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// ===================== DOCUMENT CONTENT =====================

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      // ====== TITLE PAGE ======
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        children: [new TextRun({ text: "A Research-Based, Comprehensive Guide | Updated June 2026", size: 22, color: "888888", font: "Arial", italics: true })]
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                text: "Medically reviewed against peer-reviewed clinical trials including STEP series (Novo Nordisk), TRIUMPH series (Eli Lilly), NEJM, The Lancet, and Nature Medicine publications through June 2026.",
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      // ====== KEY TAKEAWAYS ======
      h1("Key Takeaways"),
      keyBox("What You Need to Know at a Glance", [
        "Semaglutide vs Retatrutide is the central debate in obesity medicine right now — and data shows retatrutide may be more powerful.",
        "Semaglutide (Wegovy, Ozempic) is FDA-approved and available today. At 2.4 mg weekly, it delivers ~15% body weight loss; a new 7.2 mg dose (approved April 2026) delivers up to 20.7%.",
        "Retatrutide (by Eli Lilly) is NOT yet FDA-approved. It is a triple-hormone agonist (GLP-1 + GIP + glucagon). In Phase 3 trials, the 12 mg dose produced ~28.3% weight loss (about 70 lbs) over 80 weeks.",
        "Semaglutide is the right choice today if you need an approved, insured, proven medication with a long safety track record.",
        "Retatrutide may be the future of obesity treatment, but FDA submission isn't expected until late 2026, with earliest availability likely 2027.",
        "Both are once-weekly injectable peptides. Both target the GLP-1 receptor. Retatrutide also adds GIP and glucagon pathways for extra power.",
        "Insurance now covers Wegovy for Medicare patients (July 2026 GLP-1 Bridge) at $50/month. Commercial plans vary widely.",
        "Neither drug is a magic bullet — both work best alongside diet changes and physical activity.",
        "People with a personal or family history of medullary thyroid cancer (MTC) or MEN 2 syndrome should NOT take either drug.",
      ]),
      spacer(),

      // ====== INTRO ======
      h1("Introduction: America's Obesity Crisis — and Why Peptides May Be the Answer"),
      p([
        normalRun("The United States is facing one of the most serious public health challenges in its history. According to CDC data, "),
        boldRun("more than 40% of American adults — over 100 million people — currently live with obesity"),
        normalRun(". Severe obesity (BMI ≥ 40) affects another 9.4% of the adult population. These numbers are not just statistics — obesity is directly linked to type 2 diabetes, heart disease, stroke, sleep apnea, kidney disease, and several cancers. The American Society for Metabolic and Bariatric Surgery estimates that "),
        boldRun("obesity costs the U.S. healthcare system nearly $173 billion per year"),
        normalRun(". At least 1 in 4 adults in every single U.S. state is living with obesity as of 2024.")
      ]),
      p("For decades, effective treatments for obesity were limited to surgery, lifestyle interventions, and a handful of medications with modest results and significant side effects. That landscape has changed dramatically. A new class of drugs called peptide-based hormone receptor agonists — particularly GLP-1 receptor agonists — has produced weight loss results that once seemed impossible without surgery."),
      p([
        normalRun("This brings us to the biggest question in obesity medicine today: "),
        boldRun("Semaglutide vs Retatrutide"),
        normalRun(" — which one works best for obesity? Semaglutide vs Retatrutide represents a battle between a proven, FDA-approved standard of care and an investigational triple-agonist that is delivering unprecedented weight loss numbers in clinical trials. In this article, we break down everything you need to know — the science, the research data, the costs, the side effects, and who each drug is right for — to help patients and healthcare providers make informed decisions.")
      ]),
      p("Whether you are a patient exploring your options, a clinician keeping up with the latest evidence, or simply curious about these breakthrough treatments, this research-based guide on Semaglutide vs Retatrutide covers it all."),
      spacer(),

      // ====== WHAT IS OBESITY ======
      h1("What Is Obesity?"),
      p("Obesity is a complex, chronic medical disease — not a lifestyle choice or a failure of willpower. It is officially recognized as a disease by the American Medical Association, the World Health Organization, and the CDC. At its core, obesity is defined as having an excess amount of body fat that raises the risk of other serious health problems."),
      p("The most widely used measure is Body Mass Index (BMI), calculated by dividing weight in kilograms by height in meters squared (kg/m²):"),
      spacer(),
      makeTable(
        ["BMI Range", "Classification", "Health Risk Level"],
        [
          ["Below 18.5", "Underweight", "May be increased"],
          ["18.5 – 24.9", "Healthy Weight", "Normal"],
          ["25.0 – 29.9", "Overweight", "Increased"],
          ["30.0 – 34.9", "Obesity Class I", "High"],
          ["35.0 – 39.9", "Obesity Class II", "Very High"],
          ["40.0 and above", "Severe (Class III) Obesity", "Extremely High"],
        ],
        [3120, 3120, 3120]
      ),
      spacer(),
      p("Obesity affects the entire body. It raises blood pressure, increases inflammation, disrupts hormones like insulin and leptin, and raises the risk of over 200 health conditions. The complications include type 2 diabetes, heart attack, stroke, fatty liver disease (MASLD/MASH), sleep apnea, osteoarthritis, infertility, depression, and at least 13 types of cancer."),

      // ====== OBESITY VS OVERWEIGHT ======
      h1("Difference Between Obesity and Overweight"),
      p("People often use 'overweight' and 'obese' interchangeably, but they are medically distinct categories with different health implications."),
      makeTable(
        ["Feature", "Overweight (BMI 25–29.9)", "Obesity (BMI ≥ 30)"],
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          ["Definition", "Excess weight relative to height", "Substantial excess body fat causing health risks"],
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          ["Associated Conditions", "Pre-diabetes, mild hypertension, joint strain", "Type 2 diabetes, heart disease, sleep apnea, cancer"],
          ["Medication Eligibility", "Yes, with ≥1 comorbidity (e.g., high BP, high cholesterol)", "Yes, at BMI ≥30 alone"],
          ["Urgency of Treatment", "Lifestyle changes are usually the first step", "Medication and/or surgery often warranted"],
          ["Semaglutide Approval", "BMI ≥27 with at least one weight-related condition", "BMI ≥30 (any)"],
        ],
        [3120, 3120, 3120]
      ),
      spacer(),
      p("The distinction matters for treatment. Semaglutide, for example, is FDA-approved for people with a BMI of 27 or higher who also have at least one weight-related condition — not just those with BMI ≥ 30. This is important to understand in the Semaglutide vs Retatrutide comparison."),

