass index (BMI) <27 kg/m 2, or a combination was evaluated. The associations between the thresholds and achieving low disease activity to remission (meeting goals for at least four of five defined cardiometabolic risk parameters) and normalisation or improvement in SF-36v2 physical component score (PCS) from baseline to week 72 were explored. RESULTS: About 23.1%-33.9% of participants treated with tirzepatide and 14.2%-20.7% treated with semaglutide reached the TtT thresholds, with greater weight reduction than the overall population. About 77% of participants who reached WHtR <0.53 achieved low disease activity to remission, with an odds ratio of 2.31 (p < 0.001) compared to those who did not reach this target. The BMI threshold was not statistically associated with the assessed outcomes for SF-36v2 PCS.CONCLUSION: In this post hoc analysis of SURMOUNT-5, most participants who reached the proposed TtT thresholds achieved the goal of low disease activity to remission defined by cardiometabolic risk parameters. These data suggest that TtT thresholds in obesity medicine may clarify goals in shared decision-making and improve clinical outcomes.

KW - cardiometabolic measures

KW - obesity

KW - treat‐to‐target

KW - obesity management

KW - waist to height ratio

KW - tirzepatide

U2 - 10.1111/dom.70531

DO - 10.1111/dom.70531

M3 - Article

C2 - 41635114

SN - 1463-1326

SP - 1

EP - 12

JO - Diabetes, Obesity and Metabolism

JF - Diabetes, Obesity and Metabolism

ER -

A treat‐to‐target approach for obesity management: A post hoc analysis of the SURMOUNT ‐5 trial

Abstract

Bibliographical note

Data Access Statement

Keywords

UN SDGs

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