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This could lead to some serious digestive misery

Yes, most patients regain a significant portion of the weight within 12 months of stopping

It is a mix of behavior and biology, but I would say it leans heavily toward biology. When you lose weight, the body employs a number of defense mechanisms

143 , 762776.e3 (2023)

Angela Fitch, cofounder and chief medical officer of knownwell, an obesity care and primary care provider

In the meantime, the SURPASS studies assessed weight loss efficacy as a secondary outcome on low sample sizes, in limited durations, and regardless of insulin use, so less is known about the extent of that efficacy