      // ====== PRIMARY REASONS ======
      h1("Primary Reasons Behind Obesity"),
      p("Obesity rarely has a single cause. It is the result of a complex mix of biological, behavioral, environmental, and social factors:"),
      h3("1. Energy Imbalance"),
      p("The most basic driver is taking in more calories than the body burns. Ultra-processed foods, large portion sizes, and sugary beverages have made it easier to consume excess calories without feeling full."),
      h3("2. Hormonal Disruption"),
      p("Key hormones that regulate hunger and fat storage — including leptin, insulin, ghrelin, and GLP-1 — become dysregulated in people with obesity, creating a biological push toward weight gain even when eating normal amounts."),
      h3("3. Gut Microbiome Imbalance"),
      p("Research shows that the bacteria living in the gut (the microbiome) influence how efficiently the body extracts calories from food and how fat is stored."),
      h3("4. Sedentary Lifestyle"),
      p("Office jobs, screen time, and car-dependent communities have dramatically reduced daily physical activity. The body burns fewer calories, and muscle mass decreases over time."),
      h3("5. Sleep Deprivation"),
      p("Poor sleep raises hunger hormones (ghrelin) and lowers satiety hormones (leptin), increasing appetite — especially for high-calorie foods."),
      h3("6. Medications"),
      p("Several common medications cause weight gain as a side effect, including some antidepressants (SSRIs), antipsychotics, corticosteroids, insulin, and beta-blockers."),
      h3("7. Psychological Factors"),
      p("Stress, depression, anxiety, binge eating disorder, and trauma (especially childhood trauma) are strongly linked to obesity. Emotional eating is a well-documented pattern."),
      h3("8. Socioeconomic Factors"),
      p("Food insecurity, limited access to fresh produce (food deserts), lack of safe spaces to exercise, and higher cost of healthy food all contribute to higher obesity rates in lower-income communities."),
      spacer(),

      // ====== IS OBESITY GENETIC ======
      h1("Is Obesity Genetic? And How Should It Be Addressed?"),
      p("Yes — genetics play a significant and well-documented role in obesity. Studies of twins and families show that "),
      p([
        boldRun("40% to 70% of the risk for obesity is heritable"),
        normalRun(". However, having 'obesity genes' does not mean a person is destined to be obese — genes interact with environment, behavior, and hormones.")
      ]),
      h3("Key Genetic Mechanisms"),
      bullet("FTO gene variants are the most studied — they affect hunger signals and fat storage.", "FTO Gene:"),
      bullet("MC4R mutations reduce the brain's ability to detect fullness — this single-gene mutation is the most common cause of severe childhood obesity.", "MC4R Mutation:"),
      bullet("Leptin and leptin receptor gene defects prevent the body from signaling 'I am full.'", "Leptin Pathway Defects:"),
      bullet("Variants in genes that regulate GLP-1 secretion or receptor sensitivity are also linked to obesity risk — which is precisely why GLP-1-based drugs like semaglutide work so well for many people.", "GLP-1 Pathway Genes:"),
      spacer(),
      h3("Addressing Genetic Obesity"),
      p("When obesity has a strong genetic component, lifestyle changes alone are often not enough. Research supports a multi-pronged approach:"),
      bullet("Genetic counseling and testing for known monogenic causes (especially in children)"),
      bullet("Pharmacotherapy — GLP-1 agonists like semaglutide are particularly effective because they directly correct hormonal imbalances driven by genetic predispositions"),
      bullet("Bariatric surgery for severe cases, especially when genetics drive extreme hunger or metabolic dysfunction"),
      bullet("Psychological support to address behavioral patterns shaped by genetic stress responses"),
      p("This is one reason the Semaglutide vs Retatrutide conversation is so important: both drugs target the hormonal pathways that are often disrupted by genetic factors. Retatrutide's additional glucagon receptor action may offer extra benefits for people with metabolically-driven obesity."),
      spacer(),

      // ====== WHAT PEPTIDES HELP ======
      h1("What Kind of Peptides Help in Obesity?"),
      p("Peptides are short chains of amino acids — the building blocks of proteins. Some peptides act as hormones that regulate hunger, fat storage, blood sugar, and metabolism. Several peptide-based therapies have been developed to treat obesity by mimicking or enhancing these natural signals."),
      makeTable(
        ["Peptide Class", "How It Works", "Examples", "Status"],
        [
          ["GLP-1 Receptor Agonists", "Mimics the hormone GLP-1 to reduce hunger, slow digestion, and improve insulin response", "Semaglutide, Liraglutide, Exenatide", "FDA-Approved"],
          ["GIP + GLP-1 Dual Agonists", "Adds GIP receptor activation to GLP-1 effects; better tolerability, more weight loss", "Tirzepatide (Mounjaro/Zepbound)", "FDA-Approved"],
          ["GIP + GLP-1 + Glucagon Triple Agonists", "Adds glucagon receptor activation: boosts energy expenditure, burns more fat", "Retatrutide", "Phase 3 / Investigational"],
          ["Amylin Analogues", "Slows gastric emptying and suppresses glucagon", "Cagrilintide", "Phase 3 in combination"],
          ["GLP-1 + Amylin Combos", "Combines GLP-1 and amylin signaling for additive weight loss", "Cagri-sema (CagriSema)", "Phase 3"],
          ["PYY Analogues", "Peptide YY reduces appetite; being explored as standalone and combo", "Oliceptide", "Phase 2"],
        ],
        [2340, 2340, 2340, 2340]
      ),
      spacer(),
      p("Among all these options, the Semaglutide vs Retatrutide comparison stands out because both are once-weekly injectables with strong clinical trial evidence and the potential to transform obesity treatment — one is available today, the other is coming soon."),
      spacer(),

