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In phase III: Semaglutide 2.4 mg (STEP-1): nausea 44.2%, diarrhea 31.5%, vomiting 24.8% Tirzepatide 15 mg (SURMOUNT-1): nausea 29.2%, diarrhea 23.0%, constipation 16.8% Retatrutide 12 mg (TRIUMPH-1): nausea 37.2%, vomiting 22.0%, diarrhea 27.1% Key observation: tirzepatide shows the most favorable GI profile at equivalent dose, likely tied to the GIP component dampening GLP-1-mediated nausea signaling at the brainstem level