Read the endpoint, not the headline
"Weight loss" and "fat loss" are not the same measurement. Most trials report total body weight; fewer report body composition by DEXA or MRI; fewer still report visceral versus subcutaneous fat. When a claim says a peptide "burns fat", check whether the study measured fat at all.
Where the strong evidence is
Semaglutide and tirzepatide are the only peptides with large randomised trials showing clinically meaningful, sustained weight loss. Both trials programmes also show that a meaningful fraction of the weight lost is lean tissue — a finding that has driven interest in combining these drugs with resistance training and adequate protein, and in newer agents designed to preserve muscle. Tesamorelin has phase 3 evidence for visceral-fat reduction, but only in HIV-associated lipodystrophy, and the effect reverses on discontinuation.
Where the evidence is thin
Growth-hormone secretagogues such as CJC-1295 and ipamorelin are widely marketed for "lean muscle" and "fat loss". The human studies that exist measure hormone levels over hours to weeks, not body composition over months. Growth hormone itself, in older adults, produces small changes in lean and fat mass with a notable side-effect burden (fluid retention, joint pain, glucose intolerance) in trials — which is a reason for caution, not a reason to assume secretagogues will do better.
What we watch for
- New DEXA-based trials of incretin drugs and muscle-preserving co-therapies.
- Any registered human trial of a GH secretagogue with a body-composition endpoint.
- Long-term safety of chronic GH/IGF-1 elevation, including cancer signals in observational data.