      // ====== HOW SEMAGLUTIDE HELPS ======
      h1("How Semaglutide Helps in Obesity"),
      p([
        normalRun("Semaglutide is a "),
        boldRun("glucagon-like peptide-1 (GLP-1) receptor agonist"),
        normalRun(". It was developed by Novo Nordisk. It works by mimicking GLP-1, a natural hormone released by the intestines after eating. GLP-1 tells the brain to feel full, slows stomach emptying (so food stays in the stomach longer), reduces appetite, and lowers blood sugar by stimulating insulin release in a glucose-dependent way.")
      ]),
      p("Semaglutide has about 94% structural similarity to human GLP-1 but has been chemically modified at two amino acid positions and attached to a fatty acid chain. This modification allows it to bind to albumin in the blood, extending its half-life to approximately 165 hours (~7 days) — making once-weekly dosing possible. It is stabilized against breakdown by the DPP-4 enzyme that would otherwise quickly degrade natural GLP-1."),
      h3("Weight Loss Mechanisms of Semaglutide"),
      bullet("Activates GLP-1 receptors in the hypothalamus (brain hunger center) → reduces appetite and cravings"),
      bullet("Slows gastric emptying → food stays in stomach longer → you feel fuller for longer"),
      bullet("Reduces reward-driven eating by acting on dopamine pathways"),
      bullet("Improves insulin sensitivity and reduces blood sugar"),
      bullet("Reduces liver fat (demonstrated in MASH approval, August 2025)"),
      bullet("Reduces inflammation associated with obesity"),
      spacer(),
      h3("Semaglutide Research Data: 2020–2026"),
      makeTable(
        ["Year", "Study / Trial", "Dose", "Duration", "Weight Loss", "Key Finding"],
        [
          ["2021", "STEP 1 (NEJM)", "2.4 mg/week SC", "68 weeks", "14.9% avg", "Landmark trial; ~86% achieved ≥5% weight loss"],
          ["2021", "STEP 2 (Lancet)", "2.4 mg/week SC", "68 weeks", "9.6% avg", "Adults with T2D; significant vs 3.4% placebo"],
          ["2021", "STEP 3", "2.4 mg/week SC + behavior", "68 weeks", "16.0% avg", "Intensive behavioral therapy added further loss"],
          ["2021", "STEP 4", "2.4 mg/week SC", "48 weeks", "17.4% maintained", "Continued therapy vs placebo — regain on stopping"],
          ["2022", "STEP 5 (NEJM)", "2.4 mg/week SC", "104 weeks (2 years)", "15.2% avg", "Long-term efficacy confirmed at 2 years"],
          ["2022", "STEP 8 (JAMA)", "2.4 mg/week vs liraglutide", "68 weeks", "15.8% vs 6.4%", "Semaglutide nearly 2.5x more effective than liraglutide"],
          ["2022", "Meta-Analysis (Frontiers Pharmacol.)", "SC 2.4 mg", "Various", "−10.09% body weight", "8 RCTs, 4,567 patients; significant BMI/waist reduction"],
          ["2023", "SELECT Trial (NEJM)", "2.4 mg/week SC", "~33 months", "~9.4% avg", "**20% reduction in major cardiovascular events**"],
          ["2024", "STEP 10 (Lancet Diab. Endocrinol.)", "2.4 mg/week SC", "68 weeks", "~15.7%", "Prediabetes population; also reduced diabetes onset"],
          ["2024", "SELECT Long-term (Nature Med.)", "2.4 mg/week SC", "Up to 4 years", "Sustained", "Clinically meaningful loss in both sexes, all races"],
          ["2024", "SURMOUNT-5 (NEJM, 2025)", "2.4 mg vs tirzepatide", "72 weeks", "13.7% (sema)", "Tirzepatide 20.2% — sema still significant"],
          ["2025", "STEP UP (Lancet, Jan 2025)", "7.2 mg/week SC (new high dose)", "72 weeks", "20.7% (adherent)", "**New higher dose approved April 2026**; 33.2% lost ≥25%"],
          ["2025", "Oral Semaglutide Real-World (Frontiers)", "14 mg oral", "Various", "~10–15%", "Real-world oral use; 89% achieved ≥5% weight loss"],
          ["2025", "FDA Approves Wegovy for MASH", "2.4 mg SC", "—", "Liver fat reduction", "First drug approved specifically for MASH (liver disease)"],
          ["2026", "Oral Wegovy FDA Approved (Dec 2025)", "Daily oral pill", "—", "~13–15%", "First oral GLP-1 approved for weight loss; launched Jan 2026"],
        ],
        [700, 2200, 1200, 900, 1000, 2360]
      ),
      spacer(),
      p([
        normalRun("Today, semaglutide remains the "),
        boldRun("gold standard among approved obesity medications"),
        normalRun(". In the Semaglutide vs Retatrutide comparison, semaglutide has far more real-world data, a longer safety record, multiple FDA approvals, and growing insurance coverage.")
      ]),
      spacer(),

      // ====== HOW RETATRUTIDE HELPS ======
      h1("How Retatrutide Helps in Obesity"),
      p([
        normalRun("Retatrutide (development code LY3437943) is an "),
        boldRun("investigational once-weekly triple-hormone receptor agonist"),
        normalRun(" developed by Eli Lilly. It is the first drug of its kind to simultaneously activate three different hormone receptors: GLP-1 (glucagon-like peptide-1), GIP (glucose-dependent insulinotropic polypeptide), and GCGR (glucagon receptor). This triple action is why retatrutide produces dramatically greater weight loss than semaglutide in clinical trials.")
      ]),
      h3("Weight Loss Mechanisms of Retatrutide"),
      bullet("GLP-1 receptor activation: Reduces appetite, slows gastric emptying, improves insulin sensitivity (same as semaglutide)"),
      bullet("GIP receptor activation: Adds incretin synergy, improves fat utilization from fat tissue, may reduce GI side effects of GLP-1 alone"),
      bullet("Glucagon receptor activation: This is the key differentiator — glucagon increases energy expenditure (burns more calories at rest), promotes fat breakdown, and reduces liver fat through a separate pathway"),
      bullet("Combined effect: All three pathways together produce 'caloric restriction from the inside' — eating less AND burning more simultaneously"),
      bullet("LDL cholesterol reduction of ~20% (via glucagon's effect on PCSK9 degradation)"),
      bullet("Reduces liver fat by up to 86% in Phase 2 data"),
      spacer(),
      p([
        normalRun("Retatrutide is a synthetic peptide attached to a fatty diacid moiety (similar engineering to semaglutide), which gives it a half-life of approximately "),
        boldRun("6 days — enabling once-weekly dosing"),
        normalRun(".")
      ]),
      h3("Retatrutide Research Data: 2022–2026"),
      makeTable(
        ["Year", "Study / Trial", "Dose", "Duration", "Weight Loss", "Key Finding"],
        [
          ["2022", "Phase 1b (Lancet, Urva et al.)", "Up to 12 mg", "Multiple-ascending dose", "Early data", "First human data; confirmed GIP/GLP-1/glucagon triple agonism"],
          ["2023", "Phase 2 (NEJM, Jastreboff et al.)", "12 mg/week SC", "24 weeks", "17.5% avg", "**Primary endpoint met**; best result seen in any drug at 24 weeks"],
          ["2023", "Phase 2 — 48-week endpoint", "12 mg/week SC", "48 weeks", "24.2% avg", "57.8 lbs / 26.2 kg; exceeded all prior drug trials"],
          ["2023", "Phase 2 — T2D (Lancet, Rosenstock)", "Up to 12 mg", "36 weeks", "16.9% + HbA1c ↓2.0%", "Significant glycemic + weight benefit in diabetes"],
          ["2023", "TRIUMPH Phase 3 Program Begins", "2–12 mg doses", "Ongoing", "—", "5,800+ participants enrolled across 4 global trials"],
          ["2024", "Phase 2 Liver Data (Nature Med.)", "12 mg", "48 weeks", "86% liver fat reduction", "93% achieved normal liver fat levels"],
          ["2025", "TRIUMPH-4 Phase 3 (Lilly, Dec 2025)", "12 mg/week SC", "68 weeks", "**28.7% avg (71.2 lbs)**", "**First successful Phase 3**; 45% achieved ≥30% loss"],
          ["2025", "Systematic Review (Proc. Baylor)", "Various", "Pooled RCTs", "No increase in AEs vs placebo", "Safety profile confirmed; GI events dose-related but mild"],
          ["2026 (June)", "TRIUMPH-1 Phase 3 (Lilly)", "12 mg/week SC", "80 weeks", "**28.3% avg (70.3 lbs)**", "**45.3% achieved ≥30% loss**; 65.3% achieved BMI <30"],
          ["2026 (Q2)", "TRIUMPH-1 — 104-week extension", "12 mg SC (continued)", "104 weeks", "**33% avg** (subset)", "Continued weight loss beyond 80 weeks in extension"],
          ["2026", "7 additional Phase 3 trials ongoing", "Various", "Expected 2026", "—", "T2D, sleep apnea, MASLD, cardiovascular outcomes"],
        ],
        [700, 2200, 1200, 900, 1000, 2360]
      ),
      spacer(),
      p([
        normalRun("The Phase 3 data from TRIUMPH-1 (June 2026) is striking: "),
        boldRun("65.3% of participants on the 12 mg dose achieved a BMI below 30"),
        normalRun(" — meaning they effectively left the obesity range entirely. For people with BMI ≥ 40 at baseline, more than a third also crossed below BMI 30. These are surgical-level results from a weekly injection.")
      ]),
      p([
        normalRun("In the Semaglutide vs Retatrutide race, retatrutide is pulling ahead on efficacy numbers — but it is not yet FDA-approved. FDA submission is expected in late 2026, with the earliest realistic availability in mid-to-late 2027.")
      ]),
      spacer(),

      // ====== COMPARISON ======
      h1("Semaglutide vs Retatrutide: Full Comparison"),
      p("Below is a detailed Semaglutide vs Retatrutide comparison across the dimensions that matter most to patients and providers."),
      h3("Side-by-Side Overview"),
      makeTable(
        ["Feature", "Semaglutide", "Retatrutide"],
        [
          ["Developer", "Novo Nordisk", "Eli Lilly"],
          ["Drug Class", "GLP-1 Receptor Agonist", "GIP + GLP-1 + Glucagon Triple Agonist"],
          ["FDA Status", "**Approved (2021 for obesity)**", "Investigational — Phase 3"],
          ["Dosing", "Weekly SC injection (or daily oral pill)", "Once-weekly SC injection"],
          ["Available Doses (Obesity)", "0.25 mg → 2.4 mg; high-dose 7.2 mg (2026)", "2 mg → 12 mg (Phase 3 doses)"],
          ["Average Weight Loss (Best Dose)", "~15–20.7% (7.2 mg, 72 weeks)", "~28.3% (12 mg, 80 weeks)"],
          ["% Achieving ≥30% Weight Loss", "~0–3% (2.4 mg); ~19% (7.2 mg)", "45.3% (12 mg, TRIUMPH-1)"],
          ["Monthly Cost (No Insurance)", "~$936–$1,349/month", "Not commercially available; ~$1,200–$1,500/month (estimated at launch)"],
          ["Insurance Coverage", "Yes — multiple plan types", "No — not yet available"],
          ["Cardiovascular Benefit", "20% reduction in MACE (SELECT trial)", "Under investigation in Phase 3"],
          ["MASH (Liver) Approval", "Yes (August 2025)", "Phase 3 data: 86% liver fat reduction"],
          ["Oral Formulation Available", "Yes (oral Wegovy, approved Dec 2025)", "No"],
          ["Long-term Safety Data", "3–4+ years of data available", "Limited to ~2 years in Phase 3"],
          ["Best For", "People who need an approved, insured, proven therapy today", "Future patients wanting maximum weight loss once approved"],
        ],
        [2800, 3280, 3280]
      ),
      spacer(),
      h3("Dosage Schedule Comparison"),
      makeTable(
        ["Week", "Semaglutide (Wegovy) Dose", "Retatrutide (TRIUMPH Protocol)"],
        [
          ["1–4", "0.25 mg/week", "2 mg/week"],
          ["5–8", "0.5 mg/week", "2 mg/week (hold)"],
          ["9–12", "1.0 mg/week", "4 mg/week"],
          ["13–16", "1.7 mg/week", "4 mg/week (hold)"],
          ["17+", "2.4 mg/week (maintenance)", "Escalate to 6, 9, or 12 mg target"],
          ["New High-Dose", "7.2 mg/week (approved April 2026)", "12 mg/week (investigational max)"],
        ],
        [3120, 3120, 3120]
      ),
      spacer(),
      h3("Cost Comparison (June 2026)"),
      makeTable(
        ["Drug / Form", "List Price/Month", "With Good Insurance", "Medicare (2026)", "Manufacturer Savings"],
        [
          ["Wegovy 2.4 mg (SC, weekly)", "~$1,349", "$25–$100 copay", "$50/month (GLP-1 Bridge, July 2026)", "Savings card; $0 for eligible uninsured"],
          ["Ozempic (for T2D)", "~$936", "~$25–$50 (T2D coverage)", "Covered for T2D", "Savings card available"],
          ["Oral Wegovy (pill, daily)", "~$199–$299/month", "Varies", "Covered under Medicare Bridge", "Introductory self-pay offer launched"],
          ["Rybelsus (oral, T2D)", "~$936/month", "Covered for T2D", "Covered for T2D", "Savings card"],
          ["Retatrutide (projected)", "~$1,200–$1,500/month", "N/A (not approved)", "N/A", "N/A"],
        ],
        [2600, 1700, 1700, 1800, 1560]
      ),
      spacer(),

      // ====== WHEN SEMA BETTER ======
      h1("When Is Semaglutide the Better Choice?"),
      p("Based on current research and clinical guidelines, semaglutide is the better choice in these situations:"),
      h3("1. You Need Treatment Right Now"),
      p("Retatrutide is not FDA-approved and will not be commercially available until at least 2027. If you have obesity-related health risks that require treatment today, semaglutide is your evidence-backed option."),
      h3("2. You Have Insurance Coverage"),
      p("Semaglutide (Wegovy) now has broader insurance coverage than ever — including the new Medicare GLP-1 Bridge program ($50/month starting July 2026). Commercial plans increasingly cover it. Retatrutide offers no insurance pathway yet."),
      h3("3. You Have Existing Cardiovascular Disease"),
      p("Semaglutide is the only obesity drug with proven cardiovascular outcomes data. The SELECT trial showed a 20% reduction in major adverse cardiovascular events (MACE) in people with pre-existing heart disease. This earned it FDA approval for cardiovascular risk reduction in March 2024."),
      h3("4. You Have Fatty Liver Disease (MASH)"),
      p("Semaglutide was FDA-approved in August 2025 specifically for metabolic-associated steatohepatitis (MASH) — the first drug ever approved for this liver disease."),
      h3("5. You Prefer Not to Inject"),
      p("The new oral Wegovy pill (approved December 2025, launched January 2026) makes semaglutide accessible without injections. No oral version of retatrutide is in development yet."),
      h3("6. You Want the Most Safety Data"),
      p("Semaglutide has 3–5 years of real-world safety data from millions of patients globally. Retatrutide has only 2 years of Phase 3 data from clinical trial populations."),
      h3("7. Modest but Meaningful Weight Loss Is Sufficient"),
      p("If losing 15–20% of body weight would achieve your health goals (which it often will — this is enough to send type 2 diabetes into remission and significantly reduce cardiovascular risk), semaglutide is more than sufficient."),
      spacer(),

      // ====== WHEN RETA BETTER ======
      h1("When Is Retatrutide the Better Choice?"),
      p("Based on current Phase 3 research, retatrutide may be the better choice in these situations — once it is approved:"),
      h3("1. You Need Maximum Weight Loss"),
      p("If your starting BMI is 40+ and you need to lose a large absolute amount of weight (50–80+ lbs), retatrutide's 28.3% average weight loss is significantly greater than semaglutide's 15–20%. In TRIUMPH-1, the average participant lost 70.3 lbs. For very high BMIs, this can make the difference between remaining obese vs. reaching a healthy weight."),
      h3("2. You Have Tried Semaglutide or Tirzepatide Without Sufficient Results"),
      p("Clinical experience shows that some patients are 'low responders' to GLP-1 alone or dual GIP/GLP-1 therapy. The addition of glucagon agonism in retatrutide offers a mechanistically different pathway that may work where others haven't."),
      h3("3. You Have Severe Non-Alcoholic Fatty Liver Disease"),
      p("Phase 2 data showed 86% reduction in liver fat with retatrutide's highest dose — with 93% of participants achieving normal liver fat levels. This is remarkable and may exceed semaglutide's liver benefit."),
      h3("4. You Have High Triglycerides and Poor Lipid Profile"),
      p("Retatrutide's glucagon component reduces LDL cholesterol by approximately 20% and lowers triglycerides more aggressively than GLP-1 alone, via an effect on PCSK9 — a novel cardiovascular benefit beyond weight loss."),
      h3("5. You Have Knee Osteoarthritis"),
      p("The TRIUMPH-4 trial specifically enrolled people with obesity and knee osteoarthritis. Retatrutide delivered both substantial weight loss (28.7%) and significant reductions in knee pain and improved physical function — a dual benefit no other obesity drug currently provides."),
      h3("6. You Want Surgical-Level Results Without Surgery"),
      p("In TRIUMPH-1, 65.3% of people taking 12 mg retatrutide for 80 weeks achieved a BMI below 30 — leaving the obesity range. This is approaching bariatric surgery outcomes. For patients who are poor surgical candidates or wish to avoid surgery, retatrutide represents a potential game-changer."),
      h3("Important Caveat"),
      p([
        boldRun("Retatrutide is NOT currently available outside of clinical trials"),
        normalRun(". FDA submission is expected in late 2026. Prescription access for the general public is anticipated in 2027 at the earliest. Any 'retatrutide' sold online or through unregulated vendors is research-grade peptide, not a pharmaceutical product, and is NOT the same as what was used in clinical trials.")
      ]),
      spacer(),

      // ====== CONTRAINDICATIONS ======
      h1("Contraindications"),
      p("Understanding when these medications should NOT be used is critical for safety. Both drugs share several contraindications due to their GLP-1 receptor agonist component."),
      h3("Shared Contraindications (Both Drugs)"),
      makeTable(
        ["Contraindication", "Reason"],
        [
          ["Personal or family history of Medullary Thyroid Cancer (MTC)", "GLP-1 agonists cause dose-dependent thyroid C-cell tumors in rodents; human relevance unknown but risk is treated seriously"],
          ["Multiple Endocrine Neoplasia Type 2 (MEN 2)", "Associated with high risk of MTC; absolute contraindication"],
          ["Known hypersensitivity to the drug or its components", "Risk of anaphylaxis or serious allergic reaction"],
          ["Pregnancy", "GLP-1 receptor agonists are contraindicated in pregnancy; effective contraception required"],
          ["History of pancreatitis (precaution)", "Cases of acute pancreatitis have been reported with GLP-1 agents; should not be used in those with prior pancreatitis"],
          ["Use with other GLP-1 receptor agonists", "Combining two GLP-1 drugs is contraindicated due to additive risk without added benefit"],
        ],
        [3600, 5760]
      ),
      spacer(),
      h3("Semaglutide-Specific Precautions"),
      makeTable(
        ["Precaution", "Detail"],
        [
          ["Diabetic retinopathy", "Rapid blood sugar improvement can transiently worsen diabetic eye disease; monitor closely"],
          ["Renal impairment", "GI side effects may cause dehydration; caution in kidney disease"],
          ["Gallbladder disease", "Rapid weight loss increases gallstone risk; cases of cholelithiasis and cholecystitis reported"],
          ["Use with insulin or sulfonylureas", "Risk of hypoglycemia when combined; dose reduction of the other medication may be needed"],
        ],
        [3000, 6360]
      ),
      spacer(),
      h3("Retatrutide-Specific Precautions"),
      p("Since retatrutide is still investigational, its contraindication profile is based on Phase 2 and Phase 3 trial data and expected to include all the GLP-1 agonist class warnings above, PLUS:"),
      bullet("Additional caution for thyroid monitoring given glucagon agonism's metabolic effects"),
      bullet("Heart rate increases have been noted in trials — caution anticipated for those with pre-existing tachycardia"),
      bullet("No data in pregnancy — absolute contraindication expected"),
      bullet("No data in severe renal or hepatic impairment — will require warnings on prescribing information"),
      spacer(),

      // ====== COMPANY RESULTS ======
      h1("Results Published by Companies"),
      h3("Novo Nordisk (Semaglutide) — Key Published Milestones"),
      makeTable(
        ["Date", "Announcement / Publication"],
        [
          ["June 2021", "FDA approves Wegovy (semaglutide 2.4 mg) for chronic weight management — first new obesity drug in 7 years"],
          ["March 2024", "FDA approves Wegovy to reduce major adverse cardiovascular events (SELECT trial results)"],
          ["January 2025", "STEP UP Phase 3b data: 7.2 mg semaglutide achieves 20.7% weight loss at 72 weeks"],
          ["August 2025", "FDA approves Wegovy for treatment of MASH (metabolic-associated steatohepatitis) — first drug for this condition"],
          ["November 2025", "Novo Nordisk launches introductory $199/month self-pay pricing for Wegovy"],
          ["April 2026", "FDA approves Wegovy HD (7.2 mg) — highest-dose injectable semaglutide for obesity in the USA"],
          ["December 2025", "FDA approves oral Wegovy (daily pill); pharmacies stock it starting January 2026"],
          ["2027 (projected)", "Medicare-negotiated Wegovy price of $274/30-day supply takes effect under Inflation Reduction Act"],
        ],
        [2100, 7260]
      ),
      spacer(),
      h3("Eli Lilly (Retatrutide) — Key Published Milestones"),
      makeTable(
        ["Date", "Announcement / Publication"],
        [
          ["June 2023", "Phase 2 data published in NEJM: 17.5% weight loss at 24 weeks, 24.2% at 48 weeks — sets new record"],
          ["2023", "TRIUMPH Phase 3 program begins with 5,800+ participants across 4 global trials"],
          ["December 2025", "TRIUMPH-4 Phase 3: 28.7% weight loss (71.2 lbs average) in obesity + knee osteoarthritis trial"],
          ["May/June 2026", "TRIUMPH-1 Phase 3: 28.3% weight loss (70.3 lbs), 45.3% achieved ≥30% loss, 65.3% achieved BMI <30"],
          ["Late 2026 (expected)", "FDA New Drug Application (NDA) submission for retatrutide"],
          ["2027 (earliest)", "Potential FDA approval and commercial launch in the United States"],
          ["2026 ongoing", "7 additional Phase 3 trials expected to report: T2D, sleep apnea, MASLD, cardiovascular outcomes"],
        ],
        [2100, 7260]
      ),
      spacer(),

      // ====== BRAND NAMES ======
      h1("Brand Names in the USA"),
      makeTable(
        ["Drug", "Brand Name", "Formulation", "Approved Indication", "Manufacturer"],
        [
          ["Semaglutide", "Wegovy", "SC injection (0.25–2.4 mg, 7.2 mg weekly)", "Chronic weight management (BMI ≥30 or ≥27 + comorbidity); Cardiovascular risk reduction; MASH", "Novo Nordisk"],
          ["Semaglutide", "Wegovy (oral)", "Daily tablet (7 mg, 14 mg)", "Chronic weight management (approved Dec 2025)", "Novo Nordisk"],
          ["Semaglutide", "Ozempic", "SC injection (0.5, 1, 2 mg weekly)", "Type 2 diabetes management", "Novo Nordisk"],
          ["Semaglutide", "Rybelsus", "Daily oral tablet (7, 14 mg)", "Type 2 diabetes management", "Novo Nordisk"],
          ["Retatrutide", "TBD (no brand name yet)", "SC injection (investigational: 2–12 mg weekly)", "Under FDA review — not yet approved", "Eli Lilly"],
        ],
        [1560, 1560, 2340, 2600, 1300]
      ),
      spacer(),

      // ====== INSURANCE COVERAGE ======
      h1("Coverage by Insurance Types"),
      makeTable(
        ["Insurance Type", "Semaglutide (Wegovy) — Weight Loss", "Semaglutide (Ozempic/Rybelsus) — Diabetes", "Retatrutide"],
        [
          ["Medicare Part D", "**$50/month (July–Dec 2026 GLP-1 Bridge)**; $274/month from 2027 (negotiated)", "Covered for T2D (standard)", "Not covered — not approved"],
          ["Medicaid", "BALANCE Model launching May 2026 in states; varies by state", "Often covered for T2D; state-dependent for obesity", "Not covered"],
          ["ACA Marketplace / Exchange Plans", "Coverage varies widely; many plans cover with prior auth for BMI ≥30", "Usually covered for T2D", "Not covered"],
          ["Employer / Commercial Plans", "Increasingly covered post-2024; prior authorization + BMI criteria required", "Covered with prior auth for T2D", "Not covered"],
          ["TRICARE (Military)", "Limited coverage; improving", "Covered for T2D", "Not covered"],
          ["VA (Veterans Affairs)", "Case-by-case; improving with new VA obesity guidelines", "Covered for T2D + metabolic syndrome", "Not covered"],
          ["Uninsured / Self-Pay", "~$199–$1,349/month depending on form and program", "~$936/month (Ozempic)", "Research-grade only; not medical product"],
          ["Typical Prior Auth Requirements", "BMI ≥30 OR ≥27 + comorbidity; failed prior weight loss attempts may be required", "T2D diagnosis + HbA1c criteria", "N/A"],
        ],
        [2100, 2420, 2420, 2420]
      ),
      spacer(),
      p([
        boldRun("Important 2026 Update: "),
        normalRun("The Medicare GLP-1 Bridge program — running July 1 to December 31, 2026 — gives eligible Medicare Part D beneficiaries access to brand-name Wegovy for $50/month. Starting January 2027, the BALANCE Model (a 5-year CMS demonstration program) will allow Part D plans to cover GLP-1 drugs for weight loss as part of the standard benefit. Both Novo Nordisk and Eli Lilly have agreed to participate.")
      ]),
      spacer(),

      // ====== PHARMACOLOGY ======
      h1("Comparison of Pharmacology"),
      p("Understanding the pharmacology of these two drugs helps explain why retatrutide produces greater weight loss and what the differences mean for patients."),
      makeTable(
        ["Pharmacological Feature", "Semaglutide", "Retatrutide"],
        [
          ["Molecular Structure", "Modified GLP-1 peptide; 94% sequence homology to human GLP-1; C18 fatty di-acid attached at Lys26", "Synthetic peptide; fatty diacid moiety; designed for balanced potency across 3 receptors"],
          ["Receptor Targets", "GLP-1R only", "GLP-1R + GIPR + GCGR (triple agonist)"],
          ["Half-Life", "~165 hours (≈7 days) — enables weekly dosing", "~6 days — enables weekly dosing"],
          ["Protraction Mechanism", "Albumin binding via fatty acid chain; protected from DPP-4 degradation", "Fatty diacid moiety for albumin binding; similar DPP-4 protection"],
          ["Route of Administration", "SC injection OR oral daily pill", "SC injection only (currently)"],
          ["Appetite Suppression", "Strong (via GLP-1R in hypothalamus)", "Very strong (GLP-1R + GIPR central effects)"],
          ["Gastric Emptying", "Significantly slows", "Slows (GLP-1R); GIPR may partially moderate this"],
          ["Insulin Secretion", "Glucose-dependent stimulation (GLP-1R)", "Glucose-dependent stimulation (GLP-1R + GIPR)"],
          ["Glucagon Suppression", "Yes (GLP-1R → suppresses alpha cells)", "Yes (GLP-1R + partially opposed by GCGR agonism)"],
          ["Energy Expenditure", "Minor increase via weight-loss cascade", "**Active increase via GCGR** — thermogenic effect"],
          ["Lipolysis (Fat Burning)", "Indirect, via caloric restriction", "**Direct increase** via glucagon receptor signaling"],
          ["LDL Cholesterol Effect", "Modest improvement", "~20% reduction via PCSK9 degradation (glucagon effect)"],
          ["Liver Fat Reduction", "Significant (approved for MASH)", "86% reduction in Phase 2 (surpasses semaglutide data)"],
          ["GI Side Effect Profile", "Nausea, vomiting, diarrhea common during dose-escalation", "Similar GI profile; GIPR co-agonism may reduce nausea vs pure GLP-1"],
          ["Heart Rate Effect", "Modest increase (~1–4 bpm)", "Potentially higher increase; under investigation"],
          ["FDA Approval", "Yes (2021)", "No — expected NDA late 2026"],
          ["Years of Human Data", "5+ years", "~2 years (Phase 2 + Phase 3)"],
        ],
        [2800, 3280, 3280]
      ),
      spacer(),

      // ====== ADDITIONAL: SIDE EFFECTS ======
      h1("Side Effects: What to Expect"),
      p("Both drugs share a broadly similar side effect profile because both activate GLP-1 receptors. The most common issues are gastrointestinal."),
      makeTable(
        ["Side Effect", "Semaglutide", "Retatrutide", "Severity"],
        [
          ["Nausea", "Very common (30–45% of patients)", "Common; may be less due to GIPR component", "Usually mild; worst during dose escalation"],
          ["Vomiting", "Common (15–25%)", "Similar rate", "Mild-moderate; often resolves after escalation"],
          ["Diarrhea", "Common (15–30%)", "Common", "Mild; often resolves"],
          ["Constipation", "Common (10–20%)", "Common across GLP-1 class", "Mild"],
          ["Decreased appetite", "Very common — desired effect", "Very common — enhanced by triple mechanism", "Usually welcome"],
          ["Fatigue / tiredness", "Occasional", "Occasional", "Mild"],
          ["Headache", "Occasional", "Occasional", "Mild"],
          ["Increased heart rate", "Mild increase (~2–4 bpm)", "Under investigation; potentially more", "Monitor in cardiac patients"],
          ["Gallstones", "Risk increases (rapid weight loss)", "Expected similar risk", "Moderate; requires monitoring"],
          ["Injection site reactions", "Occasional redness/swelling", "Occasional", "Mild"],
          ["Hypoglycemia", "Rare without diabetes", "Rare without diabetes", "Low risk — glucose-dependent mechanism"],
          ["Thyroid tumors (rodent data)", "Risk in rodents; human risk unknown", "Expected same class warning", "Unknown human risk — contraindication applies"],
          ["Acute pancreatitis", "Rare; risk not fully established", "Rare; class risk", "Potentially serious — monitor symptoms"],
        ],
        [2340, 2340, 2340, 2340]
      ),
      spacer(),
      p([
        boldRun("Managing side effects tip: "),
        normalRun("The slow dose-escalation schedule for both drugs (starting at a very low dose and increasing over months) is specifically designed to minimize GI side effects. Most patients find nausea peaks during the first 1–2 weeks after each dose increase, then fades. Eating smaller meals and avoiding high-fat foods during escalation can help.")
      ]),
      spacer(),

      // ====== ADDITIONAL: LIFESTYLE ======
      h1("Lifestyle Changes That Maximize Results"),
      p("In every clinical trial for both semaglutide and retatrutide, participants were also following a reduced-calorie diet and increased physical activity alongside their medication. The results for these drugs at their best occurred in combination with lifestyle changes — not as standalone treatments."),
      bullet("Dietary changes: A moderate caloric deficit (500–750 kcal/day below maintenance) maximizes results. Higher protein intake (1.2–1.6 g/kg body weight) helps preserve muscle mass during weight loss."),
      bullet("Physical activity: 150–300 minutes per week of moderate-intensity cardio is recommended by the AHA/ACC. Even light walking significantly improves metabolic outcomes."),
      bullet("Sleep: Getting 7–9 hours per night reduces hunger hormones and supports the appetite-suppressing effects of these drugs."),
      bullet("Behavioral support: People enrolled in behavioral counseling programs in addition to medication (STEP 3 trial with semaglutide) lose more weight and maintain it better."),
      bullet("Alcohol: Both drugs slow gastric emptying. Combined with alcohol, this increases risks and can worsen side effects. Minimizing alcohol is strongly recommended."),
      spacer(),

      // ====== ADDITIONAL: WHO IS ELIGIBLE ======
      h1("Who Is Eligible for These Medications?"),
      h3("Semaglutide (Wegovy) Eligibility"),
      bullet("Adults with BMI ≥ 30 (obesity)"),
      bullet("Adults with BMI ≥ 27 (overweight) AND at least one weight-related health condition (type 2 diabetes, high blood pressure, high cholesterol, obstructive sleep apnea, or cardiovascular disease)"),
      bullet("Adults with existing cardiovascular disease who are overweight or obese (for the cardiovascular benefit indication)"),
      bullet("Prescription required — must be evaluated by a licensed healthcare provider"),
      spacer(),
      h3("Retatrutide Eligibility (Current Clinical Trials — As of June 2026)"),
      bullet("Must be enrolled in an active TRIUMPH clinical trial"),
      bullet("Generally: adults with BMI ≥ 30, or BMI ≥ 27 with at least one weight-related comorbidity"),
      bullet("Some trials require absence of diabetes; others include people with type 2 diabetes"),
      bullet("Not available for general prescription — no over-the-counter or telehealth access exists for pharmaceutical retatrutide"),
      spacer(),

      // ====== FAQ ======
      h1("Frequently Asked Questions (FAQ)"),

      h3("Q1: Can I take semaglutide and retatrutide together?"),
      p("No. Combining two GLP-1 receptor agonists is contraindicated. Both drugs activate the GLP-1 receptor, and combining them would not add benefit but would significantly increase side effects and safety risks."),

      h3("Q2: Is retatrutide better than semaglutide?"),
      p("In terms of raw weight loss numbers, the Phase 3 data shows retatrutide (28.3%) outperforms semaglutide (15–20.7%). However, 'better' depends on your situation. Semaglutide is FDA-approved, widely available, has years of safety data, and is increasingly covered by insurance. Retatrutide is not yet approved for general use. Most experts would say: for patients available today, semaglutide is the better choice; for patients willing to wait, retatrutide may eventually offer superior results."),

      h3("Q3: When will retatrutide be available?"),
      p("Eli Lilly plans to submit the FDA New Drug Application (NDA) for retatrutide in late 2026. If approved — and Phase 3 data strongly supports this — the earliest expected commercial availability in the U.S. is mid-to-late 2027. Seven additional Phase 3 trials are expected to report results through 2026, covering obesity with type 2 diabetes, sleep apnea, liver disease, and cardiovascular outcomes."),

      h3("Q4: Will retatrutide be covered by insurance?"),
      p("Once approved, retatrutide will likely need to go through the same insurance coverage pathway as semaglutide and tirzepatide. Eli Lilly has already agreed to participate in the CMS BALANCE Model for GLP-1 coverage starting 2027. Whether individual commercial plans cover it for obesity (vs. just diabetes, if approved for both) will depend on each plan's formulary decisions."),

      h3("Q5: What happens if you stop taking these drugs?"),
      p("Both semaglutide and retatrutide (based on Phase 2 data) show significant weight regain when stopped. The STEP 4 trial showed that patients who stopped semaglutide regained about two-thirds of their lost weight within one year. These medications appear to require ongoing use to maintain weight loss — similar to how blood pressure medications need to be continued to maintain blood pressure control. This is because obesity is a chronic disease with biological drivers that the medications are managing, not curing."),

      h3("Q6: Can people with type 2 diabetes use these drugs?"),
      p("Yes, for semaglutide — Ozempic is specifically approved for type 2 diabetes, and STEP 2 showed Wegovy significantly reduced weight in people with T2D (though less than in non-diabetic patients, at 9.6% vs 14.9%). For retatrutide, a dedicated Phase 3 trial in people with type 2 diabetes is ongoing and expected to report in 2026."),

      h3("Q7: How is the Semaglutide vs Retatrutide comparison different from Ozempic vs Wegovy?"),
      p("Ozempic and Wegovy both contain semaglutide — the same active ingredient at different doses for different approved uses (Ozempic for T2D at up to 2 mg; Wegovy for obesity at 2.4 mg and now 7.2 mg). The semaglutide vs retatrutide comparison is about a GLP-1 agonist vs a completely different drug with three hormone targets. Retatrutide is not a higher dose of semaglutide — it is a pharmacologically distinct molecule."),

      h3("Q8: Are there any drug interactions I should know about?"),
      p("Key interactions for semaglutide include: (1) insulin and sulfonylureas — risk of hypoglycemia, dose reduction may be needed; (2) oral medications taken with food — slowed gastric emptying may affect absorption of other drugs, particularly contraceptive pills and thyroid medications. Retatrutide's interaction profile is still being established in Phase 3 trials, but similar class-based interactions are expected."),

      h3("Q9: Is the weight loss maintained long-term?"),
      p("Semaglutide: Long-term SELECT trial data (up to ~3.5 years) and STEP 5 (2-year) data show weight loss is maintained with continuous treatment. Retatrutide: The TRIUMPH-1 104-week extension study showed continued weight loss even at 2 years, with average loss reaching 33% in the continuation group — suggesting weight loss does not plateau rapidly on retatrutide."),

      h3("Q10: Can adolescents use these medications?"),
      p("Semaglutide (Wegovy) is FDA-approved for adolescents aged 12 and older with obesity (BMI ≥ 95th percentile for age and sex). Retatrutide has no pediatric data yet and is not approved for or being studied in children or adolescents at this time."),
      spacer(),

      // ====== WHAT'S COMING ======
      h1("What's Coming Next in Obesity Pharmacotherapy"),
      p("The Semaglutide vs Retatrutide conversation is part of a broader revolution in obesity medicine. Here are other developments worth watching:"),
      makeTable(
        ["Drug", "Class", "Developer", "Status", "Notable Features"],
        [
          ["CagriSema", "GLP-1 + Amylin combination", "Novo Nordisk", "Phase 3", "Expected ~25% weight loss; combines semaglutide with cagrilintide"],
          ["Orforglipron", "Oral GLP-1 agonist (small molecule)", "Eli Lilly", "NDA pending 2026", "Once-daily pill; non-peptide; potentially very low cost"],
          ["Tirzepatide (Zepbound)", "GLP-1 + GIP dual agonist", "Eli Lilly", "FDA-Approved (2023)", "~20.9% weight loss; currently best-approved drug after semaglutide"],
          ["MariTide", "GLP-1 agonist/GIPR antagonist", "Amgen", "Phase 3", "Different mechanism — GIPR antagonism; monthly dosing"],
          ["Mazdutide", "GLP-1 + Glucagon dual agonist", "Innovent/Roche", "Phase 3", "Similar to retatrutide minus the GIP component"],
        ],
        [1872, 1872, 1200, 1200, 3216]
      ),
      spacer(),

      // ====== FINAL VERDICT ======
      h1("The Verdict: Semaglutide vs Retatrutide — Which One Wins?"),
      p("The Semaglutide vs Retatrutide debate does not have a single winner — it has a winner for right now and a winner for what may come."),
      spacer(),
      blueBox("For Patients Today: Semaglutide Wins", [
        "FDA-approved and commercially available in injectable and oral forms",
        "Proven in millions of real-world patients over 4+ years",
        "Produces 15–20.7% body weight loss — enough to meaningfully reduce or eliminate most obesity-related conditions",
        "Proven cardiovascular benefit (20% MACE reduction) and MASH approval",
        "Growing insurance coverage including new Medicare GLP-1 Bridge ($50/month, July 2026)",
        "If you need treatment today, semaglutide is the evidence-backed choice."
      ]),
      spacer(),
      new Table({
        width: { size: 9360, type: WidthType.DXA },
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                children: [new TextRun({ text: "For Maximum Weight Loss (When Available): Retatrutide Wins", bold: true, size: 22, color: GREEN, font: "Arial" })]
              }),
              ...([
                "Phase 3 data: 28.3% weight loss (70.3 lbs) — far exceeding semaglutide",
                "45% of patients achieved ≥30% weight loss — bariatric surgery territory",
                "65% of patients achieved BMI below 30 — effectively exiting obesity",
                "Additional metabolic benefits: 20% LDL reduction, 86% liver fat reduction",
                "Dual benefit confirmed for knee osteoarthritis pain",
                "FDA NDA expected late 2026; commercial launch anticipated 2027"
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      spacer(),
      p([
        normalRun("The bottom line on Semaglutide vs Retatrutide: "),
        boldRun("Semaglutide is today's best available treatment. Retatrutide may become tomorrow's gold standard."),
        normalRun(" Watch for the NDA filing in late 2026. In the meantime, for anyone struggling with obesity and its serious health consequences, starting proven, approved therapy with semaglutide now — rather than waiting for retatrutide — is the medically responsible path for most patients.")
      ]),
      spacer(),

      // ====== DISCLAIMER ======
      new Paragraph({
        spacing: { before: 240, after: 120 },
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        children: [new TextRun({
          text: "Medical Disclaimer: This article is for informational purposes only and does not constitute medical advice, diagnosis, or treatment. Semaglutide is an FDA-approved prescription medication. Retatrutide is an investigational drug and is NOT FDA-approved as of June 2026 — it is not available for general prescription use. Always consult a qualified healthcare provider before starting, stopping, or changing any medication. Individual results may vary. Insurance coverage and drug pricing information is subject to change. Data referenced is from publicly available peer-reviewed publications and company press releases through June 2026.",
          size: 18, font: "Arial", color: "666666", italics: true
        })]
      }),
      new Paragraph({
        spacing: { before: 40, after: 120 },
        children: [new TextRun({
          text: "Sources: STEP clinical trial series (NEJM, Lancet, JAMA 2021–2026) | TRIUMPH Phase 3 trials (Eli Lilly press releases, 2025–2026) | SELECT cardiovascular trial (Nature Medicine, 2024) | STEP UP trial (The Lancet Diabetes & Endocrinology, 2025) | CDC NCHS Data Brief #508 (2024) | ASMBS Obesity Fact Sheet (2025) | CMS GLP-1 Bridge Program (December 2025) | FDA drug approval databases | Biomolecules — Retatrutide review (May 2025) | GoodRx, AARP, and CMS pricing data (2025–2026)",
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